Underperforming NHS Trusts: Government Oversight

Wednesday 14th October 2026 Westminster Hall

[Graham Stuart in the Chair]

14:30

[Marie Goldman (Chelmsford) (LD)]

I beg to move,

That this House has considered Government oversight of underperforming NHS trusts.

It is a pleasure to serve under your chairmanship, Mr Stuart. I am the MP for Chelmsford in Essex, and my local trust is the Mid and South Essex NHS foundation trust. A few years ago, it was decided to put three hospitals under the same trust. My local Broomfield hospital is not actually in my constituency. It is in the neighbouring North West Essex constituency, but for all intents and purposes, it is my hospital because it is the main one serving my constituents, and it fills my inbox every single day with tales of woe from both patients and staff.

I thank other Members whose constituencies are served by the same trust for coming along today. Other hon. Members from across the House, served by other NHS trusts, will probably be experiencing something similarly unfortunate. I look forward to hearing their stories, because it is incredibly important to get NHS trusts to perform properly, serve their patients and look after their staff. Looking after the most vulnerable underpins everything we do in society, and I am afraid to say that the Government are not getting it right. That is what I am here to talk about.

Earlier, somebody not too far away from me said, “I think I am in the worst trust in the country,” and I said, “I will go round for round with you on that one.” Later, I will give some details about why I believe that.

Back in March, the then Health Secretary, the right hon. Member for Ilford North (Wes Streeting), announced that the Mid and South Essex trust would be placed into an intensive recovery programme, and we waited to find out the details. The reason for the programme is that, over several years, Mid and South Essex has been massively underperforming. There have been huge issues, and I do not exaggerate when I say that they fill my inbox every single day. We are talking about long waits, delays to treatment and difficulty accessing care. When patients do access care, they are not getting the service they need and, most importantly, they are not getting the outcomes they need and deserve.

I pay tribute to the staff who work at Broomfield hospital, in the Mid and South Essex trust and in all the trusts across the country. They are working in difficult circumstances, and quite a lot of the time they are using infrastructure that is not fit for purpose and has not been properly invested in over many years. They are doing their very best, but unfortunately, they are not getting the support they need. I have met the staff, patients and leadership of Mid and South Essex foundation trust many times over a sustained period, and I know hon. Members from across the House have done the same. Unfortunately, I believe it is one of the worst trusts in the country on both patient and staff measures. We pushed for changes locally, but national support is needed.

Let me talk about the range of issues that have been raised with me. I have walked around Broomfield hospital both with the senior leadership team and with the less senior leadership, shall we say? I do not think it should be possible for me to walk around a hospital and point out things that are so obviously wrong, yet I could. There were lights outside theatres that had not been working, I was told, for 10 years. Those are things that should be relatively easy to fix, but when patients have to write to me about mould growing on the walls and windows of a children’s ward, something is going seriously wrong.

Two weekends ago, an 80-year-old gentleman told my staff that he had queued out the door of the emergency department on a Saturday for an hour. He is in his 80s and nobody even bothered to offer him a seat. Something is going drastically wrong when we have lost sight of the importance of common decency and human compassion when looking after patients. When consultants retire, they are not being replaced, and their waiting lists are just being disbanded.

People are writing to me about those sorts of things all the time. Patients have very few ways to raise their concerns. They can go to the patient advice and liaison service, but unfortunately the delays in getting responses back from PALS are enormous. MPs can raise an issue with the trust leadership and go through PALS as well, but we still do not get the responses that we need. There seems to be a lack of communication between leadership and staff, and we seem to have lost sight of what is important—the things that just make sense to keep on doing.

There was a roundtable earlier this week for the leadership of Mid and South Essex and the Essex MPs whose constituencies are in that trust. While not all the MPs could come along—I know many sent their staffers—I was certainly there. We talked about heat and the very long, hot summer we have had. We talked about how that has impacted on the running of the hospital. The chief executive told me that it meant some of the theatres had to be closed because there was too much humidity. Obviously, that has a knock-on effect on patient waiting lists, outcomes and experiences.

The chief executive said that the hospital had been gifted some air-conditioning units by a very generous national company. That sounds great, but the hospital cannot plug enough of them in because the electrical circuits cannot cope. It is a fairly new build hospital—it is a combination of PFI and some older buildings—yet we cannot plug in enough air-conditioning units to keep our theatres open. I was told that humidity is not reduced by air-conditioning units, but I am not too sure about that. I am sure there are other ways of reducing humidity.

I said to the chief executive that it was a really hot summer, and with El Niño, we are possibly expecting an even hotter summer next year. I asked the chief executive whether they are developing contingency plans to make sure that we can deal with that, because we know that long, hot summers are going to keep on happening. He said, “No, we’re not.” My mind was blown that he said that out loud. I say this as gently and courteously as possible, but it is obvious that the trust is massively struggling. It is not just the staff working day to day; it is the leadership. It is a new leadership team, and they have obviously lost sight of the importance of focusing on certain things.

[Mr Richard Holden (Basildon and Billericay) (Con)]

The hon. Lady makes some important points. We share a hospital trust. Many of my constituents in Basildon and Billericay go to Broomfield hospital. Some of them go down to Basildon hospital in the constituency of the hon. Member for South Basildon and East Thurrock (James McMurdock), as well as the Southend hospital in another neighbouring constituency.

I want to pick up on that point around contingency planning, because Basildon hospital, which is part of the trust, is particularly bad for corridor care. It is very clear to me that it is a major issue that is really hammering people. I want to make a very brief point about that care.

[Graham Stuart (in the Chair)]

Very brief.

[Mr Holden]

Thank you for your indulgence, Mr Stuart.

A constituent came to me who was handed a second-hand book on grief, with somebody else’s notes in it, after he had just lost his wife. It really struck me that, whether it is corridor care or that almost thoughtlessness, care is actually missing in parts of the Mid and South Essex NHS foundation trust.

[Marie Goldman]

The right hon. Gentleman is right to point out that we are in the same trust, and that our constituents experience each other’s local hospitals. I want to build on what he said about the experience of patients. It is really important that we remember the patients in all this. We can talk about financial planning, keeping budgets down and sticking within the envelope of how much we are supposed to be spending, but at the end of the day, it is patients who are suffering.

One patient wrote to me in February—it was February this year, but just to give an idea of how long this has been going on, it could have been February two, three or five years ago. They said:

“I waited four hours for triage, and it was eight hours until I was admitted to a ward. I spent much of that time sitting on the cold floor, by the open doors or standing as there were not enough seats.”

It is not just about patients; it is also about the staff who work there. A nurse wrote to me just last month, in September 2026, to say:

“I have worked at the trust since 2008 and when I first joined, I was so proud to say I worked there. The next few years this feeling remained but for the last 8 years or so things have definitely taken a nosedive. The trust seems to run on broken promises and the good will of front­line staff. I am no longer proud to say where I work. I know many staff feel the same and worry for the safety of the patients, the staff and the trust.”

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

The merger of Basildon, Broomfield and Southend hospitals six years ago has turned out to be an abject failure. That is not the fault of the patients, and it is certainly not the fault of the very hard-pressed staff; it is the fault of the management. We have seen endless revolving-door changes of management. Does the hon. Lady agree that it is now time for Clare Panniker, the east of England regional director of the NHS who was the first chief executive of the trust and, indeed, the cheerleader for the merger, to intervene and finally put this problem right once and for all?

[Marie Goldman]

I think this is bigger than just one person; it needs much more attention from the Government and across the board—and I do not just mean the local trust board. It needs a lot of oversight and intervention, and really quickly. We are talking about an intensive recovery programme that was billed by the then Health Secretary as being a rapid improvement programme. I have not seen anything rapid yet, I am afraid. The programme was announced in March, and I am still waiting to see any real outcomes. It is supposed to deliver results within six months. I know they waited until the new chief exec was in place in June, so we are now a few months in, but patients—my constituents—are really suffering.

Let me give a few stats. For cancer being diagnosed or ruled out within 28 days, the national median is 78.6%. The average for Mid and South Essex is 64.3%, placing it 114th out of 117 trusts. For elective patients waiting under 18 weeks—in this case, higher is better—the median is 65.2%. In Mid and South Essex, it is 50.4%, placing it 117th out of 117. For elective patients waiting over 52 weeks—lower is better—the median is 1.5%. In Mid and South Essex, it is 8.1%, again placing it 117th out of 117. I would rather not claim the prize of having one of the worst trusts in the country, but here we are—the numbers don’t lie.

[Sarah Edwards (Tamworth) (Lab)]

The hon. Member is making an excellent speech about the importance of NHS trusts being able to meet their targets and provide care. My local trust, similarly, is not in my constituency. University Hospitals of Derby and Burton NHS foundation trust has been missing its cancer targets, with 40% of patients waiting two months, which is just not good enough. Does she agree that despite the fact there have been announcements and increased funding, we are bearing the brunt of the cut after cut that we saw under the previous Government, and it will take a long time to turn this around unless we have increased intervention from Government?

[Marie Goldman]

Yes—the hon. Member makes a really important point. I have no problem with making cuts if they are genuine efficiencies. If we look at a system and go, “Do you know what? There’s wastage over here, so we can cut it from here because we’re confident that things are going to continue to do well over there”, but that never seems to be the case. It seems to be a case of just cutting, and to hell with the consequences. I find that really frustrating.

The bottom line is that patients suffer from it, and that is never good for the economy. If we want to boil it down to money, economics and finances, that is never good for the economy, because when people have worse outcomes, they tend to need to stay in hospital for longer, which costs more money. It is ridiculous—it is a crazy way of running things.

A staff survey was done in the trust last November, and the results speak for themselves. Members can look it up, but this is the money answer that tells us pretty much everything we need to know, even if we read nothing else. Staff were asked whether they would be happy with the standard of care provided by the organisation if a friend or relative needed treatment. The national average for those agreeing is 60.83%. For Mid and South Essex, it is 38%—my word! Nearly two thirds of staff working in the trust are saying, “I wouldn’t want my friend or loved one to be treated there.” That has to be ringing enormous alarm bells. If we are not throwing everything at turning this around right here, right now, I do not understand the point of Government.

I am conscious of time and I have taken three interventions, so I will go on for just a few more minutes.

There have been six years of interventions at the trust, starting after the merger in 2020, when the Care Quality Commission rated it “Requires improvement”. In April 2024, we had a recovery support programme, which was a successor to special measures, and in March this year, as I have said, we had the intensive recovery programme. Six years and two programmes, with no CQC improvement.

We have had so many health inquiries in this country—inquiries into maternity and other services—and they have all made loads of recommendations. Can the Minister say how many of those recommendations have been implemented, across the country and in Mid and South Essex? How are we keeping track of that? Let’s not reinvent the wheel. We have had inquiries that have told us what is going wrong, so let us make sure we are implementing their recommendations.

I have written to the Minister three times, and three times I have had a response back. I have welcomed the announcement and asked questions about the detail, but I have had different details back each time. In June and July, I was told that the responsibility lies with the trust’s board, with targeted external expertise. In the July response, I was told that there was a recovery compact and a six to 18-month recovery period. In the September letter, I was told we would be getting enhanced support from NHS England regional and national teams.

It struck me when rereading those letters earlier today that there is very little reference in them to improving patient outcomes or experience. They focus a lot on money. I genuinely think that we need to get things right and then deal with the money afterwards. Sometimes we have to invest to get things to the point that they need to be, and then step back and make savings; we cannot do it all in one go—I can tell hon. Members right now that it just will not work. There is too much of a focus on financial performance right here, right now. We can get to that later, but we must first sort things out for the patients who are suffering right now.

The September response promised long-term sustainability. I just have to point out that NHS England is reportedly set to be abolished in April 2027, which is inside the recovery window I have been given. That creates a certain amount of confusion and uncertainty. Where will we be getting consistency on this?

Members will be pleased to know that I am on my last page, but I do have a list of questions for the Minister. Where is the “external expertise” coming from that will be helping Mid and South Essex? I get fed up with the merry-go-round of chief executives moving from one failing trust to another. Why on earth do we think we will get a different answer or outcome? If they did not fix it over there, why do we think they will be able to fix it over here? Where is the genuine expertise with a tried and tested track record coming from?

Who chooses the experts? Who reviews whether the support is working—or are they going to be marking their own homework? Who holds the trust to account? Do not just tell me “the board” or “MPs”—that is not the answer. What specific support is Mid and South Essex getting? If there is no improvement within the six to 18-month window, who will intervene then, and what will be the consequences? How is this long-term if NHS England is going to disappear in April 2027?

Finally, where is the commitment to making things better for the people this really matters for: the patients and the staff? I conclude by paying tribute once again to the staff who do amazing work under very difficult circumstances. Patients—my constituents—deserve better.

[Several hon. Members rose—]

[Graham Stuart (in the Chair)]

Order. I need to introduce a time limit of three minutes.

14:48

[Rebecca Long Bailey (Salford) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Chelmsford (Marie Goldman).

The staff at Salford Royal are absolutely amazing. I have seen their dedication, and I have joined them on picket lines as they have campaigned to improve patient safety as much as their own workplace conditions. I have also met whistleblowers ringing the alarm on patient safety, and I have repeatedly raised their concerns and patients’ concerns and called for them to be listened to by trust management. Sadly, they have been let down and now the situation is critical.

The Minister may know that Salford Royal was the poster child of NHS safety; it was one of the best hospitals in the country, if not the best. Savage austerity and round after round of cuts have undoubtedly brought our NHS to the point of collapse right across the country, but the fact that an individual trust’s services can fall from “Outstanding” in 2018 to “Requires improvement” a few weeks ago warrants her personal oversight and intervention.

I will briefly canter through how matters got to this point. In 2018, the CQC rated Salford Royal NHS foundation trust as “Outstanding”. The stand-alone hospital trust then merged to form a super-trust across Greater Manchester called the Northern Care Alliance. Just a year after the merger, the CQC rated the newly formed trust “Requires improvement”—a long way from Salford’s previous position.

Between 2023 and 2024, worrying reports about patient safety started to emerge, and there were then various interventions. In 2025, there was a rapid quality review process, and that September the CQC issued its first section 29A warning notice regarding the trust’s surgical services, citing inadequate staffing arrangements and ineffective systems for identifying and managing patient safety risks.

A few months later, in August 2026, another warning notice had to be issued due to significant concerns about the trust’s management of risk, patient safety complaints, freedom to speak up, and workforce wellbeing and inclusion. That brings us to the latest CQC report, a couple of weeks ago, which rated the hospital “Requires improvement” and identified 12 regulatory breaches relating to safe care and treatment, governance and staffing.

All that is very worrying, but one staff member recently told me:

“It really is getting worse, especially with theatres, and they’ll try and blame the current industrial action, but it’s not those days. It’s normal days, they are just horrendous. Staff crying. Staff exhausted, increasing sickness rates.”

It is clear that there is a crisis unfolding, and the staff are exhausted. I urge the Minister to meet me to discuss what action she can take to get the trust back on the steady and safe footing that its staff and patients deserve.

14:52

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to serve under your chairmanship, Mr Stuart, and to follow the hon. Member for Salford (Rebecca Long Bailey) and my hon. Friend the Member for Chelmsford (Marie Goldman).

I have four NHS trusts serving my enormous constituency, which is the second biggest in England: the North Cumbria foundation trust, which is ranked 117th out of 134; the Cumbria, Northumberland, Tyne and Wear foundation mental health trust, which ranks 39th out of 58; the University Hospitals of Morecambe Bay foundation trust, which ranks 97th out of 134; and the Lancashire and South Cumbria foundation mental health trust, which ranks 54th out of 58.

What do those four trusts have in common? They are run and staffed by outstanding people who are wonderful, compassionate, committed and capable. They all also struggle with a common underlying challenge: rurality, which this Government, like their Conservative predecessors, fail to understand and, indeed, to tackle.

Let me start with the Morecambe Bay trust. It has three hospitals, but it is funded as if it had just one. This year, NHS England and the Department of Health and Social Care are forcing £32.5 million-worth of cost savings on the trust, causing it to have to close 42 beds, despite the fact that it has been at level 4 of the operational pressures escalation levels framework—the highest level of alert and extreme pressure on services—a total of 14 times over the last 12 months, including three times in June, July and August.

We have some of the worst cancer waiting times in the country, and it is no surprise, because in south Cumbria we have no direct or close access to radiotherapy treatment. The OECD average, and the target, for the proportion of people with cancer who receive radiotherapy is 53%. In the UK, that figure is a mere 36%, and Lancashire and south Cumbria is the worst area in the worst country in the OECD, at only 29%. In north Cumbria, people use the Penrith urgent treatment centre, which is brilliant, but it is often under enormous pressure because the nearby Keswick urgent treatment centre—in the constituency of the hon. Member for Penrith and Solway (Markus Campbell-Savours)—is often closed because of understaffing.

Mental health provision in the two mental health trusts is under enormous pressure. When Cumbria has a suicide rate twice the national average, that is unacceptable. In addition, the local council is proposing to close Applethwaite Green care home in Windermere because of a 31% cut that the Government have made to the council’s funding this year. Why have the Government done that? Because they do not get rurality and they do not fund services in rural communities.

I want to finish by mentioning a Policy Exchange report, the foreword of which was written by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the title of which reads: “The Rural Penalty: How NHS funding formulas are disadvantaging rural and coastal areas and putting health devolution at risk”. It is not just putting health devolution at risk; it is putting the health and the lives of my constituents at risk, and I hope the Minister will put that right.

14:54

[Jack Abbott (Ipswich) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this important debate.

Too many communities have paid a price for the failure of NHS trusts. In Ipswich, we know that all too well. Two trusts serve my community: East Suffolk and North Essex foundation trust, which provides our acute hospital services, and Norfolk and Suffolk NHS foundation trust, which is responsible for our mental health services. Unfortunately, both, but particularly the latter, have a history of patients enduring long waits, inconsistent standards of care and services that fall well short of what patients have every right to expect. Families were sidelined, and concerns went unanswered.

For many years, NSFT has been synonymous with failure. In 2015, it was the first mental health trust in the country to enter special measures, and it was later put into an NHS recovery support programme. Two years ago, I stood in this very room and described NSFT as

“arguably…the worst performing mental health trust in the…country.”—[Official Report, 10 October 2024; Vol. 754, c. 177WH.]

That judgment reflected a litany of failings stretching back many years.

It is important to acknowledge that genuine progress has been made. The picture today is markedly different from the one even just a few years ago. The number of patients waiting more than 18 weeks has fallen by over 80%, crisis services have improved, and more than 95% of patients experiencing a first episode of psychosis now begin treatment within two weeks of referral, which represents outperformance of the national standard. Although the trust is still rated “Requires improvement” overall, several services are now rated “Good”. That is testament in part to the leadership of NSFT, which brought stability to the trust after years of disruption.

I am grateful to be hosting a quarterly meeting between NSFT and MPs in the region to ensure that progress is made. We can learn from the problems at the trust that improvement is possible even in the organisations with the most difficult legacies. However, we must not confuse progress with success; this is a first step and the beginning of a recovery that has a way to go.

The Government’s reforms are finally starting to turn the page of years of failure. We have invested record-breaking amounts in our health service, reducing waiting lists, cutting ambulance response times in my area and expanding our workforce, so we should be tentatively hopeful. Neither NSFT nor ESNEFT, which I would talk about if I had more time, are yet where patients deserve and need them to be, but there are reasons to be optimistic.

I make a plea to the Minister to ensure that we are fully funding mental health, as it desperately needs to be. Our trust never recovered from brutal cuts in 2014 and massive redesigns. We are on the path to recovery. We now have stability, and I recognise the progress made so far, but we must build on it and maintain a relentless focus on delivering the improvements that all our local patients deserve.

14:58

[James Wild (North West Norfolk) (Con)]

I congratulate the hon. Member for Chelmsford (Marie Goldman) on securing the debate.

I represent the Queen Elizabeth Hospital King’s Lynn trust, which serves 300,000 people across Norfolk, north Cambridgeshire and south Lincolnshire and was ranked 134th out of 134 trusts in the league table released in September last year. That very disappointing result was uncomfortable for the trust and its staff, but transparency can galvanise action. Performance is simply not good enough at the moment. Only 65% of cancer patients are treated within the 62-day timeframe, against the standard of 85%, and only 64% of patients at A&E are seen within four hours. The trust has also heard worrying reports from the Royal College of Surgeons about culture and management weaknesses, and in August the CQC rated emergency care as “requiring improvement”.

When the league table was published, I was told by Health Ministers that intensive help would be made available to deliver better care, but it is not clear what extra support has actually been provided. Cancer and elective waiting times have improved slightly. A&E diagnostics have not. There have certainly been more reporting requirements, but they will not drive improved performance and productivity, nor will requiring a 10% budget saving or the current management instability. We had a temporary chief executive and then a supposedly permanent appointment, and there is currently no recruitment for a managing director, with the post being covered by the Norfolk and Waveney University Hospitals Group deputy chief executive. We need visible, active, full-time leadership, on site, to deliver better care. What support is the national performance framework providing? A year on from the league table, how are Ministers holding the trust to account?

Dedicated staff are working in a hospital that is not fit for purpose, which is why we secured a commitment, which this Government have honoured, to a new QEH. New facilities and improvements go hand in hand, but it should be about improving services, not removing them. That is why I am extremely concerned about leaked proposals showing that the Norfolk and Waveney University Hospitals Group is considering downgrading A&E, maternity and intensive care unit services. The plans have been drawn up behind closed doors, with no transparency, by organisations that are seemingly unaccountable and that fail to recognise the needs of my constituents and those across the area. Clinicians have warned of the impact on patient safety. The proposals are completely unacceptable and should be ruled out now. Indeed, the group leadership has repeatedly said publicly that it wants more services closer to home. If that is the case, those services must include a proper 24/7, tier 1 A&E; maternity services; and an ICU in King’s Lynn.

QEH is at the heart of my community, and we all want to see sustained improvements. I urge the Minister to give my constituents and the staff at the hospital the reassurance they want by ruling out any downgrading of services at QEH on this Government’s watch.

15:04

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

I thank the hon. Member for Chelmsford (Marie Goldman) for securing the debate.

I wish to raise the serious and long-standing problem of ambulance delays at the Royal Stoke university hospital, which is run by the University Hospitals of North Midlands trust and is situated in the neighbouring constituency of Stoke-on-Trent Central. Many of my Stoke-on-Trent South constituents, local campaigners such as Ian Syme, and West Midlands ambulance service have repeatedly raised with me their concerns about this crisis.

Ambulance handover is the point at which responsibility for a patient transfers from the ambulance crew to the hospital team. NHS England guidance specifies that it should take place within 15 minutes of an ambulance arriving at a hospital. Between April and September this year, the average wait at the Royal Stoke was one hour and 33 minutes, and the longest was 17 hours and 41 minutes. Only 16% of handovers met the 15-minute standard, making the Royal Stoke the worst-performing hospital in the west midlands on that measure. House of Commons Library research indicates that it is the third worst in the country. Such handover delays cause harm and increase the number of avoidable deaths. This is not a recent problem: for most months since 2023, the trust’s handover times have been among the longest in the country.

To be clear, this is not an attack on frontline NHS staff. Our paramedics, ambulance crews and emergency department staff are working under immense pressure, often to the point of burnout, and I acknowledge some of the outstanding work that happens at the Royal Stoke. But there is a false narrative that the problem is the result of more people turning up to A&E. It is not. A&E attendance figures at the Royal Stoke remain broadly stable, so deeper questions need to be asked about the overall culture, the patient flow through the system and the response of senior leadership.

In August, the CQC conducted an inspection of the A&E and correctly instructed that the 15 corridor care spaces at the Royal Stoke be closed. I support the principle behind that decision, but closing those spaces does not address the problems that led to patients being treated in corridors in the first place, nor have those closures caused the long-standing ambulance delays, which existed before. In September 2025, NHS England took enforcement action against UHNM, yet a year later—this September—average ambulance handover delays at the Royal Stoke still hit two hours. There has been a failure of oversight and accountability.

Having attended the recent UHNM board meeting and spoken with the integrated care board chair, I acknowledge that actions are being taken to address the problem. I am pleased that, on my suggestion, the ICB chair has agreed to convene a joint meeting of senior people and MPs to address the issue of ambulance handover delays. However, more needs to be done, and questions must be raised as to how we got into this situation in the first place.

My constituents deserve safe, timely treatment. Our frontline staff deserve a system that allows them to do their jobs properly. Will the Minister commit to taking direct oversight of ambulance handover delays at the Royal Stoke, commission an independent inquiry and set a clear timetable for improvement?

15:04

[Steve Darling (Torbay) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate my hon. Friend the Member for Chelmsford (Marie Goldman) on securing this extremely important debate.

I serve the population with the highest number of frail elderly people, and the irony is that our hospital is frail and elderly. It is the third oldest in the country, and the poor quality of the estate massively impacts the service that can be delivered to my community. More than 80% of it is not fit for purpose. We were one of the areas promised a new hospital by the previous Conservative Government, but sadly we are now in wave 2. There have been more than 700 sewage leaks across the hospital in recent years, and that impacts on clinical areas. Members can draw their own conclusions about how that has shunted treatment for patients down the line.

The tower block at Torbay is swathed in scaffolding to stop bits of it falling off and braining patients. In February, my hon. Friends the Members for Newton Abbot (Martin Wrigley) and for South Devon (Caroline Voaden) and I wrote to the Minister, backing our NHS managers, who desperately need an £8 million investment to sort out the tower block. We wrote again, and I met the Minister in September to bang the drum again, and we got £1.8 million, rather than £8 million.

Devon and Somerset fire and rescue service has now served a fire safety notice on our trust, as it has serious safety concerns about patients, and the CQC served another warning notice in the last few days. The chickens have now come home to roost. We need action. We need the cheque that I asked for in September in the post to tackle the fire safety issues in the tower block.

The staff are doing incredible work, but the patients deserve better. Will the Minister meet me and other colleagues from south Devon constituencies to explore the impact of the fire safety notice and the CQC warning? There are rumours swirling around the internet about the closure of beds in Torbay hospital.

15:07

[Lola McEvoy (Darlington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I commend the hon. Member for Chelmsford (Marie Goldman) for securing the debate, which is about—politely—underperforming trusts. This is Breast Cancer Awareness Month, and I will be talking about the breast cancer failings at my local trust, County Durham and Darlington NHS foundation trust.

In April 2025, the trust began going through the case files of women who had been patients of its breast services between 2023 and 2025. Of the 538 women whose cases have been reviewed, 321 experienced some form of harm: 77 suffered significant harm, 20 underwent unnecessary mastectomies, and the trust has confirmed that one woman has died, and it is currently investigating the situation. Let me take a moment to reflect on that. The women in this room know how much pain we are deemed to have to endure and put up with. But to hear that women put their trust in our NHS at a time of great stress and anxiety and had their breasts removed unnecessarily is truly abhorrent.

The trust has rightly changed leadership and is now undertaking a further review of the treatment given to women by the breast services from 2015 onwards. The cases of a further 4,500 women need to be reviewed by specialists. The current rate of review—538 cases a year—means that, without further resource to fund more specialists to review the cases, the process could go well into the 2030s. Recent Health Service Journal modelling estimates that the work could cost the trust £4.5 million. The trust does not get any financial support for that work, which I find counterintuitive, as the victims need answers and justice, and the trust must learn the lessons from what went wrong while also carrying on its vital duties.

Campaigners are calling for a public inquiry—I support them and understand why—but I fear that it will take years and years for answers to be found and lessons to be learned. The Prime Minister recently agreed and said in a BBC interview:

“Of course there needs to be the fullest possible inquiry…we will ensure that those affected have all of the answers that they need”.

He said that there are different routes to the truth but, without additional resources, how can the trust be expected to keep other services running effectively while conducting the inquiry? It will inevitably go into debt and probably be bailed out by the Department of Health and Social Care—that is, the taxpayer.

Given that the Health Bill, which is focused on abolishing NHS England and giving direct powers back to the Secretary of State, is going through the House, we have the legislative opportunity to change the culture from fearing and fighting for scrutiny to funding and facilitating it. Our trust needs to provide the answers and support the affected patients in a timely and compassionate manner, and to improve and change services to gather the information necessary to do that. We all in this House agree that patients across the country deserve better.

15:10

[Richard Foord (Honiton and Sidmouth) (LD)]

It is an honour to serve with you in the chair, Mr Stuart. I am grateful to my hon. Friend the Member for Chelmsford (Marie Goldman) for securing the debate.

When we discuss underperforming trusts, we must recognise that some NHS trusts are operating in circumstances that would challenge even the best management teams. The Royal Devon University Healthcare NHS foundation trust serves a largely rural and coastal population, with an ageing demographic, workforce pressures and significant barriers to access. I do not want to blame the Royal Devon leadership team. This is certainly not about blaming hard-working staff, because they do a brilliant job in very trying circumstances. But let us face it: the geography and demographics are stacked against them.

The chief medical officer, Sir Chris Whitty, has repeatedly highlighted the unique health challenges facing rural and coastal communities, including when he visited Devon in May this year. Sir Chris has warned of

“the health challenges of coastal towns”,

and that attracting staff in such areas is significantly harder, noting that transport links are often limited. In his 2023 report Sir Chris warned:

“People living in peripheral areas experience issues relating to accessing primary and secondary healthcare, domiciliary care, medicines, shopping and transport. The response times of health care professionals are often longer because of the distances involved, which is particularly important for emergency presentations”.

Steve Brown, the director for public health in Devon, said:

“In Devon, our records show that some people are dying up to 15 years earlier than they should because essential building blocks of health…like reliable transport…and services that people can reach…are missing.”

My constituent Hilary Robarts-Arnold, from Seaton, wrote to me to describe the lack of transport and the difficulty of getting services in east Devon. Her husband is increasingly frail and suffers from skin cancer. Until recently, he attended dermatology services at Axminster hospital, seven and a half miles away. Those local services have now gone, and patients are instead forced to trek to Exeter, if they can. For her and her husband, that would be 22 miles, which is simply not possible because it is just too challenging a distance. As a result, his cancer is not being dealt with. The RDUH told me that

“this is a workforce and capacity issue, not a reflection of the clinical priority we place on patient care”.

If Government oversight of NHS trusts is to be meaningful, they must recognise the realities of rural and coastal healthcare and weight funding accordingly.

15:13

[David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)]

It is an honour to serve under your chairmanship, Mr Stuart. I thank my hon. Friend the Member for Chelmsford (Marie Goldman) for securing this vital debate, which could not be more timely for my constituents. I want to use my contribution to offer a warning from Wales about what happens when Governments distance themselves from the decisions being taken by NHS trusts or boards under their control.

Community hospitals across Powys, including in Knighton, Llanidloes, Llandrindod Wells, Ystradgynlais, Welshpool and Machynlleth, face a perilous future, with vital local services potentially lost. Powys teaching health board is currently running a consultation called “Better Together”, which proposes that the number of hospital beds be slashed from 146 to as few as 60, with further cuts made to minor injuries units, mental health services and X-ray units.

My constituents and I fear that the proposals essentially amount to closure by stealth for some hospitals, particularly at Llandrindod Wells and Ystradgynlais. All the GP practices in Powys have written to express their concerns about the proposals, which have provoked enormous public opposition, with nearly 10,000 people signing my petition against the cuts and hundreds attending public meetings that I have organised across the county.

At the same time, in order to save money, the same health board has been slowing down treatment times for patients awaiting surgery in neighbouring health boards and trusts in Shropshire and Herefordshire. Despite that, the new Plaid Cymru Welsh Government have repeatedly refused to intervene, insisting that the issues are operational matters for the health board. We now face the extraordinary situation in which a health board is putting forward proposals that appear to directly contradict its Government’s own stated policy to improve step-down care.

Welsh Ministers refuse to take responsibility and step in before it is too late. The health boards and trusts in Wales are accountable to the Welsh Health Minister, yet successive Welsh Health Ministers have refused to take responsibility for their funding. Welsh Ministers are responsible for the financial contributions of health boards; they cannot wash their hands of the consequences when those boards propose deep cuts to frontline services.

It is striking that, while Governments elsewhere in the UK have sought to strengthen scrutiny and intervention in struggling NHS trusts, the approach in Wales has too often been to place greater distance between Ministers and local health boards. It is important that the Welsh Health Minister takes responsibility for his job and the Welsh health service that he runs, listens to the people of Powys and scraps the proposal for the removal of hospital beds across our communities.

15:16

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Stuart. I thank the hon. Member for Chelmsford (Marie Goldman) for raising this issue and giving us a chance to participate in this debate.

The new intensive recovery programme has identified several NHS trusts in England that are underperforming as a result of waiting lists, persistent financial difficulties and leadership instability. The trusts identified include North Cumbria, Mid and South Essex, Hull, North Lincolnshire and Goole, and East Kent. Performance across those trusts and beyond has raised serious questions about whether patients in England are receiving consistent access to cancer treatment.

I want to focus on cancer treatment in particular. The NHS has a long-standing target that 85% of patients should get treatment within 62 days of an urgent referral for suspected cancer. However, the performance at many trusts is substantially beneath that, and it is having serious consequences on patient outcomes. For example, in 2023, the death of a patient admitted to Mid and South Essex was linked to the trust’s failure to meet any of NHS England’s cancer waiting time targets. At that trust, only 47.7% of patients began treatment within 62 days, and by 2025 the number had further declined—in other words, it was getting worse.

At the County Durham and Darlington trust, which the hon. Member for Darlington (Lola McEvoy) referred to, the situation is similar. Significant failings were identified in breast cancer care, as she illustrated very well. A review of the care received by women between 2023 and 2025 found that 32 women had undergone unnecessary surgery, 20 had experienced a late diagnosis and a further 78 patients were found to have suffered moderate or severe harm. A review has been committed to, demonstrating that the true scale of the issue is likely much bigger than we know.

Analysis of NHS cancer waiting time performance found that nearly every English NHS trust missed cancer targets. In Northern Ireland, we have also experienced serious concerns regarding cancer care. For example, recently there has been a call for a public inquiry into urology services at the Southern Health and Social Care trust, where it was identified that cervical screening services had reported some results incorrectly. Patients were told their scan was clear, and then shortly afterwards told it was not. That is an absolute scandal, and it caused patients and families considerable distress. Northern Ireland’s waiting time statistics further illustrate the pressure on cancer services. Some 30% of patients began treatment within 62 days, and that percentage has been on a downward decline.

I know the Minister has no responsibility for Northern Ireland, but she has responsibility for the trusts here. I look to her to ensure the promotion of effective oversight and accountability in all our trusts. Underperformance is widespread and must be addressed. These failures are undermining public confidence in the health service. A suspected cancer diagnosis is already a distressing experience, and patient outcomes are not being helped by lack of clarity and reassurance.

[Graham Stuart (in the Chair)]

Last but not least from the Back Benches, I call Adam Dance.

15:19

[Adam Dance (Yeovil) (LD)]

Thank you, Mr Stuart. I also thank my hon. Friend the Member for Chelmsford (Marie Goldman) for securing this debate.

Despite the hard work of staff, the performance of my NHS trust, from maternity services to stroke care, has been at the forefront of people’s minds because of underperformance. Since the merger, Yeovil hospital has been the poor relation. Thankfully, we managed to get our maternity unit in Yeovil safely reopened after a CQC report found serious failings and the trust closed the unit. We got Government oversight, as Baroness Amos reviewed our trust’s maternity services during the closure, and she concluded that

“from the evidence we collected during our visits and the concerns expressed by staff, we remain concerned about patient safety at Yeovil District Hospital.”

I am hearing that concern too, so I really want to hear from the Minister about the particular steps being taken now to improve oversight and support patient safety and staff in rural maternity units.

Another priority issue for people in Yeovil is stroke services. After targets were not met, the NHS in Somerset closed Yeovil’s hyper-acute stroke unit as part of a service restructure. Patients will now have to travel to hospitals in Taunton or Dorchester. Local campaigners and I kept being told that there was a strong evidence base to suggest that a restructure would improve the service, but when we made a freedom of information request we found data suggesting that, in 2024, if stroke patients from Yeovil had been taken to Taunton, only 13% would have made it within the target call-to-needle time of 180 minutes, while only 30% would have made it to hospital in Dorchester in time. We have been working with the NHS in Somerset to get things such as pre-hospital video triage, to help to cut waiting times, and a refurbished acute stroke unit at Yeovil hospital, but we are still really concerned about travel times and outcomes.

That is why we need Government oversight—specifically, a review of stroke services in rural areas, focusing on the evidence and the consultation process around service provision, health outcomes for patients and travel times. We need a proper national picture of how rural areas are being impacted by service restructures and mergers, because what works for Bristol or London will not always work for south Somerset and other rural areas.

Sadly, I have heard really concerning reports of bullying and poor work culture across our entire NHS trust. That is why I believe the Government urgently need to improve oversight of working cultures and tackle bullying in NHS trusts. That should start with training for leadership teams across NHS trusts on bullying. Where there is poor performance, working culture is often a key factor.

There is real scope for improved oversight of NHS trusts such as ours in Somerset. Ultimately, however, without Government support and funding, we will not be able to improve our NHS services.

15:22

[James McMurdock (South Basildon and East Thurrock) (Ind)]

I appreciate your allowing me to speak at the last moment, Mr Stuart, and it is an honour to speak under your chairmanship. I thank the hon. Member for Chelmsford (Marie Goldman) for bringing this very important and timely debate to Westminster Hall.

I want it to be clear that although the list of figures that I am about to bring forward is concerning, I do not place any of the burden of blame on the shoulders of frontline staff—indeed, the more concerning the figures, the more gratitude and appreciation I show the staff for enduring these challenging circumstances and the challenging work environments they turn up to each day to give the highest quality of care—so much so that whistleblowers have brought to my attention, at great personal risk to their careers, concerns and details about the state of care and operational functionality at Basildon hospital.

I can give a quick example: a surgeon reached out to me, stating how senior management had come in and put in place the organisation and throughput practice that they thought best, while the surgeon was sat there with his own experience, seeing that surgical spaces were very often left empty because of the way processes were being put forward and forced upon the staff. Some changes have been put in place, but—although I have not personally been able to verify this—a consultant said to me that actually more management staff than consultants have been hired in the last couple of years.

I want to share some figures. I have almost a dozen bullet points here, and every single one is rather concerning, but suffice to say that Mid and South Essex trust—of which Basildon hospital, in my South Basildon and East Thurrock constituency, is part—ranks 131st out of 134. The Care Quality Commission ranked Basildon hospital as inadequate, and it was so concerned with the state of affairs there that it performed multiple repeat visits to try to improve things.

Complaining alone is not enough, but the hon. Member for Chelmsford raised two points that are really striking. The first is that problems should not be obvious. I should not turn up to a medical practice as a layman and be able to spot clear errors. I remember visiting the mental health ward at Basildon hospital; there was a foyer with overgrown grass, weeds up to your chest, garbage and concrete strewn everywhere. I was walking around with the CEO, and I said, “What’s happened here?” He turned around in complete shock, as if he had never seen it before, and said, “Oh, I’m not sure. Sometimes you just go nose-blind”—staggering. The problems do not just start there, but that is the standard of things.

While many of my constituents will be concerned to hear that Basildon hospital was ranked poorly, I want to stick up for the staff there and say that I will personally continue to use that hospital, because I recognise how important it is. I will make one last point, as I am being encouraged to conclude—

[Graham Stuart (in the Chair)]

Order. I call the Liberal Democrat spokesman.

14:44

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate my hon. Friend the Member for Chelmsford (Marie Goldman) on securing this important debate.

Tackling underperforming NHS trusts is essential if we are serious about taking the necessary strides forward for patient safety and experience—as well as for the wellbeing of NHS workers, who are suffering anxiety and burnout at an unprecedented and frankly unacceptable scale. The Liberal Democrats have put forward our robust plan to end corridor care and transform patient safety, with essential measures needed to fix our NHS and relieve the pressure at both the front door and the back door of the service.

Years of Conservative mismanagement and neglect of the NHS have left many trusts on their knees, with huge challenges from which to recover. The onus is now on the new Labour Government, with their intensive recovery programme, to finally create the right conditions for failing trusts to succeed where their predecessors have failed.

[Caroline Voaden (South Devon) (LD)]

My hon. Friend talks about the challenges that NHS trusts face. My local hospital, Torbay hospital, has an ageing tower block that has now received a fire enforcement notice, which could affect up to a quarter of the beds in the hospital. Panic is spreading today in the local community about what this means for future treatment. Does she agree that when things become as urgent as that, with a quarter of the beds in the hospital potentially having to be closed by the fire brigade, the Government desperately need to bring forward the new hospital programme funding, so that repair and remedial work can begin immediately to restore this part of the hospital?

[Helen Morgan]

I do agree, and I echo my hon. Friend’s call. The estate that people work in is part of the fundamental problem that we are trying to tackle across the NHS.

I hope all the Members here who have made excellent speeches highlighting shocking failures in their own trusts can take heart from the fact that it is possible to tackle the issues in underperforming trusts. In my time as the MP for North Shropshire, I have seen meaningful changes for my constituents. From 2018 to 2023, Shrewsbury and Telford hospital trust was obviously underperforming, with CQC inspections consistently rating it as inadequate. That included inadequate levels of safety and services—reflected in the horrifying stories received at the time in my inbox and those of the other Shropshire MPs, and on doorsteps—and a churn in the management team that led to constant uncertainty about what was going to happen there. The human consequence of those stories was devastating.

When I was first elected, the overwhelming issue was the abysmal ambulance waiting times, related to poor handover times, as the hon. Member for Stoke-on-Trent South (Dr Gardner) highlighted. I will never forget the letter I received from a headteacher: after a pupil dislocated his knee playing football, he and the teachers waited so long for an ambulance in the dark and cold on a winter night that he was at risk of developing hypothermia by the time the ambulance arrived. We heard countless devastating stories, including ones where the ambulance had taken so long to arrive that it was too late, and the outcome was fatal.

Following a targeted campaign, which included me joining the West Midlands ambulance service team for an eye-opening shift, wait times have significantly improved, and we see far fewer of these cases in our inboxes. But challenges remain, not least in corridor care in the accident and emergency department, which has at times been rated one of the worst in the country.

A constituent told me of the shocking experience of her aunt Cath during this period, who was admitted to Royal Shrewsbury hospital following a serious stroke. One night, Cath fell out of her hospital bed and broke her hip after staff had failed to put up the necessary guardrails. She spent nearly half an hour trying to attract the attention of staff on the ward with the alert bell, but they were so overworked that they did not respond, and in the end she was forced to dial 999 from the floor of the ward. She was left in the ridiculous position of explaining to the call centre staff that she was actually on the floor of a ward in Royal Shrewsbury hospital before the staff reached her. That cannot be right. We heard of many heartbreaking situations where cancer patients’ scans could not take place because waiting lists had meant that they were booked in the wrong order and of fatally long waits for diagnosis in some cases, with the trust failing to hit key targets across the board.

Finally, the 2022 Ockenden report shook my community with its devastating finding of over 200 preventable deaths of babies and unimaginable harm done to families. Campaigning and voicing justified anger, which everyone has done today, and working with Ministers on the failings can bring about change. That was essential in Shropshire, and though things are not perfect, it is encouraging to see the improvements that have been made so far. It has been a really difficult environment for staff to work in. I pay tribute to them and the new leadership team for all the hard work that they have put into turning this extremely difficult situation around. The trust’s CQC rating has recently been upgraded, although it still requires improvement, with emergency department waiting times and understaffing as key focuses. However, there is much to be pleased with. Reviews have noted a positive culture, and the trust has recently been shortlisted for several awards for its performance improvements.

We must celebrate the many trusts in the UK that provide high levels of care and innovation, and support those making significant improvements. For underperforming trusts, it is our duty to our patients and constituents to ensure that we campaign to bring them up to good standards, and I congratulate everyone here today on doing just that. However, if conditions for care are stretched and staff are expected to deliver the impossible with limited time and resources, it is patients who suffer. How can we transform patient safety? To start, we need to hold failing leaders to account, as I have discussed. Reports have pointed to a culture of unaccountability among NHS leaders, which has accompanied recent scandals and undermines public confidence. Failing trusts need to be held to account, and our amendments to the Health Bill would help do that by retaining the necessary structures for accountability.

First, we must retain the independent patient voice, Healthwatch, which was established in the wake of the Mid Staffordshire scandal. Although still in its infancy, HSSIB, the Health Services Safety Investigations Body, should also be retained because it promises to improve the patient safety environment. Our amendments would also introduce duties and a standardised framework for the reporting of suspected health system failings and medical malpractice by coroners, medical examiners and members of ICB and NHS trust boards.

Whistleblowing routes to the CQC, the Department of Health and Social Care, HSSIB and the police would be accompanied by statutory protections. We would also place a corresponding duty on senior leadership to escalate any concerns they have about safety or malpractice to the relevant boards. My colleagues in the other place will be re-tabling those amendments at the next stage of the Health Bill, and I urge the Government to accept them.

[Jim Shannon]

The hon. Lady referred to whistleblowing, as did the hon. Member for South Basildon and East Thurrock (James McMurdock) before her. Does she agree that there should be more encouragement for those who want to blow the whistle, but also protection for their jobs?

[Helen Morgan]

I fully agree, and that is why HSSIB has a role to play, because it provides a safe space for people to raise concerns without fearing for their jobs. The National Guardian’s Office, which is also being removed by the Health Bill, enables and encourages safe whistleblowing across the NHS, and it is important that we retain it.

The Thirlwall inquiry highlighted constant reorganisation as a problem as well. I received a notification in my inbox this week that Shropshire, Telford and Wrekin ICB had clustered with Staffordshire and Stoke-on-Trent ICB to get ready for a merger, but that it is all on hold now because it does not line up with local government reorganisation. It is really problematic for local health services when their management teams do not know whether they are coming or going from one month to the next. I urge the Minister to deal with that problem as well.

It is clear that urgent action is needed to turn around underperforming trusts for the safety of their patients, the welfare of their staff and the value delivered for the taxpayer. I hope the Government will look at the measures we have outlined and accept some of them in the Health Bill as it passes through the House of Lords, so that we can really affect people’s lives and put back their confidence that the NHS will be there for them when they need it most.

[Graham Stuart (in the Chair)]

I call the spokesman for His Majesty’s Opposition, Dr Caroline Johnson.

15:34

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

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Chelmsford (Marie Goldman) on securing this debate on a subject important not only to her constituents but to all of us right across the country. The performance of the NHS is key to the health of the nation. It gives us all the best chance of good health and recovery, which is important for our social wellbeing and brings economic benefits.

The first question is this: how do we know which trusts are performing well and which are not? First, we need to decide what good performance looks like. We can look at that in a couple of ways, in particular in relation to outcome and experience, both of which are important. The outcome, for example, may be a death. That will come to us all eventually, but the experience might be one of comfort, in line with the wishes of the individual—as good as can be delivered. Conversely, one could on the face of it have a good surgical outcome from a trust but a poor experience of care during that experience.

Experience is measured in a number of different ways: individual staff, such as consultants, have patient feedback as part of their appraisal and revalidation; the friends and family test enables people to give anonymous feedback; the number of complaints or compliments can be measured; and trusts do their own surveys—but those are all to some extent internal processes.

[Marie Goldman]

I would love to hear more of what the hon. Lady is saying, but none of us can hear her well. My plea to the hon. Lady is to speak up a bit.

[Dr Johnson]

Sorry, the microphone went off, but it has just come back on again.

The processes are mostly internal. Healthwatch is an independent patient voice, which looks at people’s experience across the health service in a way that is independent of Government. As part of the Health Bill, however, the Government plan to abolish Healthwatch and to bring it inside the Department. Will the Minister comment on whether they still plan to do that?

When he was Mayor of Greater Manchester and in charge of its integrated care board, the Prime Minister wrote to the Government to suggest that they might be on the wrong path. As Prime Minister, does he still think so? What instructions has the Minister had in relation to that? People are sometimes frightened to provide feedback to trusts, but they will be more willing to do so when they have confidence in being heard independently.

Other ways in which the Government measure experience relate to waiting times—how long it takes to be seen in clinic, how long it takes to be seen in A&E, how long it takes from the decision to admit a patient to actually admitting them, or how long it takes for a procedure or an operation. The Government produce lots and lots of figures but many of them, I am afraid, go in the wrong direction.

The Government have a dashboard for the referral to treatment statistics, and the waiting lists are rising. The number reached a low point in March 2026, just after the reports of exceptional numbers of removals, but it has now risen by 222,000 in the past four months. I am afraid that the numbers waiting for a procedure or operation are higher now than at the general election. This year, many more people than in 2024 waited more than 12 hours in A&E after a decision to admit them. Staff sickness rates, mentioned earlier in the debate, are also consistently higher than they were before the general election. Statistics across the NHS are not going in the right direction.

The Government also measure outcomes through the financial management of a trust, leadership and Government metrics, the number of procedures performed, the number of “never” events, and CQC inspections. Again, the Government are planning to fold HSSIB into the CQC, which many commentators have warned against; the Liberal Democrats and we the Opposition have spoken against the abolition of HSSIB. When the Government take the Health Bill through the Lords in Committee in the next week or two, I hope that they will think again. The Government also plan to roll a number of other things into the CQC at the same time, including events management; I wonder whether they are asking an organisation that they acknowledge has been struggling to take on too much.

If poor performance is identified, who is responsible? Is it the consultant or the matron? Is it the directors’ suite—the chief executive or the chair? Ultimately, if a trust is underperforming at the moment, governors are supposed to hold the board to account. The Health Bill abolishes those. The ICBs—the commissioners—can hold the trust to account but their budgets have been halved, so will they have the capacity to do so? Many of them have merged, and some of those mergers have been paused by the Government. This is all a distraction. NHS England has a role, but it is being abolished too. Apparently, the overall headcount in the DHSC and NHS England is to be halved. How will they have the bandwidth to provide the scrutiny that the Government say they will have?

Having identified the management of poor performance, the Government chose five trusts—North Cumbria, Mid and South Essex, Hull University Teaching Hospitals, Northern Lincolnshire and Goole, and East Kent—to have a special intensive recovery programme in March 2026. However, it is not clear what has been instituted in those trusts, what outcomes that programme is developing, how long it will last or what the Government will do for those trusts that fall just outside that group of five.

How will the Government improve the variability between trusts that do not fall into the bottom cohort? How did they choose the five trusts that were chosen? As we heard earlier, there are several metrics by which some trusts could be considered in the bottom five, but they were not chosen, and some metrics by which those that were chosen may not be in the bottom five. How has the Minister chosen those trusts and how does she intend to improve those that do not fall into her chosen few?

The Government have promised a workforce plan, but the workforce is the most important thing. Right hon. and hon. Members have spoken in this debate about the really good staff in their trusts working extremely hard in very difficult conditions. The previous Conservative Government developed a long-term workforce plan. This Government decided that they wanted their own workforce plan—they won the election so they are very much entitled to make one. But they have still not written it. They promised it by the end of 2025; we are rapidly approaching the end of 2026 and it is still not with us. Can the Minister—[Interruption.]

15:41

Sitting suspended for a Division in the House.

15:55

On resuming—

[Dr Johnson]

Before the interruption, we were talking about the importance of workforce to the health service and to any improvements that we wish to make to services. The previous Conservative Government developed a long-term workforce plan. This Government decided to develop their own, which is fair enough, but it is very delayed. Can the Minister tell us, without using the words “in due course”, “imminently” or “soon”, when it will be published, preferably giving a date?

Returning to other plans, the Government say that maternity and neonatal care is their priority, which is good, but when they came into government, they said that they had a plan to improve it. They spent the first 12 months writing their 10-year plan, which said that they would produce a maternity and neonatal plan. They did a review, which took six months longer than it was supposed to. They were then two years into a parliamentary term. That plan says that they will have a commissioner, who they have yet to appoint, and another plan for a modern service framework, which is apparently due by Christmas. Can the Minister guarantee that, two and a half years into the Parliament, they will have a delivery plan for maternity improvements?

The bottom line is that I am concerned that the Government are too busy reorganising the NHS to deliver on their promises. NHS performance is declining in many areas. There is huge variability between trusts and departments. The Government picked five for intensive treatment. What about the others? Can the Minister clarify that it works? The Government are internalising patient experience, which means that it may suddenly look much better, but how will anyone have confidence in the figures if they are produced by the Government marking their own homework? The abolition of NHS England has been badly planned. ICB cuts, mergers and paused mergers are simply a distraction. The removal of the need for governors removes another layer of accountability and scrutiny.

The Government say they are working at pace, but it is a very slow pace. The workforce plan and the maternity plan have been delayed, but so have things like the Hughes report. People suffering from valproate and mesh have been waiting and waiting. It is getting towards three years since that report was published. They have waited long enough. I urge the Minister to say when the Government intend to respond to that report.

The Government need to get a grip of who is holding the trusts to account, so that when the Health Bill comes out the other side of the Lords, there is a clear chain of command. Perhaps it will lead up to the Secretary of State, but it is clear that they will not be able to micromanage every detail. There needs to be a clear path so that people know who is accountable, who will drive improvement, who to congratulate when improvements are made and who to hold accountable when it goes wrong.

[Graham Stuart (in the Chair)]

Thanks to the discipline of the speakers so far, there are some extra minutes for the Minister to take interventions if she so chooses.

16:00

[The Minister for Secondary Care (Karin Smyth)]

That is very kind of you to encourage me, Mr Stuart. What are the timings now?

[Graham Stuart (in the Chair)]

We will finish at 4.15 pm, so ideally we will allow the wind-up at 4.13 pm.

[Karin Smyth]

Thank you. It is a pleasure to serve under your chairmanship, Mr Stuart.

I want to try to get back to most colleagues. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this debate, and all Members who have spoken about the experiences of patients, because this is absolutely about the experiences of patients, families and the NHS staff in all our constituencies.

When an NHS trust underperforms, however we define it, the effects are very real. Patients wait longer, staff work without the stability and support they need, and public money is not used as effectively as it should be. Since becoming a Minister, I have made it clear that I think Members of Parliament should be part of conversations with local trusts. I commend my hon. Friend the Member for Ipswich (Jack Abbott) for hosting his trust in the way he has and seeing an improvement in his constituency, as he outlined, with mental health being considered as well as acute services. The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), spoke about her work in supporting her local trust and seeing those improvements. It can and does happen.

Many of the trusts that have been discussed today have faced problems built up over many years. In fact, I remember some of them from being a manager in the health service over the past 20 years or so. There is rarely one cause or a quick fix. There are varying problems, whether they be workforce shortages, poor estates, weak leadership, organisational change or rising demand, and some of those can reinforce one another. Let us be clear for patients and members of the public who are paying attention and for all our constituents: this Government will not accept poor performance, and we are determined to accelerate the recovery, particularly in the most challenged trusts.

I will just clarify some of the rules. Everyone knows that NHS England is an arm’s length body. That was a decision taken a number of years ago by my good friends the Liberal Democrats and the Conservatives when we were in opposition. The Health Bill, which is progressing through the House of Lords, changes that arrangement to put the NHS together with the Department of Health and Social Care. The Bill was not opposed in principle by any political party, because we all know that the arrangement has not worked.

As we bring the two bodies together, it is important to maintain the distinction between running large trusts and running the system as a whole, with operational performance oversight. It is a skilled job. It is hard to run a big trust. It requires good clinical and operational managers, and good leadership and knowledge. The complete separation of the Department and Ministers from NHS England meant that the oversight and what we could see in our constituencies as Members of Parliament was not linked up under the previous Government. That is one thing that will improve. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) just said, of course Ministers will not be micromanaging. It is a skilled job. The complete separation that removed oversight from local trusts has been a dysfunction of the system over the last decade.

To be clear, I regularly meet teams and Members of Parliament in my role. I want to share how some of that operational oversight works. I will highlight two major areas. One is the oversight framework, which provides a clear and consistent assessment of every NHS organisation. In her expertise, the hon. Member for Sleaford and North Hykeham recognised that there are many ways to judge performance, but the new framework looks at what matters most to patients and taxpayers: waiting times, quality of care, use of staff and money, and leadership capability in order to have good-quality patient care. They cannot be separated in my view. I have made sure that it is transparent for the public and Members of Parliament. That is quite controversial; some people do not like what they call league tables, but I think it is important that people can see that.

[Dr Caroline Johnson]

Will the Minister give way?

[Karin Smyth]

I will move through some of these points for the moment. For providers with the most entrenched financial, operational, leadership and structural challenges that impact patient care—that is what these trusts are about—we are taking a more holistic approach to that enhanced support because, as the shadow Minister asked, how do we choose? They are the most challenged long-term systems.

At a national level, the intensive recovery programme is providing short-term, intensive support for organisations to help strengthen their immediate operational and financial stability while developing an organisation-owned plan for long-term sustainability. We cannot keep going round in this circle; at the end of the day, these organisations need to be well run and well led, and local systems need to own that problem. That is also part of our wider devolution agenda. I think I outlined that in my letter to the hon. Member for Chelmsford in September, but I am very happy to meet again and go through that in more detail if that is helpful.

The first IRP cohort includes Hull, Northern Lincolnshire and Goole, East Kent, North Cumbria and Mid and South Essex. Each faces very different circumstances, so there is not a one-size-fits-all response. I will touch on some of them, for hon. Members have raised their own issues with them.

There is interest in Hull and Northern Lincolnshire and Goole. Following an independent review, the decision has been taken to dissolve the Humber health partnership arrangements. In Hull, the focus is on strengthening core hospital services, making the best use of specialist services, improving productivity and reinforcing clinical leadership and accountability. For Northern Lincolnshire and Goole, the priority is to move more care into neighbourhood and community settings, reflecting the demands in those areas. There are good signs of progress.

The hon. Member for Chelmsford and others who intervened highlighted Mid and South Essex. The 2020 merger of those three trusts has not delivered the planned benefits for 1.2 million people. Staff culture and morale remain a serious concern, with little improvement, as was highlighted in those terrible survey results over the past five years. We have heard those. The trust has long-standing performance problems linked to how demand is managed across the wider health system in that part of Essex. Work is under way to improve the long waits, improve patient flow, strengthen governance and make better use of the estate. I shared the analysis in productivity packs with everybody earlier in the year, and I am sure that everybody looked at them in detail, but I am very happy to go through them again. It identified more than £122 million of productivity opportunities. It is not simply about saving money.

Better organisation across sites and stronger clinical integration should improve patient experience, reduce delays and raise quality for patients. The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by £80 million for Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

I will touch on North Cumbria because, for the hon. Members for Westmorland and Lonsdale (Tim Farron), for Honiton and Sidmouth (Richard Foord) and for Yeovil (Adam Dance), the work going on there really highlights what can and needs to be done in rural healthcare. I remind hon. Members that hospitals in some of those areas are additionally funded to cope with some of those rurality issues. We highlighted that in our 10-year health plan. We absolutely understand that across the country, there are different issues with regard to rurality. I will not talk about Kent, because it has not been raised, but again, it has very different issues. That is why those areas have been chosen. They have long-standing and deeply entrenched problems.

My hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) raised ambulance handover delays. I did not know she was going to raise that today, but to assure her, the continued problem with the ambulances was raised with me in my oversight meeting with the team yesterday. Those issues are flagged by NHS England and its operational management across the country. They are long-standing issues, as she knows, but I gently disagree with her. She is absolutely right in her assessments of history, but this issue is not a failure of oversight and accountability. Good co-operation, collaboration and management are the responsibility of the services locally. The oversight has worked. We know that this is a problem. We and her constituents can see that. We very much want the services to work together to resolve that flow so that the ambulance handover works much better.

My hon. Friend the Member for Salford (Rebecca Long Bailey) highlights, sadly, her constituency’s downward improvement trajectory. She asked to meet me, and I am very happy to do that. My hon. Friend the Member for Darlington (Lola McEvoy) did the incredibly difficult job of raising the terrible distress for women in her constituency. She highlighted a terrible case, and I will make sure that she has a meeting with the Minister to go through how that can be supported on behalf of her constituents. I know that she will work closely to make sure that they are served better.

We are seeing early improvements through the IRP, but we need to demonstrate progress through safer care, better operation and financial performance. We have clear milestones and credible plans for stronger organisations. Support nationally is time-limited but proportionate, because trusts ultimately have to stand on their feet. Intensive oversight is not about naming and shaming. Staff in challenged trusts are working in exceptionally difficult circumstances. As we need to encourage people to work there, we must show them that it can be better. The purpose is to remove barriers to improvement, provide the right expertise and hold boards and NHS leaders to account for results.

The Government will continue to work with NHS England. I am committed to keeping Parliament informed of significant developments. We will judge our approach by its effect on patients and staff, not by the creation of more processes. The oversight framework and the intensive recovery programme provide a clear route from identifying the risk to taking targeted action. There is much more to do. It can only be done in local circumstances with co-operation and transparency, including working with Members of Parliament. Where we hear examples of trust chief executives not doing that, I am prepared to call it out. It is not acceptable.

There is more to do, but we want practical, safer and more timely care, and stronger organisations. I am pleased to have had the opportunity to debate this issue today. It is important for MPs to be part of the discussion. We want to improve all trusts, but we are focusing on those with long-term issues, sometimes having been affected for decades. The people in those areas deserve better, and we are determined to make sure they get it.

16:11

[Marie Goldman]

I thank all Members who have taken part in this important debate and the Minister for her response. Hon. Members from across the House have pointed out that rural constituencies are not the same as urban constituencies, and that they have very different needs. They have pointed out that we need investment in the infrastructure at our hospitals. Some hospitals are failing because their buildings have been neglected for decades. That needs to be fixed. None of us is here just to criticise. We are all listening to our constituents, to patients and to staff. It is our duty to call problems out and demand better, and that is what we have done today.

I do not like hyperbole, and often when people talk about life and death, it is hyperbole. That is not the case here. It is literally life and death for people on waiting lists. People have tragically died because they have been on a waiting list too long or because they have been mistreated or misdiagnosed, as we have heard from Members.

I make a final plea not to concentrate only on the finances. Finances will help with rural issues and infrastructure issues, but they will not help with cultural issues. The CQC did a well-led inspection of the Mid and South Essex trust recently. The stark line coming out of it was that staff are afraid to speak up for fear of reprisal. Money is not the problem with that system; it is a cultural problem, and we need to do something about it.

The Minister said that we could meet again. I gently say that we have not actually met yet, so I would love to take her up on the opportunity to meet for the very first time. I thank her for her response, and everybody who took part in the debate.

Question put and agreed to.

Resolved,

That this House has considered Government oversight of underperforming NHS trusts.