Commons Chamber

Monday 1st June 2026

(began 1 week, 2 days ago)

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None Portrait Q1. What steps he is taking to improve recruitment and retention in the armed forces. (900108)
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>> Mr. speaker, can I start by condemning the reckless Russian drone strike on Romania early on
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None Portrait Ministerial statement: Response to Humble Address Motion
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We now come to the statement. Secretary. Darren Jones. Secretary. Darren Jones. >> Yeah, yeah.

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With permission, Mr. Speaker, I would like to update the House on the government's response to the Humble Address of the 4th of February. Before I do, I think it's important for all of us to reflect again on the impact that this debate will have on the victims of Jeffrey Epstein. Members across the House will be aware of the truly horrific crimes he committed against countless women and girls, and we hold them in our thoughts when discussing these issues again today.

Mr. speaker, the government has today laid the second tranche of documents. These were laid before the House in advance of the statement and are now on gov.uk for the public to see. The documents we are publishing today are one of the largest government publications ever laid before this House. This disclosure process has been wide ranging, costing the Cabinet Office alone over £1 million. As the House knows, this was an official led process with judgements made by senior officials, and I am grateful for the careful work they have undertaken right up until today's publication.

Whilst the first tranche dealt with Peter Mandelson's appointment, withdrawal and severance, this second tranche responds to the parts of the motion which requested communications and documents concerning his appointment in vetting, as well as messages between Peter Mandelson and Ministers, special advisers and civil servants in the months prior to and throughout the duration of his appointment. Mr. speaker, I recognise that the House will need sufficient time to review today's tranche in full, given the size of the publication, as we have just heard from the Leader of the House.

That is why I have secured government time on Wednesday for a subsequent general debate, so that there is an opportunity for members to ask further questions after today's statement to inform that debate and for clarity and accountability. I draw the House's attention to the methodology set out in the publication today. This explains in detail how the government undertook the disclosure process. I will not repeat that in full here today, Mr. Speaker, but I will make reference to a number of areas that I know the House has expressed an interest in previously.

First, on redactions in line with the motion. Over 300 individual documents were referred under a process agreed between the government and the Intelligence and Security Committee. I can confirm that no material has been redacted on the grounds of prejudice to national security or international relations, without the committee's approval. For clarity, all redacted material agreed with the ISC is labelled in the bundles today, with three asterisks. Outside of this arrangement, this process does not change the important and well-established constitutional principle that national security and international relations judgements are ultimately for the government.

I once again express my thanks to the Intelligence and Security Committee for their engagement in this process. Further limited redactions have been made outside of the ISC process in respect of information that relates to junior officials names, contact details like telephone numbers and email addresses, the personal or commercially sensitive data of third parties not relevant to the motion and, where relevant, legal professional privilege. I would also like to confirm that no reduction reductions have been made to references to Global Council, other than to protect the identity of individuals who worked there and are not themselves public figures.

Officials have sought to be transparent in the material where the individual is a global council employee. No redactions have been made to references to Palantir and Anduril outside of the scope of the existing ISC redactions process, and no clear references to current or former UK politicians have been redacted on the basis of there being third parties. I can also confirm to the House that no government Ministers or special adviser has determined any of the redactions themselves. The redaction process has been overseen by Cabinet Office officials and, where relevant, in agreement with the ISC, the Cabinet Office Humble Address team has taken advice.

In addition to this, from an independent king's counsel, including reviewing the methodological approach followed by officials and acting on that to inform their work. This has helped ensure that the government is confident that its approach is compliant with the Humble Address and the government's legal obligations. These additional targeted redactions, made outside of the agreed ISC process have been made in line with the Freedom of Information Act, the Ministerial Code and the resolutions on ministerial accountability passed by both houses in 1997.

This is important, Mr. Speaker, because it goes to the question of whether the government has complied fully with the Humble Address. That question should be answered in the context of the established rules and precedents that relate to humble addresses. If these rules were not relevant, then the Humble Address would have required extensive additional detail on the face of the motion dealing with these procedural issues. However, I do recognise the level of interest in the House in respect of these non-national security and international relations related redactions and so on.

The recommendation of the Intelligence and Security Committee. I can confirm that the hon. Member for North Dorset, the chair of the Public Administration and Constitutional Affairs Committee, has reviewed our approach to third party redactions this morning. He has confirmed that we have applied the methodology set out in the document and that, in his view, the redactions are sensible, reasonable and proportionate. I thank the Intelligence and Security Committee for this recommendation and the hon. Member for the additional reassurance he has provided on this point.

Mr. speaker, as the House is aware, the Metropolitan Police has also asked the government to withhold some material in scope of the motion, which they considered could be prejudicial to their ongoing criminal investigation for any subsequent prosecution. This request remains in place and I am very grateful again to the chair of the Public Administration and Constitutional Affairs Committee, with whom we have also shared this information, in order to provide additional accountability of the government's actions. I hope that members appreciate the need not to prejudice the investigation and understand that I will not be able to answer questions about certain documents which have been withheld.

No responsible government would wish to undermine a criminal investigation and put at risk the justice that it seeks, and I am sure the House will share this position. I can, however, Mr Speaker confirm that this material does include questions put to Peter Mandelson by the Prime Minister's then chief of staff, and Peter Mandelson's responses. In addition, a small number of documents have been withheld at the request of the police, which fall broadly into the following categories. Firstly, national security vetting information.

Secondly, conflict of interest process material and thirdly, relevant internal correspondence with Peter Mandelson. Such information will, of course, be published at the conclusion of the investigation, or at the point at which it would no longer be prejudicial to the police investigation to do so. Mr. speaker, the documents published in the first and second tranches contain the entirety of the documents the government has available for disclosure, except those few documents I have just referred to in relation to the Metropolitan Police. Members will no doubt have questions about what might be perceived to be missing messages and meeting notes, which I would like to address in turn on messages that some might expect to be included.

I can confirm that we have conducted multiple rounds of discovery from relevant Ministers, special advisers and officials. In line with the motion passed by the House. This has involved requesting searches of email messaging platforms such as WhatsApp and other related communication services on both work and personal devices. However, the House should note that some messages may not have been backed up, where devices may have been changed or disappearing, messages were turned on for reasonable and permitted reasons, including before the dismissal of Peter Mandelson or the passing of the Humble Address, myself included.

I do recall, Mr. Speaker, having some limited exchanges with Peter Mandelson over WhatsApp, including those I have already discussed in the media, but these conversations did not involve transacting government business and were in line with official guidance on the use of non-corporate communications channels at the time. Mr. speaker, I also share the view put by the Intelligence and Security Committee to the House that there are lessons for the Civil Service to learn in respect of better note keeping, archiving and the use of appropriate levels of secure IT systems in the future.

The government has already committed to a review of the use of non-corporate communications channels. The terms of reference, for which we will shortly publish, taking into account the concerns that have been raised in this House and the two tranches of documents we have published in response to the Humble Address. I will, of course, keep the House updated as we progress that work. Mr. speaker, I will now turn to the material relating to Peter Mandelson's national security vetting process. I can confirm that the vetting process, summary and recommendation that was put by UK security vetting officials to the Foreign Office has been shared with the Intelligence and Security Committee.

This was shared for the purpose of agreeing redactions as part of the agreed process, so that it can be published when we are in a position to do so. What hasn't been shared is the highly sensitive personal data inputs collected during the interview process. These could, for example, relate to how much money an individual might have in a particular account, or who a person may have had a personal relationship with in the past. Mr. speaker, if those participating in the vetting process cannot trust that the information they feed into that process is confidential, it will harm the integrity of the whole system.

Anything less than full candour, candour would be hugely damaging and be profoundly negative for our national security. This would be felt by this and future governments and ultimately by the British people. As such, sharing this data for any person undergoing developed vetting would undermine the very basis of our national security vetting system. Mr. speaker, this is the 10th update to the House on this matter that I have provided, and with the exception of the small number of documents that are withheld at the request of the police, which we intend to publish when the police are content for us to do so.

The government now considers that it has duly discharged the duties set out in the Humble Address. I will, however, return to the House for the general debate on Wednesday to provide a further opportunity for colleagues to ask questions, and on that basis, Mr. Speaker, I commend the statement to the House.
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Alex Burghart Portrait Alex Burghart MP (Brentwood and Ongar, Conservative)
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The Opposition Secretary of State, Alex Burghart. >> Thank you very. >> Much, Mr. Speaker. >> I thank. >> The Chief. Secretary to the Prime Minister for advance sight of Prime Minister for advance sight of his statement. The story in the times is to be believed. He may be positioning himself to be the chief successor to the Prime Minister. I also thank him for giving me advance sight of the material that was published today, which I was fortunate enough to see this morning.

However, it is very important to put on record that only a very few members of this House were able to see it this morning. It was available at 930, and yet it was only published at 2:00. And yet here we are today with hon. Members of the House not having had a chance to read it, and yet being expected to ask the right hon. Gentleman questions. Now, I know the response will come that we are going to have a general debate on Wednesday. But as hon.

Members opposite will know in a general debate, if the Ministers chooses not to take interventions, there is no scrutiny at all. You know, this is, at worst, obfuscation. This is an attempt to deny scrutiny in a way which is unnecessary. The documents should have been published at 930 this morning in advance of this statement. It was on the news, the case of Peter Mandelson's appointment remains of the utmost national importance, simply because it touches on national security and on the Prime Minister's honesty, integrity and competence in the material before us today, I want to make two basic points.

The first is about disclosure, and the second is about the process by which Peter Mandelson was appointed on disclosure. Although we have a huge number of documents. It is clear that very many are missing, some have been withheld, some have been lost. And it is clear that some have probably been destroyed because of the approach the government has taken. However, it is impossible for hon. Members to know which documents fall into which category. We are told that the Metropolitan Police has requested that certain documents be retained, but the government has refused to tell us which documents are being retained.

I respect the fact that the right hon. Gentleman has told us about three broad categories. Now this is progress. We did ask for those categories some time ago and we were told we couldn't have them, but it turns out we can have them. We know that there is no good legal basis for the government not to disclose to this House which documents are being withheld. The government should tell us, indeed, it would be possible for it to disclose those documents to the IOC or indeed to certain members of the House on Privy Council terms.

Again, this is obfuscation. It is an unnecessary attempt to defer scrutiny or deny it. And the Humble Address did not allow for the government to redefine the request in this way. If the government wishes to retain documents because the Met Police have asked, it should come back to the House and change the terms of the Humble Address. It has not done that and consequently it risks being in contempt. Some Ministers have duly handed over their WhatsApp messages. It is clear that some have not.

Are we to believe that there was no WhatsApp exchange at all between the Prime Minister and Peter Mandelson? We know that there were, because it's been reported in the press. And yet those messages, the messages that were reported in the press, do not appear in the release today. It's clear that some messages have gone missing. It is also the case that in the all of these documents, the Prime Minister's presence is almost non-existent, almost non-existent. Yet despite the fact that he was appointing a man to be head of our most senior mission, we have almost nothing in his name.

It is as though somehow he appointed Peter Mandelson as ambassador without leaving any documentary trace of that decision at all. It is. It really beggars belief. Mr. speaker, we take the. For example, you know, the Secretary of State for DSIT are well known to be a friend and ally of Mandelson. He appears to have submitted a nil return on his WhatsApp messages. I hope that the hon. Gentleman will tell us. Why was it that there were never unlikel it that those messages had been deleted? The house has.

The house has a right to know in each case whether information has gone missing or whether it has not been handed over. We know that Peter Mandelson has refused to hand over his phone. It's in the. It's in the document. But we know that he was asked to give over his phone on the 31st of March, sometime after the Humble Address. He's declined to do so, and this is simply not acceptable, that the government should allow this to pass without some sort of pushback.

You know, the government has within its power the opportunity to take legal action to recover the exit payment it gave to Peter Mandelson. If he is not playing ball with the Humble Address, there is then the matter of redactions. Acres and acres of white space. Constellation of asterisks, perhaps all too appropriate for a labour document. Mr Speaker. It is clear from the reports in the press that the ISC has had serious concerns about the reduction process. I listened to what the right hon. Gentleman said, and I will listen with interest to what members of the Committee say in a moment.

There are a huge number of reductions under the heading third party. On what grounds have these reductions been made? For example, on page 251 of volume three, Mandelson refers to someone who is currently staying with him in government property. This name is redacted. Why has it been redacted? Why can the house not be told who is staying in government property? With the ambassador on the national security vetting material? It seems once again that the government is happy to provide the Guardian with more information than it is prepared to provide to Parliament.

Preparation of the security document document for publication appeared in recess, leaked by someone in government who was familiar with it. And then we've seen that the Guardian has achieved from multiple sources that there were concerns raised by the vetting agency about Peter Mandelson's foreign contacts with the Chinese, Ministers, with Oleg Deripaska, with Tamir Heyman, and so on. Multiple sources. And yet we are being asked to believe that this information was only seen by a tiny handful of people within government, as someone, somewhere, is not being frank with us that if we had time, Mr.

Speaker, and we all have time on Wednesday, we could talk about the concerning information about Chagos here. We could talk about the fact that Peter Mandelson, after he had been appointed, asked whether he could do paid work in Shanghai, you know, on a private basis. We could we could talk about the fact that Peter Mandelson wrote to the then Foreign Secretary saying, if you were indeed minded to appoint me, I would make sure you never regret it.

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Yeah, yeah. But the truth is that we must return once again to the process by which Peter Mandelson was appointed, and everything in the documents today show that the Prime Minister today show that the Prime Minister did not follow the instructions he was given by the then Cabinet was given by the then Cabinet Secretary on the 11th of August 2024. He was told to get security vetting done before the appointment vetting done before the appointment was confirmed and this the Prime Minister did not do, and he was asked to do that because the Prime Minister had been provided with a due diligence document by the Cabinet Office, which said that Peter Mandelson had an ongoing friendship with Epstein after Epstein had been sent to prison.

The fact that Mandelson had been a director of a Russian defence company which had supplied arms to Putin during Putin's invasion of Crimea, and the fact that he had maintained unhealthy business relations in China. And yet, despite this, the Prime Minister did not get the security vetting done before he made the appointment. He went ahead and made it anyway, and then the rest of the system was scrabbling around afterwards to try and make up for this error. But it was his error.

It was clear that due diligence was not followed. It is a failure and is visible from space. It is a failure that will define this Prime Minister's premiership. It is a failure that epitaph.
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Darren Jones Portrait Rt Hon Darren Jones MP, Minister of State (Chief Secretary to the Prime Minister) (Bristol North West, Labour)
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Yeah. >> Secretary Jones. >> Mr. Speaker, and I thank the hon. Gentleman for his questions. I think there were three broad questions, one on access to the documents today. Second, on what documents are available or not, and the third, on the redactions process in terms of access to the documents. Mr. speaker, as I said to the House in the urgent question before the recess, I've been very mindful of the fact that, given the significant number of documents being published today, that we wanted to create as much time as possible for the House to scrutinise them and to be able to ask the government questions.

I agree that had I published these documents 45 minutes before standing up to give the statement for 45 minutes, that would have been insufficient in the circumstances, and I hope that he welcomes the lengths that I and the government have gone to, not just to provide these in advance today to himself, but also the Leader of the Opposition, the chairs of the relevant select committees and other stakeholders, but also by publishing them at a much earlier time compared to normal before the debate today and then securing a general debate on Wednesday in respect of the documents that are available.

As I said in my statement, Mr. Speaker, this tranche plus the first tranche of documents, represent the entirety of the documents that the government has available for disclosure, except for those that have been made available to the Metropolitan Police. He has invited me to list those documents given to the Metropolitan Police. As I've said from the Dispatch Box before, Mr. Speaker, I'm acting on the advice of the Metropolitan Police in not being able to do that, but I'm pleased that he welcomes the commitment we have secured from them to give a little bit more shape to that today with the with the categories of documents that are being held, I would remind the hon.

Gentleman and indeed the House, that we have also shared the documents directly with the chair of the Public Administration Committee, so that there is an additional check and balance within Parliament. With that, being able to share these documents more widely until the Met Police tell us. He also asked me, Mr. Speaker, about notification of the Prime Minister's decision to appoint Peter Mandelson as ambassador. I would refer him to the first tranche and the document from his principal Private Secretary, number ten, communicating that decision both to the Foreign Office and to the Palace.

And then finally he asked me about the redactions process, which I think I set out in detail in my statement, Mr. Speaker, which was predominantly with the Intelligence and Security Committee, where it relates to national security or international relations, and then second, to non-national security redactions in line with established process and precedent. With the additional check provided this morning, again by the chair, the Public Administration Committee, in relation to third parties for which he has confirmed and understand it, that he's happy with the process the government has followed.
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Lisa Smart Portrait Lisa Smart MP (Hazel Grove, Liberal Democrat)
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Very much. statement, as well as members of the I. S and the Member for North Dorset, for their work on this matter. I want to acknowledge again matter. I want to acknowledge again the women and girls who found the courage to come forward about the abuse they endured at the hands of rich and powerful men. As we rich and powerful men. As we continue to discuss this, we must remember that those women are owed justice. When Peter Mandelson was appointed, UK security vetting advice was overridden.

The then FCDO Permanent Secretary suggested that he was subject to constant pressure. And there's a line in today's file suggesting that senior people had expressed interest that the vetting process goes smoothly, given the minister's repeated assurances that there was no pressure from government relating to vetting. What does the Ministers think that line refers to? We now know that Cabinet Ministers were privately praising and flattering Mandelson from before his appointment all the way to. After his dismissal, senior Ministers showed a staggering lack of judgement.

Could the Chief Secretary explain why so much business relating to one of the most controversial public appointments in recent years appears to have been conducted over WhatsApp, private, informal and outside the official record government by WhatsApp, which the Lib Dems have continually called for an end to must end because informal messaging outside official channels creates accountability gaps that should trouble us all. Does the Chief Secretary agree that government by WhatsApp must come to an end? Documents released today display concerning evidence that Peter Mandelson lobbied Ministers on behalf of his clients.

This would appear to be a serious breach of the Code of Conduct for the Other place. Yet an initial reading of the file seems to suggest that many Ministers were pliant and responded warmly to him. Could the Ministers confirm, if any Ministers reported their concerns about this seemingly egregious lobbying? The government has outlined its plans for the removal of peerages bill, and at first glance, it's a narrow and woefully unambitious bill that completely fails to rise to the moment. Could the Ministers outline what it will take for the government to make meaningful reforms to the second chamber? Senior Cabinet Ministers asked Mandelson for advice on a range of issues.

Despite many of these issues falling outside the scope of his role, issues of how we run this country stretch far beyond this scandal. The ministerial code, which should strongly inform the conduct of those who hold the highest offices in the land, continues to exist as guidance rather than the law. Ministers who breach it face no legal consequences. The Prime Minister can choose whether or not to act on the findings of independent advisers, and this means accountability is optional, and it's far from clear what consequences follow when rules are broken.

Will the government now use this moment to bring forward legislation to enshrine the ministerial code in law?
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Darren Jones Portrait Rt Hon Darren Jones MP, Minister of State (Chief Secretary to the Prime Minister) (Bristol North West, Labour)
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Gerald Jones thank you, Mr. Speaker. The hon. Lady invites me Speaker. The hon. Lady invites me in her first question to comment on the content of conversations had the content of conversations had between people other than myself. I'm sure the House will understand that all I can do at the despatch box is refer to the documents disclosed in the bundle. Given. I was not privy to those conversations, and she asked me a number of questions about the use of non-corporate communications channels.

The guidance is very clear that non-corporate communications channels can be used, but where government is being transacted, the decision then needs to be recorded on official government channels. Nonetheless, WhatsApp has been used extensively, which has raised a number of questions for the government to consider, which we will do as part of our review of the use of non-corporate communications channels, the terms of reference for which I'll be announcing very shortly. She then asked me about the peerages bill, which of course was confirmed in The King's Speech recently, which we will be bringing forward in due course.

We share the ambition to use this as a piece of legislation to modernise the House of Lords in respect of peerages, who brought the House into disrepute. And she asked me again about putting the ministerial code on a statutory footing. And as we've exchanged a number of times across the despatch box, I would just point to the fact that the changes this government has already made have proven to be effective, given a number of Ministers have had to resign.
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Rachael Maskell Portrait Rachael Maskell MP (York Central, Labour )
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Rachael Maskell Mr. >> That Mr. Mandelson's business interests permeated. >> Every aspect of government. >> This afternoon we are to debate.

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This afternoon we are to debate. The health Bill, of which will be debating the federated data platform, of which clearly Palantir, platform, of which clearly Palantir, a client of Peter Mandelson, will have a specific interest written, hardwired into the Bill, and we are expected to vote on that without seeing the full documentation and

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having time to. Digest it. So can he set out exactly what the relationship was exactly what the relationship was between Mr. Mandelson and Mr. Thiel, and with that was disclosed in the

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and with that was disclosed in the interview process? Gerald Jones I'm afraid, Mr. Speaker, I'm not here at the Speaker, I'm not here at the despatch box to speak on behalf of Mr. Mandelson, and I was not in the developed vetting interview process, nor have I seen that information. nor have I seen that information. So I'm afraid I can't answer the specific questions. The hon. Lady asks me. What I would, though, do is point her to the relevant comments in my statement, where the government has gone to lengths to ensure that references to Palantir ensure that references to Palantir have not been disclosed in the document, in line with normal commercial process, given the level of interest and respect of that of interest and respect of that company here in the House.
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Darren Jones Portrait Rt Hon Darren Jones MP, Minister of State (Chief Secretary to the Prime Minister) (Bristol North West, Labour)
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I refer the hon. Lady to my previous answer at the despatch box previous answer at the despatch box in relation to calls for an investigation into Labour Together, which is a privately owned which is a privately owned organisation outside of government and public service. In relation to her invitation to name individuals who have been protected in the disclosure by third party redactions for whom they do not have a direct relationship to the motion in front of us. I'm not at liberty to do that, but as I said in my statement, we have put those reductions in front of the chair of the Public Administration Committee for additional checks and balances.



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Thank you. Mr. Speaker. Mr. speaker, given that the key person in this scandal, Lord Mandelson, refused to hand over his personal WhatsApp messages, how can the government guarantee that Parliament and the public have seen Parliament and the public have seen the full truth? And the Prime Minister was. Was the Prime Minister misled, or does the Prime

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Minister and the Chief Secretary accepting partial disclosure? I would gently remind members

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I would gently remind members from the SNP that I think Nicola Sturgeon was very effective at deleting messages during the Covid inquiry, and it's important that Ministers do not do that, and I'm sure the SNP have learnt those lessons as much as everybody else.

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I've made very clear from my statement that the documents that we have available in front of us. Can I just say I'm not

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Can I just say I'm not responsible for the answers. Those appealing to me, the Ministers can answer of his own ability, doesn't

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he? My help. Thank you, Mr. Speaker, for any encouragement. Welcome. As I said to the hon. Gentleman, the to the hon. Gentleman, the documents in relation to his questions are clearly set out in the bundle, and they speak for themselves.

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themselves. Thank you, Mr. Speaker. It's very clear that Peter Mandelson should never have been appointed as our ambassador, and I know that we will all have Epstein's victims in our minds today. It is right that the Prime Minister has called for the removal of peerages from disgraced peers, and I am conscious of the comments from the member opposite earlier. Can the Chief Secretary confirm that the peerages bill that appeared in the King's Speech will actually have teeth and enable us to radically reform the upper chamber?
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Darren Jones Portrait Rt Hon Darren Jones MP, Minister of State (Chief Secretary to the Prime Minister) (Bristol North West, Labour)
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Very, gentlemen. his question. He knows because I've said repeatedly at the despatch box that I take the the role of Parliament very seriously in relation to holding the government to account. And as a former Select Committee chair, in particular, the role of select committees, as well as the statements and questions we can undertake on the floor of the House. That's why I have gone to lengths to ensure that the Intelligence and Security Committee, the Public Administration Committee and the Foreign Affairs Committee as the lead committees in relation to this issue, have been given as full and as transparent access to the process and the documents as I've been able to make available, and why I've secured additional time for members to be able to ask

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further questions on Wednesday. Final question. Charlie Dewhirst thank you very much. Mr. Speaker. In volume two, part

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Mr. Speaker. In volume two, part one of the documents released today, pages 115 to 116, there is an email pages 115 to 116, there is an email from Olly Robbins dated the 16th of September 2025, in which he writes to another senior civil servant in to another senior civil servant in Downing Street, saying that he has still not yet seen potentially crucial documents in relation to the appointment of Peter Mandelson. the appointment of Peter Mandelson. Now that date is important. It is the same day that Chris Wormholt, the former Cabinet secretary, wrote to the Prime Minister saying that all appropriate processes had been followed in appointing Peter Mandelson.

Can those two things be true? Can appropriate processes have been followed? If Mr. Robbins himself hadn't seen these potentially crucial documents? potentially crucial documents?
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None Portrait
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Which brings us to a statement >> Which brings us to a statement on the Equality Act 2010 Code of

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Practice. Ministers. Seema Malhotra. Thank you, Madam. Deputy Speaker. With permission, I would like to make a statement on the draft Equality Act 2010, Code of Practice for services, public functions and Associations, the Equality and Human Rights Commission. The A C is the independent equality regulator and ensures compliance with the Equality Act 2010. Their code of practice covers all nine protected characteristics and the steps service providers should take to comply with the law. On receipt of the draft code from the Ehrc in September, we consulted with the devolved governments in Wales and Scotland as per the process set out in the Equality Act 2006, the Ehrc sent the government an updated draft code last month, following engagement and further legal analysis, ensuring it is robust and accessible with clear explanations.

The Ministers for Women and Equalities updated Parliament in April, with the government committed to laying the code in May following restrictions during the pre-election period. My right hon. Friend honoured that commitment on the 21st of May. The E have worked hard to produce a code that works for everyone. Following the laying of the draft code, there is now a 40 day period, not including the recess that allows for parliamentary scrutiny, as set out in the Equality Act 2006.

If neither House disapproves the draft in this period, the Ministers can then revoke the 2011 code by regulations and then bring the new code into force by a commencement order. Today, I want to update the House on the contents of the code, in particular with what has changed between this draft code and the 2011 version. The updates are primarily where there have been legislative changes, developments in case law, a change or clarification of terminology, or new guidance issued since the original code was published in 2011, the most substantial changes relate to the ruling by the Supreme Court.

In the case of four women Scotland Limited versus the Scottish Ministers handed down on the 16th of April 2025. This judgement, Madam Deputy Speaker, set out that sex means biological sex for the purposes of the Equality Act 2010, and that trans people are still protected by the act. In their judgement, the Supreme Court also warned against reading this judgement as a triumph of one or more groups in our society at the expense of another. That is why this government will always treat these issues sensitively and will refuse to use any group as a political football.

The government has been clear that we will protect single sex spaces based on biological sex where they are needed, such as women's refuges. We have also been clear that everyone, including trans people, should have the right to access the services they need in a way that is respectful, protects dignity and
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None Portrait Ministerial statement: The Equality Act 2010 Draft Code of Practice for Services, Public Functions and Associations
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privacy, and ensures adequate provision. Changes primarily relate to the provision of sex based services when it is lawful to limit access to services and associations based on sex and gender reassignment implications for competitive sport, and asking about someone's sex. For duty bearers. The draft code provides further clarity on how service providers can follow the Supreme Court ruling in practice. Whilst it cannot cover every single scenario, the Ehrc have provided key explanations and worked examples, meaning that there is something every organisation can take from this and apply in their own context with common sense.

If a service provider still isn't sure, perhaps because of a quite specific circumstance, they should take legal advice for clarity. The code indicates that a single sex service should be provided on the basis of biological sex, so a woman only service should be for biological women only. Service providers should find the code provides certainty and clarity in terms of who can access single sex services and how they can invest. Ensure women's privacy, dignity and safety.

The code also encourages services to clearly communicate their policy on single sex provision, empowering women to make informed choices when accessing services. This could be especially useful for those women who, for feelings of safety or cultural or religious reasons, are unable to share some spaces with men. The draft code is also clear that trans people should not be left without services to use. Providers could provide mixed sex facilities or specific support for trans people. We believe service providers will be able to find the right balance for everyone.

Members have also raised accessing toilet facilities. Madam Deputy Speaker, the code indicates that toilets designated as male or female should be for those of that biological sex, trans people can use accessible toilets, individual lockable toilets or unisex toilets. The draft code reflects that there should be must be toilet services for all, and many businesses and service providers will already meet those requirements. For example, a small cafe might only have 1 or 2 individual locked toilets for use by all customers.

The draft code provides practical guidance on different ways to comply with the law. Some organisations will not need to make any changes at all, and for those that do, in the majority of cases, we are talking about changing signs on existing facilities or updating them so that they are fully enclosed. What this code does not provide is the right for members of the public to challenge one another on their sex and access to those spaces. People have been using single sex spaces with a sensible and respectful attitude to others for years, and will continue to do so.

Most people have the common sense to step in when necessary. For example, when a person of the opposite biological sex enters a single sex facility in error, and when to alert a member of staff, the draft code provides clarity to service providers to ensure people have access to services that are private and safe. I am aware that there have also been concerns raised by some over the codes content regarding special category personal data. The code states that where an individual is asked to confirm their sex, this should be done sensitively and with respect for their privacy.

The draft code explains that information about sex is likely to constitute special category personal data, where, for example, asking about sex may lead to the disclosure of someone's medical history or that they have a G c, the code advises providers to handle such conversations appropriately. We will work with the Ehrc to ensure service providers understand what is required of them when handling data. Madam Deputy Speaker There is also an interest in associations. If an association is for women only, the draft code indicates that should be on the basis of biological sex.

If an association wanted to be trans inclusive, the draft code section on associations based on more than one protected characteristic means they can do so by choosing their membership to be both sex and gender reassignment. There are also changes regarding disability, maternity and pregnancy protections for disabled people. The draft code highlights protections for them in the Equality Act that expand on what was included in the previous code, such as non-discrimination in relation to access to services. This will be the first time they are recognised and explained in the code, and this is an important step for disabled people's rights for pregnant and breastfeeding women.

The updated code highlights that harassment relating to breastfeeding may also constitute unlawful harassment on the grounds of sex, confirming that women are protected. The code also highlights that while the protected characteristic of maternity of pregnancy and maternity is not covered directly under the harassment protections in the act, it is indirectly covered as it amounts to harassment related to sex. We note the wider interest in the implementation of the For Women Scotland judgement and the draft code across government.

We are committed to this and to working with departments. Considering the implications of the code to policies and activities. Madam Deputy Speaker, the Equality Act is one of the most significant achievements in modern British history, enacted by the last Labour government. It is the quiet guardian in millions of people's daily lives. This government will uphold it and protect it, not weaken it. We are grateful to the Ehrc for their work on the draft code to ensure that duty bearers and service users have up to date guidance on the Equality Act, we will always uphold our British values of treating everyone with dignity and respect, and I commend this statement to the House.
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Mims Davies Portrait Mims Davies MP (East Grinstead and Uckfield, Conservative)
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Shadow Ministers Mims Davies. >> Shadow Ministers Mims Davies. >> Thank you, Madam Deputy. >> Speaker. >> And I thank. >> The Ministers for advanced sight

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The Ministers for advanced sight of the statement. The Secretary of State first received. It's understood the draft Ehrc code of understood the draft Ehrc code of practice in September last year, nine months ago, nine months in which the law has been clear. The Supreme Court had ruled women, girls, public bodies, businesses across the country have been waiting for the government to act. What they did, what did they do and when they received it instead, delay after delay after delay.

A government reluctant to face its backbenchers and protect vulnerable women and girls first, the Secretary of State claimed she needed impact assessments. Then she said consultation with devolved governments was required. Despite this being a reserved matter. After that it was purdah and now, having exhausted every excuse, she chose to lay the code of practice. On the very last day before the parliamentary recess, seemingly to actively minimise scrutiny. That is not acceptable. It is also greatly telling that the Secretary of State has sadly, not even come to the House herself to account for these decisions.

Seeming the law of Makerfield is too great. She previously told the House that she requested only minor changes to the draft. If that is the case, then I ask this Ministers in the Secretary of State's absence, why did it take eight months to request them? I note from the statement it talks about engagement and in the interest of transparency, who was that with? That's why my right hon. Friend the Member for East Surrey and I have written to the chair of the Ehrc asking for clarity on what changes were made under the Equality Act 2006.

The Secretary of State must provide written reasons for rejecting the original draft, as changes have plainly been made. Will the Ministers importantly commit to publishing what has changed and to why? Madam Deputy Speaker, the Code of practice is right to emphasise the importance of protecting single sex spaces and services for women. However, let us be clear the law has been settled since the Supreme Court judgement over a year ago. Sex means biological sex, yet the ruling the Secretary of State has failed to enforce.

Women have faced ongoing harassment and discrimination for stating this basic fact. We have seen cases such as the Darlington nurses hounded out of their roles or drawn into lengthy tribunal processes for asserting their legal rights not to share changing rooms with men. The government has done nothing to protect them. So what does the Secretary of State in this Ministers say to those many women whose privacy, safety and dignity have been compromised during these nine months of inaction? And why did she fail to get a grip on her own government? When department after department claimed they could not update their policies while awaiting this code? And I ask regarding the statement we heard from the Ministers and I quote, we are committed to doing this and are working across departments.

Considering the implications of the code to policies and activities. Is that why, after more than a year after the Supreme Court ruling that the NHS is still not updated, its policies on single sex spaces for staff, perhaps following the new Health Secretary's recent remarks, there may now be greater clarity within the Labour wider government about what a woman is. This revisionist mindset about a supposed Labour long term support for single sex spaces will, frankly, be fresh news to the hon.

Member for Canterbury. And so will the Ministers set out the steps that all departments will now be taking to comply with this code, and will they all do so without further delay? Madam Deputy Speaker In the meantime, some have sought to actively misrepresent this issue as an attack on trans people. It is not. It is simply about applying the law correctly while safeguarding women and girls. And at the start of Pride Month, I do think the Green Party's deputy leaders.

Inflammatory rhetoric on this is frankly reprehensible and frankly unhelpful. And not to be outdone, we are witnessing peak Lib Dem re the party leader claiming to accept the Supreme Court's judgement while opposing the guidance that flows from it. As it has been rightly pointed out, that position is frankly unprincipled. You cannot claim to support the rule of law while rejecting its practical application unless you are a Liberal Democrat. Mr. speaker, this code of practice is welcome as it covers, and, as the Ministers rightly said, a broad range of areas including age, disability, pregnancy and maternity, race and so much more.

But it's been disgracefully nine months overdue that it has landed helpfully after local elections, where we women have been voting. And during that time women have paid the price of inaction. And now it's finally been published. Women and girls need proper action, Madam Deputy Speaker, not hiding away, not further delay, not more excuses. Immediate enforcement of rights that women and girls are entitled to under the law of this land. Thank you.
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Seema Malhotra Portrait Seema Malhotra MP, Parliamentary Under-Secretary of State (Department for Education) (Equalities) (Feltham and Heston, Labour )
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Mr. >> Thank you, Madam Deputy Speaker, and I also thank the hon. Lady for her response and for her questions. her response and for her questions. Let me say up front that on this side of the House, we take this issue incredibly seriously, and services and associations need to operate and to comply with the law, and we want to support them. The issue is not a political football for us, and nor should it be for any member of this House.

We are focussed on the practical, treating everyone with compassion, dignity and respect and we should never fan the flames or seek to grab headlines and we will support services to operate and provide single sex spaces where needed and ensure trans people have access access to all the services to support their needs. To Madam Deputy Speaker, The hon. Lady accuses the government of a delay, but she will know, as a shadow Equalities Ministers, that there is a process that has to be followed and she will know that in line with that process outlined in the Equality Act 2006, we consulted the devolved administrations.

We worked across government on the myriad of services that we provide or support others to provide. We conducted analysis of the code and its impact. The EHR made some changes themselves following their engagement and consultation. We were told by the Cabinet Office Permanent Secretary that we could not lay the code during the pre-election period, and we have now laid the draft, she has said that delaying the draft, as my right hon. Friend did in her commitment to lay the draft in May.

Laying it before recess, was somehow seeking to delay scrutiny. Madam Deputy Speaker, it may help to clarify that in laying the draft, there is a 40 day period that allows for parliamentary scrutiny and those dates exclude the parliamentary recess. There is sufficient time for adequate scrutiny and I am sure the House will give that matter their attention. I do just want to also make a. Remark in relation to guidance for the NHS, because it is helpful, I think, to the House to know that NHS guidance is.

NHS England is currently reviewing its guidance and will ensure it reflects the Supreme Court ruling in the. In the. For Women Scotland versus Scottish Ministers case and will take account of the Equality and Human Rights Commission statutory Code of practice. It is also important to note that while the code does not directly apply to employers, an explanation of the Equality Act 2010, its explanation of the Equality Act 2010, particularly around unlawful discrimination and harassment, will be relevant to and helpful for employers in considering how to best comply with their obligations under that legislation.

The Ehrc has a separate Employment Code of Practice, which it also intends to

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update in the future. Care of the Women and Equalities Select Committee. Sarah Owen thank. You.

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You. Madam Deputy Speaker. I really. Wish there was a better beginning to Pride Month than what we are

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to Pride Month than what we are discussing today. Although the code. Is marginally.
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Marie Goldman Portrait Marie Goldman MP (Chelmsford, Liberal Democrat)
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Halifax spokesperson Marie Goldman. Goldman. >> Thank you, Madam Deputy Speaker and I thank the Ministers for advance sight of her statement. After the Supreme Court's ruling After the Supreme Court's ruling last year. The government's job was to give people, businesses and organisations clear, workable guidance. This code is instead unworkable, exclusionary and expensive to businesses. As the Ministers knows, the government must ensure they meet the legal obligations placed on them by the public sector equality duty. This requires the Ministers to have due regard to the need to eliminate unlawful discrimination, harassment, victimisation and any other conduct to advance equality of opportunity between people who share a protected characteristic and people who do not, and to foster good relations between people who share a protected characteristic and people who do not share it.

Yet it's the government's own equality impact assessment that identifies disproportionate harm to those with protected characteristics, and a failure to set out how that harm will be addressed. Can the Ministers really say, hand on heart, that she believes the guidance does that? The impact assessment notes how the guidance will likely impact women who aren't trans yet don't meet cultural and social expectations around what a woman should look like. There have already been stories of women with mastectomies being challenged when accessing women only spaces, because they don't look like women.

Has the Ministers truly considered this for trans, non-binary and intersex people? This code operates from a position of exclusion. It risks driving those small minorities away from public life, as leading mental health charities have since warned this guidance conflicts with our core British values of tolerance, decency, respect for individual liberty and the rule of law. That's why I urge the Ministers to withdraw it and accept that this needs resolving by Parliament as lawmakers. To achieve this, I beg the Ministers to adopt the Liberal Democrat proposal to appoint a joint committee of cross-party MPs and peers to conduct Post-legislative scrutiny of both the Gender Recognition Act and the Equality Act 2010.

Taking evidence from all communities who have been impacted in order to propose amendments on new, all new legislation. It sees as necessary to ensure that existing rights are protected. If we work together, we can fix this. Sowing division will not be.
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Seema Malhotra Portrait Seema Malhotra MP, Parliamentary Under-Secretary of State (Department for Education) (Equalities) (Feltham and Heston, Labour )
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I thank the hon. Lady for her, her comments and her question. I will also say that I do want to highlight again how the draft code does provide further clarity on how service providers can follow the Supreme Court ruling in practice, and that we can do both in making sure that we protect single sex spaces, as well as ensure that we have services and support for trans people. And it is important to recognise that whilst it can't cover every single scenario, the EHR have provided key explanations and worked examples that are also based on wide consultation.

That there is something that every organisation can take from and apply in their own context with common sense. It is also important to say that if a service provider isn't sure, then they can and should take legal advice. I want to I want to also make a mention of a burden on business, because the Ehrc expects that for most aspects of the draft code, businesses will already be compliant, and for some businesses there will be no cost at all.

For example, a small cafe might just have one individual lockable toilet for use by all customers, and they would not need to change anything. But it may be helpful as well to the hon. Lady and to the House to know that the Ehrc will also be running a session to answer questions from Members of Parliament later this week, and there may be some matters she wishes to raise directly.
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Stella Creasy Portrait Ms Stella Creasy MP (Walthamstow, Labour )
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Stella Creasy thank you, Madam.

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Is scrutiny. That is why it is so problematic that this legislation is coming forward in a legislation is coming forward in a draft form through a negative s I, because when we look at this guidance, it falls apart on hard guidance, it falls apart on hard contact with the real world. I want to quote back to the Ministers something she just said in her something she just said in her statement, because I know businesses in my local community who just want to be able to be a who just want to be able to be a cafe or a restaurant will be troubled by it.

She says that the guidance does not provide the right of members of the public to challenge one another on their sex and access to those spaces. But she also says where an individual is asked to confirm their sex, this should be done sensitively. Now, for most businesses, that will be deeply confusing as to whether or not somebody can or cannot be challenged. And frankly, what they don't want is fights between their customers. So to prevent that being people being judged by their appearance on their gender, which we know will harm many more people than I suspect, even those people who wish to see harm through this guidance would like.

Does she accept that for most businesses, getting rid of women's toilets altogether will probably be the the safest option to do? And won't that be an inevitable consequence of what this guidance does? Ministers.
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Charlotte Cane Portrait Charlotte Cane MP (Ely and East Cambridgeshire, Liberal Democrat)
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Charlotte Cane thank you, Madam Deputy Speaker. I've also had lots of trans people, their families and of trans people, their families and friends contacting me with genuine fear about the implications of of fear about the implications of of this this guidance. We've heard about the practicalities. I I've got someone who has cancelled a hip operation because they're not sure they will be treated with dignity when they go into hospital. I have people who are changing their pattern of work and, and travel and leisure because they can't be certain that they can use toilets unchallenged and therefore face extra risk of of violence.

But the thing that really comes through really strongly from all of them is the challenge. This is to their identity. Many of them have lived decades in their gender, and now they're going to have to think of telling their work colleagues, people who who think of them as that gender, because that's all they've ever known them as, they're potentially going to have to say, actually, I was born a different gender. So can you tell me how I

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can use the toilets, how I can use unacceptable? Order, order! The hon. Lady

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Order, order! The hon. Lady really does need to get to a question. She's spoken for nearly as long as her front bench now. Yes.

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as long as her front bench now. Yes. My question is, is the Ministers going to consider changing the law? So the Equality Act lives up to its

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So the Equality Act lives up to its name here. Madam Deputy Speaker, I the

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Madam Deputy Speaker, I the Equality Act, I believe, does live up to its name, and I'm proud of the Equality Act. I think what we
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James Murray Portrait Rt Hon James Murray MP, Secretary of State for Health and Social Care (Ealing North, Labour )
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Yes.

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Madam Deputy Speaker, like me, everyone across Britain will have their own story of the NHS or their their own story of the NHS or their view to share about its future. It is an achievement that we all share is an achievement that we all share together and one that is personal for us all. My predecessor as Health Secretary, my right hon. Health Secretary, my right hon. Friend the Member for Ilford North, has spoken movingly about the importance of the NHS to him.

He importance of the NHS to him. He explained how it saved his life when he was diagnosed with kidney cancer at the age of 38, and how, amidst all his worries, the one thing he never had to worry about was how much this treatment might cost. Let me pay tribute to what my right hon. Friend did in the role before me as a great champion of patients everywhere, and as someone with a huge passion for building a modern NHS, something we can see in this bill which he and my hon.

Friend the Member for Bristol South put so much energy into. Madam Deputy Speaker, as a former Chief Secretary and Exchequer Secretary before that, let me also say how incredibly proud I have been to support my right hon. Friend the Chancellor, in her determination to take the right decisions on the public finances to enable record investment in our National Health Service. Madam Deputy Speaker, thanks to that investment and the changes that we as a government have begun to make, leadership at the Department of Health and Social Care and NHS England, and, of course, the incredible work of frontline staff across the NHS.

I take on this role as Secretary of State just under two years into this Labour government, with over half a million fewer people on the waiting list, 2000 more GPS, 8500 more mental health workers, 4 in 5 patients seen within four hours in A&E, over 100 community diagnostic centres now open in the evening and weekends, and over 240 000 more people getting their cancer tests on time. That is the difference that this Labour government is making and NHS, where more patients get the treatment they need when they need it, and where taxpayers get better value for money.

I'll

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give way. Some achievements. And some. Progress being made within the NHS. Can I bring him back to one particular issue? When it comes to cancer treatment, 53% of cancer patients, according to OECD figures, patients, according to OECD figures, should receive radiotherapy as their primary treatment. In the UK, their primary treatment. In the UK, it is only 35%. In Cumbria and Lancashire it is only 29%. This is Lancashire it is only 29%. This is delaying treatment, delaying cures and it prevents people living longer lives they could do.

Will you take a personal interest in correcting the commissioning, so that every single part of this country has access to radiotherapy, close to where people live, so

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people can be cured with the most up to date technology. Yeah. Well, I thank the right hon.

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Well, I thank the right hon. Gentleman for his intervention, and he's absolutely right to draw attention to the importance of having the right approach to cancer. having the right approach to cancer. And our national cancer plan sets out what we, as a government are doing to achieve that. He's also right, I think, to point to the regional variation and the variation between different parts of the country and how important it of the country and how important it is to us, not just to raise standards across the country, but to make sure that increase in standards is evenly distributed so that all areas improve.

One of my roles as Secretary of State is to make sure that not only we deliver our national cancer plan, but also that we support local areas to make sure they have the right services

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and local areas to. Take a further intervention. I will. Congratulate him on his excellent speech and the work of the Member for Bristol South in developing the bill. And could I also just ask about Healthwatch? also just ask about Healthwatch? Healthwatch Haringey plays an enormously important role in being a champion for the ecosystem within a champion for the ecosystem within a locality. The Local Government Association is very concerned about some of the discussions. Would he some of the discussions.

Would he give me his reassurance that as the bill passes through the House, this area of how we do the NHS, as well as what we do, will be really integral part so that everybody can

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feel included in its NHS. Thank you. Well, I thank my hon. Friend for her intervention, and I can her intervention, and I can reassure her that what the Bill seeks to achieve in terms of local health watches across the country health watches across the country is to bring the voice of patients closer to those people who are planning and delivering services, planning and delivering services, because I think too often, too often, Madam Deputy Speaker, we've seen action not following feedback seen action not following feedback that is given.

We need to make sure that's integrated into those planning and delivering services so that patient voices are heard. Now, Madam Deputy Speaker, I set out some achievements of this Labour government less than two years into office, and what that shows to me is that decline is not inevitable. Our determination to deliver on what people voted for is making a real difference. We have started to make progress and we are building an NHS that is fit for the future. Madam Deputy Speaker, Labour's choice in government has been and will always be to strengthen and improve the NHS as a service that is universal, publicly funded and with use based on need, not on ability to pay.

That choice is one backed by people across Britain. Yet for the first time in a generation, some members of this House are openly calling for the NHS founding principles to be abandoned. The hon. Member for Clacton, who I note is not in his place, has made clear it never is. Good point. The hon. Member for Clacton. The hon. Member for Clacton, has made it clear, Madam Deputy Speaker, time and again that he would tear up the principles of the NHS to shreds and bring in an insurance based system that would benefit only his friends in finance.

Be in no doubt, Madam Deputy Speaker, Reform would sell our health service to the highest bidder. That would be a devastating mistake and we must not let it happen. Instead of turning our backs on the principles that the NHS was founded on, as some members opposite would have us do, I will fight every day as health and social care secretary, to build the modern health service that our

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country demands, and that patients deserve. We. I'm for giving way and I welcome

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I'm for giving way and I welcome him to his place as Secretary of State. He's spoken about two themes the scale of the ambition of this bill and the need for patient voice bill and the need for patient voice to be at the heart of it, given how closely all of our constituents closely all of our constituents care about the NHS. In the case of Healthwatch, can he reassure the House that bringing the scrutiny of House that bringing the scrutiny of local voices up to the level of the Secretary of State will not diminish the independence of local health watches in Oxfordshire and elsewhere, which do so much to bring patient voice and hold the NHS to account for its services

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here. I thank the hon. Gentleman for his intervention and for his words about me taking on this post, and I can reassure him that, as I'll get to later in my speech, what the to later in my speech, what the Bill sets out to do is to integrate national Healthwatch into the Department of Health and Social Care through a new Patient Care through a new Patient Experience Directorate and for local local health watches. Integrate them into icbs and local authorities who are responsible for delivering health and care at a local level.

So what this is about, Madam Deputy Speaker, is making sure that patient voices at a national and local level are closer to those who are deciding on and delivering services. So those voices are heard. I will give way

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one more time to make some progress. Just on that point, I think. Can the Ministers confirm that at the heart of this bill is about modernising the NHS and reducing inequalities across this country, and because my constituency has the third lowest healthy life third lowest healthy life expectancy in the UK, which is shocking, my constituents are going to benefit from this bill and all

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to benefit from this bill and all the action on inequality that it intends to deliver. Hear, hear. Well, my hon. Friend is

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Well, my hon. Friend is absolutely right that this bill is about modernising the NHS, because as a Labour Party, as a government, our priority is to boost investment and to modernise the NHS for the future. And it is exactly that combination of investment and reform that will deliver the health service that her constituents need and deserve. Now, Madam Deputy Speaker, I will make a little I will make a little bit one more

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time. Then I will make progress one more time. First of all, can I welcome the Secretary of State to his place? I Secretary of State to his place? I wish him well in the role he now takes on. I'm very pleased to see that he's experienced the NHS at that he's experienced the NHS at its best. I'm glad to hear that government has called for a duty of candour, so government must ensure that there is still. That is still that there is still.

That is still possible. The decision to scrap the independent body. I make this point. Healthwatch and the Health Service Healthwatch and the Health Service CFA investigation body risks sentencing the patient voice, so there is a need to be careful. Can the Secretary of State ensure us or assure us that that will be one of the things that government is

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taking on board in this bill. Thank you. OK. Thank. Well, I thank the hon. Gentleman for his intervention. And he raises for his intervention. And he raises questions relating to Healthwatch and also to HSSIB being integrated into the CQC. I'll set out some more detail in a few moments in relation to those questions, but fundamentally, they derive from fundamentally, they derive from conclusions arrived at by doctor Penny, who did a review into the patient safety landscape. Her patient safety landscape.

Her review found that the landscape is too full of different organisations, where it's unclear how the impact has had on the services which are provided to patients. And what we seek to achieve through this bill is to simplify that landscape, make sure that patients voices are heard closer to decision makers and improve the NHS for everyone across the country. Madam Deputy Speaker, I'll make some progress, if I may, because, as I've said, for me, the way to build on the progress of the past two years is not just to maintain the improvement in performance we have seen, but also to accelerate our fundamental transformation and modernisation of the NHS.

As Health Secretary, I am absolutely focussed on delivery, putting the values that all of us in the Labour Party share into action and, crucially, I am determined to make sure that we benefit from the fullest possible use of technology, digitisation and AI to renew the NHS for the future. These changes. Madam Deputy Speaker in technology, digitisation and AI are not an add on to the NHS core business, with a determined focus on driving innovation at every level and the confidence to reimagine our approach to the nation's health for the modern world, they offer us the chance to transform the way the NHS works.

They will improve the speed of diagnosis, helping people to get the right treatment much more quickly than they do today. They will. I'm going to make some progress if I'm if I may, they will streamline tasks for NHS staff, freeing them from admin and bureaucracy to focus their energy on caring for patients. They will transform the experience we all have as patients, giving us control and reducing our anxiety over the care we receive, and they will reduce the costs of delivering healthcare so that more of the money we spend goes to the front line where it belongs.

That is the future we must build. Madam Deputy Speaker, and the road to that future runs through this bill. Now, Madam Deputy Speaker, for many years, patient groups have warned about the pitfalls and shortcomings of fragmented information systems in the NHS. And they are absolutely right. Right now, information in the NHS tends to follow the institution, not the individual. That is why we all know the familiar frustration of having to repeat the same story over and over again, every time in front of a new nurse, doctor or consultant.

And the reason for this is that too often no one can see a full summary of a patient's medical record in one place, including the patient themselves. These patchy care records are not just an inconvenience or a source of anxiety and distress. They can also be a risk to patient safety. I'll

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give way. I thank the Ministers for giving way and I welcome him to his place. Hinchingbrooke hospital, in my Hinchingbrooke hospital, in my Huntingdon constituency, is one of the new hospitals that's going to be built as part of the new hospital programme, and it's in hospital programme, and it's in wave zero, but it currently doesn't have an electronic patient record system. So we have that same fragmented patient history that he fragmented patient history that he was just referring to. It desperately needs to increase its rating on the Him scale as part of the new hospital, but it doesn't the new hospital, but it doesn't have the funding required to install that patient record system.

Would he guarantee that the hospital will receive the funding

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required to deliver a new electronic patient record system? Secretary of State. I thank the hon. Gentleman for

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I thank the hon. Gentleman for his intervention, and I'm happy to look into the specific circumstances he referred to and get back to him. But more widely, Madam Deputy Speaker, the investment is secured within the government for implementing the single patient record system across government. And what this will what this what this will mean is that this what this will mean is that rather than data being transferred from where it exists at the moment to a new system, it will remain where it is.

So in GP surgeries, hospitals and so on. But it will be linked up so that one person, including the patient themselves, can seal that data from the middle of the the network of information I'm going to make, I'm going to

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make I'll give away one. Yes. Thank you. Specifically on. The single.

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Specifically on. The single. Patient record, the explanatory. Note says it will allow patient information to be shared with patients and their relevant health patients and their relevant health and social care providers such as GPS, hospital doctors, social care workers and others involved with.

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workers and others involved with. Direct care. By my maths, that's probably going to be a couple of million people. So could the million people. So could the Ministers please talk about how safeguards were implemented, particularly for children's care

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data? Well, I thank my hon. Friend for raising the very important question raising the very important question about data privacy and security. I'll address that in a moment in my speech, because I'm going to set speech, because I'm going to set out some of the protections in the single patient record approach that we're taking, which I think will fulfil exactly the questions that fulfil exactly the questions that she raises. I'm going to make a bit of progress, Madam Deputy Speaker, because I'm conscious of time.

But as I've said, these patchy records as I've said, these patchy records which exist at the moment, Madam Deputy Speaker, are not just an annoyance or a source of anxiety or distress. They can also be a risk to patient safety in other areas of our lives, getting the information wrong or not having it immediately available might be an inconvenience, but in a health service, the consequences can be profound. What happens to the patient rushed to A&E with complex conditions that require multiple medications, yet the emergency team have no way of knowing that what happened to do the dementia patient, who cannot keep track of all the different documents from all the different specialists in all the different providers in today's NHS, the GP or practice nurse at the clinic, the paramedics stepping through your front door and the consultant at your bedside are doing everything they can to try and solve a puzzle.

But without all the pieces, this bill will change that. It will do so by introducing a new approach the single patient record. And this is nothing short of a game changer. Yes.

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Well, I. I thank my. Right hon. Friend very much for giving way. I congratulate him on giving way. I congratulate him on his new position and my committee, the science, Innovation and Technology Select Committee, will Technology Select Committee, will on Wednesday publish its report on the government's digital ambitions, and he will not be surprised to know we will be raising serious know we will be raising serious concerns about data management, data hygiene and vendor locking. data hygiene and vendor locking.

Many projects, like the single patient record, have failed over the last 20 years. So could you confirm this to to me that he will be ensuring that patients have can control when and how their data is seen that he will be building on existing records like the Great North Care record, and that he will this will be treated as critical national and sovereign infrastructure and not subject to being to being captured by a single provider like Palantir.

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Well, I thank my hon. Friend for her intervention, and she's absolutely right to underscore the absolutely right to underscore the importance of data security and data privacy, and that's essential in building trust for what we're in building trust for what we're seeking to do to to be clear, Madam Deputy Speaker, the single patient record, as I was just saying a moment ago in response to the moment ago in response to the gentleman opposite, doesn't move data from one system to another. It preserves the data where it is, but builds links between it so that one person, whether that's their clinician or a patient, can see all of that data at once.

So the data will still be governed by the same privacy policies on a GP system, in a hospital trust system, and so on. And when linked together through the single patient record, it will be governed by the highest levels of security, where only authorised individuals will be able to access that data, and there will be an audit trail of anyone who has and of course, the cyber security protection will be the strongest available as well. And I'll give way to Hugh.

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I really appreciate you giving way on that point. Ministers. So way on that point. Ministers. So this morning on radio four, you failed to rule out, sorry. failed to rule out, sorry. Ministers fail to rule out Palantir being awarded the single patient being awarded the single patient record. We know that the 330 million offered to them for the current federated data has been current federated data has been highly criticised by unions and the BMA. So what assurances can you actually give us that patient safety will be free from abuse and

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misuse? Well, Madam Deputy Speaker, as my hon. Friend will have heard as my hon. Friend will have heard as she listened to the rest of my interview on radio four this morning. The the situation with the single patient record is very different than the Federated Data platform, because it is likely that we will let a series of contracts we will let a series of contracts to de-risk the delivery of the single patient record. The situation with Palantir is that it's.

The contract for the Federated Data platform is, as I'm sure she knows, being reviewed ahead of a potential break clause in 2027. But the situation with the single patient record is a very different setup, whereby, as I said a couple of times now, information is stored on the individual systems in GPS and hospitals and so on. The single patient record links them up and will be delivered through a range of different contracts to make sure that system works in the interests of clinicians and patients, because, Madam Deputy Speaker, the single patient record will mean that wherever a patient is being treated, even if they are going to make some progress, the single patient record will mean that wherever a patient is being treated, even if they are not at a local GP or if they are in a hospital that they have never been to before, those caring for them will have access to all the accurate, relevant, up to date information they need.

Through this new approach, we will bring together people's health and social care records digitally, securely and conveniently and available to patients on the NHS app. Now. Madam Deputy Speaker, a number a number of a number of members have raised questions about data privacy. And let me just be very clear to this point, patients rightly expect that their highly personal and sensitive medical details are protected and they will be, under our plans, strict safeguards, strong cyber security and clear controls on who can read information will be backed by an audit trail of who has accessed what.

The single patient record will also be subject to existing forms of scrutiny and oversight in the NHS, from data protection officers to legislative safeguards, and where the single patient record is being used for research or planning, it will be treated the same as all other sensitive health data, subject to the same legal protections, ethical

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approvals and governance. On that point, he is making himself the data controller of all himself the data controller of all the data that's going to be in place. How does that impact on the

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sections he's just talked about? And I thank the hon. Gentleman for his intervention. But when the for his intervention. But when the data is held, for instance, by a GP surgery or by an NHS hospital trust, surgery or by an NHS hospital trust, the relevant bodies will remain the information controllers, where that information is then shared through the single patient record. The Department for health, the Secretary of State will take on a role as data controller as well, but this will all be governed in the way that data protection currently applies across the NHS through existing forms of data security.

But Madam Deputy Speaker, fundamentally what will happen is that it will re-orientate the NHS to be a service that revolves around patients, rather than patients, having to revolve around the NHS.

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Poole to my right hon. Friend for giving way just before he moves away from single patient record, away from single patient record, can I highlight the remaining challenge that we have in cross-border communities like mine cross-border communities like mine in Cumbria, where my constituents in Carlisle quite often will be registered with a GP across the registered with a GP across the border in Scotland. So unfortunately, at present it does mean that their single patient record won't necessarily flow with record won't necessarily flow with them.

Could I ask him to work at pace with his colleagues in Scotland and indeed Wales? As my colleague nodded in front of me, to ensure that we get this right for anyone, regardless of where they

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live. Well, I thank my hon. Friend for her question. And while she's her question. And while she's absolutely right that this project, the single patient record, applies to the NHS in England, my colleagues in the ministerial team colleagues in the ministerial team have regular conversations with our counterparts in Scotland and in other devolved governments to make sure that we are working at those

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cross-border issues wherever we can. Madam Deputy Speaker, I will give it one more time, and then. I thank the Ministers for giving way. Does he agree with me that the introduction of the single patient record will be a huge step forward in the safe treatment of people with allergies? And will he join me in calling on the new Ministers in the Plaid Cymru government in Wales, in urging them to follow our lead for the betterment of the treatment of allergy care for people in Wales.

Hey.

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I thank my hon. Friend very much for her question, and I would very much join her in urging the new much join her in urging the new Health Ministers in Wales to follow our lead and introduce a way that patients can access the data and, patients can access the data and, crucially, that clinicians can see all of the patient's data when taking those decisions. Because taking those decisions. Because with complex cases, when people see multiple different nurses, doctors, multiple different nurses, doctors, consultants and so on, it can be crucial that clinicians can see all the relevant information when making choices about how to treat their patients.

So I thank my hon. Friend very much for her question. Madam Speaker, I should make some progress. As I know there are many members who want to speak this evening. I'm getting a nod from you, Madam Deputy Speaker. That's the right thing to be doing. And, Madam Deputy Speaker, as I've set out how the single patient record will help improve patient safety, I also want to be clear that no government should ever pretend that things do not go wrong. It is crucial that when they do, the right systems are in place to hold people accountable and to make sure that we learn from the mistakes to prevent them from happening again.

As I mentioned earlier, doctor Penny Dash conducted an independent review into the patient safety landscape, and what she found was a confusing landscape of multiple overlapping organisations which are responsible for patient safety in the NHS, making it harder for for staff and organisations to do the right thing. And that is why this bill simplifies the patient safety landscape, streamlining and consolidating functions, making the system more effective and efficient and restoring patient confidence. I'm going to make some progress following Doctor Dash's recommendations.

This bill will embed the mission and functions of the Health Services Safety Investigations body into the Care Quality Commission to establish a clearer link between investigating safety concerns and increasing the quality of care. We will make sure that we protect the principle of a safe space for people to share their concerns and to make sure that patients are heard at every stage, from commissioning to delivery. We will make sure that

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patient feedback is embedded alongside decision makers at every level. Bernard Jenkin Secretary.

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Bernard Jenkin Secretary. State for giving way and I congratulate him on his appointment, but he's inherited this policy. but he's inherited this policy. It's not his own. And can I assure him that the abolition of HRC is a him that the abolition of HRC is a dreadful mistake? Because which other investigative function in the other investigative function in the health care system is completely unconflicted in what it does and by by abolishing HRC, he's taking EHCPs functions into CQC, which is a regulator and compliance enforcer, not an investigator, so that there is no longer any independent unconflicted body conducting healthcare investigations.

And has he consulted the Royal Colleges about this? Because I have not spoken to a single Royal College that is in favour of the abolition of. Yeah, yeah. Madam Deputy Speaker, as I made clear, we will protect the principle of a safe space for people to share their concerns, and the investigatory function will remain protected within the CQC. What the benefit will be of embedding the SIB into the CQC will be to establish that clearer link between investigating safety concerns and increasing the quality of care, and that is something that we can all agree with.

I'm going to make some progress because, Madam Deputy Speaker, you've asked me and looked at me several times suggesting that is what I should do. Madam Deputy Speaker, I've mentioned the changes the bill makes to EHCP and the CQC, but also the functions of Healthwatch England, as I've spoken about earlier today, will move to a new patient experience directorate within the Department for health, and the functions of Local Healthwatch groups will be incorporated within Icbs and local authorities. This approach brings the voices of patients closer to decision makers, so that people will have a direct impact on the services they receive.

Of course, these changes will not fix everything at the stroke of a pen, nor will they take effect overnight. But rather than the voices of patients being kept at arm's length, this bill puts them where they should be, right at the heart of the NHS. I'll give way.

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I thank the. Secretary of State for giving way. The Secretary of State hasn't talked about the role of governors talked about the role of governors of hospital trusts, which do also appear to be being abolished in this. And so with the creation of Mega Icbs, the removal of Healthwatch and the removal of

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governors, I'm actually worried that the voice of local communities is reducing rather than increasing. Yeah, yeah.

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Yeah, yeah. And I thank the hon. Lady for her intervention. But the principle behind our changes to local health watches is to bring the voice of patients closer to those people who are planning and delivering services, whether through icbs or through local authorities for health and care, respectively. That's a really important principle to make sure that feedback is followed by action, and that people can have an influence on the design and delivery of health and social care at an earlier stage in the process.

Now I'm going to make some progress, Madam Deputy Speaker, because I need to update the House about the important measures in this bill to abolish NHS England, which are a critical measure that we are taking and which will reduce bureaucracy so that more energy, time and funding in the NHS can be focussed on the front line helping patients. This Bill will abolish the world's largest quango by merging NHS England into the Department for Health and Social Care, and the wider NHS system. As

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hon. Members, I will give way. Hon. Gentleman, for. Giving way, and I've asked this

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Giving way, and I've asked this question both as a member of the Health Select Committee and on the floor of this, the floor of this chamber to his predecessor. So chamber to his predecessor. So given he's a numbers man, I hope he can answer it where his predecessor couldn't. How much in redundancy couldn't. How much in redundancy costs is this going to cost the British taxpayer? And can he confirm that no person employed by confirm that no person employed by NHS England currently will be fired, paid redundancy fee and then

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rehired by the Department of Health? Well, Madam Deputy Speaker, as I'm sure the hon. Gentleman will appreciate, the process is one that we're going through with the workforces at NHS England and the workforces at NHS England and the Department of Health and Social Care. But crucially, Madam Deputy Speaker, by 2028, across the Speaker, by 2028, across the Department of Health and Social Care, NHS England and Icbs, we will see a 50% reduction in headcount, which means that that money, which would otherwise be spent on those members of staff, will now go towards healthcare on the front line, which is what patients want to see.

Madam Deputy Speaker, As hon. Members will know, NHS England was established by the Health and Social Care Act 2012. This act established more than 300 new NHS organisations and it has led to too much time, money and effort being wasted on overlapping processes. Too much time, money and effort wasted as good people tried to navigate a labyrinthine system that holds them back for delivering for patients. In short, we have a system that gets in the way of what staff, patients and taxpayers want to see.

I will give way.

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Wendy Morton from him to his new role as the Secretary of State for health. I just want to pick up on health. I just want to pick up on the point of icbs, though, and devolution, the devolution of responsibility for NHS eye tests, responsibility for NHS eye tests, something which often I think we forget to talk about in this place and and I, I care. I know there are some experts in here, but just on some experts in here, but just on that point, can he assure me that in the changes it won't result in a postcode lottery when it comes to eye care tests? Because at the end of the day, Madam Deputy chairman, speaker, NHS sight tests are a universal settlement.

So can he make entitlement? Can he ensure

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that will continue? Well, Madam Deputy Speaker, the

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Well, Madam Deputy Speaker, the hon. Lady raises an important point, but obviously local services already commissioned locally in already commissioned locally in many cases, and the changes we're making by abolishing NHS England making by abolishing NHS England will mean that more power, more resources, go to icbs and local areas to make the right choices. areas to make the right choices. They make the right choices for their local area, and that is a way of bringing services that we deliver closer to the people who need them.

But Madam Deputy Speaker, let me be absolutely clear that in abolishing NHS England, this is in no way a reflection on the committed public servants who work at NHS England and in my department. The truth is that unnecessary structures are getting in their way, getting in the way of them doing their crucial work, and it is time for us to change that. This bill will mean that more time, money and effort will be spent on improving the the care that patients receive, rather than navigating the system around them.

I will give way.

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I thank the Secretary of State for giving way. Obviously, he's just outlined a huge raft of changes that are coming with the abolition of NHS and everything else that goes with it. Last year, else that goes with it. Last year, people, families and MPs got the inquiry into tube, the mental health trust that had been failing in the north of England. My worry in the north of England. My worry is, is that we were meant to have a chair of that inquiry already in place.

Will that now be lost amidst place. Will that now be lost amidst all this changes to the health care system, and will he commit to meet with the families of those affected by the tube scandal and get a chair in place as soon as possible? Yes.

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I thank the hon. Gentleman for his intervention, and I'm happy to look into the case that he look into the case that he references the change that we are undertaking with abolishing NHS England and transferring responsibilities to the Department responsibilities to the Department for health or to local Icbs is one that we're managing very carefully to ensure that we can continue to ensure that we can continue making progress whilst that structural change is is happening. But I go back to my earlier point, But I go back to my earlier point, Madam Deputy Speaker, that the amount of money saved through these changes can go directly into frontline patient care.

We expect around £1 billion to be saved, which is 15,000 nurses, and I don't see how anyone can disagree with our decision to make sure resources are spent on the front line. Madam Deputy Speaker, as I've explained, abolishing NHS England as a separate organisation will strip out bureaucracy and make sure we focus on delivery. But this decision also has an important democratic role. The core goal of the Conservatives and Lib Dems Act in 2012 was to take politics out of the day to day running of the NHS, but that is a fundamental misunderstanding of the NHS and its place in the democratic life of the nation.

The public pays for the NHS, they own it, they use it, they care deeply about its future. And so they should always have a say in how it is run. People voted Labour because they trust us to build on our party's legacy by transforming the NHS for the future, and they will rightly hold us responsible for the decisions we take as we do so. This is not about politics getting in the way. It is about accountability, driving change. That accountability has been lost in the confusion of having two separate centres for the NHS, and this Bill will end I'll give it one more time.

Giving welcome to his post as Secretary of State. Could you explain what the pathway of local accountability is for Icbs. Secretaries of State. Icbs and as the hon. Gentleman will know, have a board structure which oversees how they operate and the and the removal of local health watches will mean that the more patient experience and patient voice goes directly into the bodies, which are commissioning and overseeing services. One of the changes this bill makes is to make sure that strategic mayoral authorities will have a place on the board for Icbs, which helps them to ensure we are aligning wider objectives in an area with health.

Madam Deputy Speaker, I'm going to make a bit more progress now because, alongside the removal of confusion and duplication at a national level, this bill will also give those with local expertise the power, resources and flexibility they need to design and deliver health and care services for their area. This bill will empower them to innovate, drive progress and do what is in the best interests of the patients they serve. Under this bill, Icbs will have more direct responsibility for their services than ever before.

They will be at the heart of integrating health and social care, and they will include those people responsible for housing, transport and jobs so we can tackle the root causes of ill health. That is better for patients and better for the NHS. Yes, Madam Deputy Speaker, the NHS gave me a second chance at life and so, as Health Secretary, I will fight for the NHS every single day with the strength it has given me back. The Tories ran down the NHS through 14 years of neglect and the Lib Dems enabled them.

Reform want to abolish the NHS altogether and replace it with an insurance based system. The Greens seem intent to ignore clinical advice and they have no practical solutions for the health service. Only Labour has a plan to get the NHS back on its feet. Only Labour is determined to both invest in the NHS and to fundamentally transform the NHS for the future. Only Labour is showing that change is possible. We promised to cut waiting lists and we have delivered the biggest annual fall in 16 years.

We promised an extra 1000 GPS in our first year. We delivered twice that number. We promised 8500 more mental health staff by 2029. We have delivered them three years early. We promised 700,000 more NHS dentistry appointments. We have delivered an extra 1.8 million already. We promised to transform the NHS for the future and that is what this bill will do. We are already boosting investment in the NHS where it needs more. We have begun stripping out bureaucracy from the NHS where it needs less.

And now we will build a truly modern NHS that will be there for generations to come. This bill is the next crucial step in our mission, and I commend it to the House.

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The question is that the bill be now read a second time. I shall call Shadow Secretary of State

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call Shadow Secretary of State Stuart Andrew. Thank you very much, Madam Deputy Speaker. And can I begin by Deputy Speaker. And can I begin by welcoming the Secretary of State to his new post? And also sharing is his new post? And also sharing is very personal story about what the NHS means to him, and I look NHS means to him, and I look forward to our future exchanges, however long he may be there, of course. And may I also pay tribute to.

May I also pay tribute to the former Health Secretary. We've had a few moments across the. The despatch box, and I know that it's been. The NHS has equally been very important to him personally. During my time in hospices I saw the incredible work that NHS does and I think despite the politics that we may have. And I will be referring to the right hon. Gentleman a bit more later on. We. I think we all
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Stuart Andrew Portrait Rt Hon Stuart Andrew MP (Daventry, Conservative)
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deeply care about the National Health Service and want the very best for it. Now, Madam Deputy best for it. Now, Madam Deputy Speaker, there are moments in politics when one almost has to politics when one almost has to admire the confidence of governments, not their competence necessarily, and not their judgement, and certainly sometimes not their timing, but certainly their confidence. And nowhere has the confidence that confidence been more magnificently displayed than in the presentation of this health bill.

Because if one had listened carefully to the former Secretary of State for Health and Social Care over the past two years, one could only conclude that this bill was not merely legislation. No, Madam Deputy Speaker, this bill was apparently the parliamentary equivalent of the Second Coming. Every speech, every interview, every carefully staged hospital visit with sleeves rolled up, the same message. At last, at long last, the NHS was to be modernised, integrated, digitised, streamlined, revolutionised and transformed into a gleaming technological marvel where patients floated frictionlessly through a system powered entirely by innovation, efficiency and ministerial self-belief.

Now, I say gently to Ministers whenever a politician begins using the phrase once in a generation change on such a regular basis, it is usually wise to place one's hand protectively over one's wallet at the sheer cost of what is to follow. Because what became increasingly striking was not simply the scale of the promises, but the sheer showmanship of them. The former health secretary spoke less like a Cabinet Ministers, wrestling with one of the most complex public services in the world, and more like a man auditioning to narrate the trailer for his own leadership campaign documentary.

And now, Mr. Speaker, Madam Deputy Speaker, we arrive at the great political twist. The man who spent two years announcing the future has departed before the delivery date arrived. Like an architect unveiling magnificent

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blueprints before quietly moving began. The future, once.

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The future, once. And into this situation walks the new health secretary. He wasn't.

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He wasn't. You can imagine the scene. The Prime Minister sits stubbornly in number ten, grinning with all the reassuring confidence of a man standing knee deep in a flooded rowing boat, insisting the situation merely requires a modest redistribution of water. Into this bunker is summoned. The new Secretary of State, formerly the Chief Secretary to the Treasury, the very man who helped allocate the famous £202 billion funding settlement, now repeatedly cited as proof that every problem in British health care has theoretically

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already been solved. Of course. Thank you very much. I wouldn't

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Thank you very much. I wouldn't give your political adviser a raise just yet for those speech writing qualities, but why do you think

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qualities, but why do you think we're having to talk about once in a generation change to the NHS? Yeah, very.

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Yeah, very. Good point, the hon. Member to how the NHS was being run in Wales certainly was not the great success that she's trying to allude to now. Madam Deputy Speaker, there are difficult jobs in politics. There are impossible jobs, and then there is inheriting a department after your predecessor has spent two years promising the electorate that this is the one bill to rule all bills, to fix virtually everything short of death itself. This was not a hospital pass.

This was a hospital pass delivered by catapult. And you can almost hear the poor Secretary of State gulping. Thank you, Prime Minister, he replies faintly in the tone of a man accepting command of the Titanic after it's already struck the iceberg. Now off. He trudges. Off. He trudges to the Department for Health and Social Care. The automatic doors open, and immediately his nostrils are struck by a strange, lingering aroma, not the scent of modernisation, nor the smell of efficiency, certainly not the fragrance of falling waiting lists.

No, Madam Deputy Speaker, it is the unmistakeable odour of political panic, mixed delicately with the perspiration of failed leadership manoeuvres and lightly seasoned with ashes, ashes of abandoned promises. And they're waiting for him, naturally, is Sir Humphrey, because however much governments modernise, digitise, integrate, recalibrate or synergize, Whitehall always produces a Sir Humphrey. So I can imagine the conversation. The new Secretary of State says brightly. Good news, Sir Humphrey. I understand my predecessor has already solved everything through the health bill.

At this point, an eerie silence descends. Civil servants suddenly become more fascinated by ceiling tiles. One junior official attempts to escape through a stationery cupboard, and Sir Humphrey clears his throat in the way only permanent secretaries can. A sound rather like an early give me time, give me time, will indeed, Ministers. And I understand, sir, the Secretary of State, that abolishing NHS England will instantly reduce bureaucracy, improve accountability and unleash vast efficiencies will Ministers. It will certainly create a large number of meetings, and the single patient record will revolutionise healthcare, won't it? Yes, Ministers.

Assuming the NHS IT systems eventually stop communicating with each other via what appears to be medieval semaphore. But we have delivered 5 million more appointments as the Secretary of State. Certainly Ministers only 1.5 million appointments behind the last conservative government and integrated care boards now directly answering to Ministers. Yes, Ministers. So accountability is now indisputable. Well, Ministers blame certainly is. And so the conversation goes on. He then says, and what about the workforce plan still developing Ministers and social care still delayed Ministers and mental health implementation still proceeding at approximately the speed of continental drift and pharmacies still under pressure, and GP contracts still alarming GPS and productivity, he says desperately.

At present, Ministers the NHS measures productivity in the same way ancient Greece. Astronomers measured distant planets with great optimism and very limited visibility. At this point, the health secretary clearly begins searching the office for the exit map. But Sir Humphrey, he says, surely my predecessor left me with a fully deliverable programme, at which a long pause. He replies, well, your predecessor was primarily focussed on a different pathway. A different pathway, yes, the pathway to number ten and I give way.



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Thank you, Madam Deputy Speaker. I'm sure that sounded really good in the mirror when he. But can I in the mirror when he. But can I bring him back to the real world where the permanent Secretary is in fact, a woman and an outstanding fact, a woman and an outstanding leader at that? In the real world, I am able to say something that not I am able to say something that not a single one of my conservative predecessors was able to say when they left my office, which is, I they left my office, which is, I left the NHS in a better state than I found it.

Why is he so determined to defend the bloated bureaucracy his party created over 14 failed

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years? Yes. Well, Madam Deputy Speaker, let

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Well, Madam Deputy Speaker, let me say to him, let me directly, directly to him. There's been a lot of announcements from the government. We know, for example, that the fall in the waiting lists, that the fall in the waiting lists, not just comments from us in this chamber challenging what's really happening, patients being taken off happening, patients being taken off the list, sometimes without their knowledge. We are receiving emails after email after email from people who have been taken off waiting lists because they still need the treatment.

This has not been about more appointments for patients. It's about massaging the figures and he knows it now. Madam Deputy Speaker, I know that there's a lot in this bill that actually we will support. There's a lot in the bill where we would like them, perhaps to go further. But there is a rhetoric here that needs to be addressed because there are unresolved problems. Still, social care is unresolved, workforce pressures are unresolved, mental health backlogs are unresolved, productivity is unresolved, pharmacy pressures are unresolved, and GP satisfaction are unresolved.

This is not just about an apartment, a department that he is inheriting, but an expectations crisis. Because the greatest danger in politics is not under-promising. It is convincing the public that complexity itself can be announced away. Now, when we look at this bill, yes, it abolishes NHS England. It centralises significant powers to be governed by the Secretary of State. It takes control out of

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patients hands and I'll give way. To say that there's a lot of

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To say that there's a lot of principle to be looking forward in relation to this Bill, and we must recognise that. But. And the recognise that. But. And the cutting of red tape. But the the shadow Ministers mentioned accountability. Does he feel that accountability. Does he feel that the accountability is in the process to ensure that the Bill must resist unchecked state control, must resist unchecked state control, and will that be part of the bill as going forward?

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These are exactly the points. I think the hon. Gentleman raises a very important point, and these are exactly the points that will need exactly the points that will need further scrutiny in committee. There is accountability. I note There is accountability. I note local authorities will not have the same seat at the table, but where same seat at the table, but where there that will be transferred for mayoral regions. But what if your region doesn't have a mayor that is region doesn't have a mayor that is going to create a real deficit in democracy in the NHS? And I do hope that this is something we can look at in further detail in committee, because I do believe there is a serious oversight there that absolutely needs addressing.



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Just on the point of of accountability and scrutiny, the fact that the government is looking fact that the government is looking to abolish or bring it into the CQC, the fact they're getting rid of Healthwatch in places like Surrey Healthwatch in places like Surrey and Hampshire that serve my constituency so well, the fact that they're getting rid of governors they're getting rid of governors off the boards of foundation trusts does seem to suggest that they haven't really thought the accountability through. And would accountability through.

And would not this be the occasion for the new Secretary of State to stamp his mark on this bill by actually conceding that some of these changes in the bill aren't actually what was intended, and this was his opportunity to actually give confidence back to the public that they will have accountability and

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scrutiny that they deserve. And raises a very important point. And I do think this is an point. And I do think this is an area that the committee are going to have to look at very, very carefully, because I listen carefully to what the Secretary of carefully to what the Secretary of State was saying, and I absolutely believe his, you know, his intention that he wants there to be a patient voice. But I believe there is a serious flaw with the there is a serious flaw with the bill in abolishing Healthwatch, certainly abolishing EHCP, I think, is a terrible mistake.

And I praise my right hon. Friend, for the work that he's been doing on this. The reality is that he gives members of staff who work in the NHS the confidence to come forward and be a whistleblower. We need that. We need people to feel they're in a safe environment. The CQC is a totally different beast in the minds of people who work within the NHS and social care. And so to put it within that organisation, I feel is a terrible mistake, and certainly one I hope the committee will look at very, very carefully.



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Before I thank. The Shadow Secretary. I thought he was giving an excellent speech, he was giving an excellent speech, but on on specific I commend I commend the speech writer. I'm sure commend the speech writer. I'm sure he wrote it himself on the point of accountability, though the Secretary of State spoke repeatedly about the devolving of powers. But actually what we're seeing in this act, in this bill is a massive power grab by the Secretary of power grab by the Secretary of State.

And actually, our constituents, who will be patients, won't be able to get that accountability that they ever so crave. Some of the reforms that we put in in 2022 gave them that accountability. Does he share that concern?

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I do I am genuinely concerned about this. I believe I mean, about this. I believe I mean, members of Parliament from across this House have often brought to this House have often brought to this House some very, very serious cases and of of perhaps things that have gone terribly wrong for their have gone terribly wrong for their constituents or services or services that are being commissioned in their area. And awful things have happened to patients. It is because of organisations like Healthwatch of and H SIB that we some of those issues have come to light and work has gone into improving those services.

That's what we all want to see and I'm really worried that that will be lost, you know, absorbing it into the Secretary of State's office. I don't I really don't think they're going to be able to cope with the sheer volume it needs to be on a much, much more localised basis. I give way to the hon. Gentleman.

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I thank the Shadow Secretary of State for raising that point, because if I read this right, I because if I read this right, I actually schedule the IT of the bill actually allows CQC actually bill actually allows CQC actually to carry out investigations into Northern Ireland and indeed Wales, where a CQC has actually no where a CQC has actually no presence or remit within Northern Ireland. And because it's devolved and those functions are carried out and those functions are carried out by the Rqia, so has the Shadow Secretary at any clarification as to regards how the Secretary of State is now reaching into devolved matters in regards to regulation,

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quality and improvement and assessment? Well. I would suggest that this is exactly some of the issues that are exactly some of the issues that are going to need to be ironed out, and I'm sure that the hon. Gentleman will make sure the committee is considering the impact for devolved administrations, particularly where they have responsibility, of course, for health in their areas. So I hope that he will raise that with

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hope that he will raise that with with members of the committee. Yes. Of course. Accountability. Thank the hon. Gentleman. So I worked in the Department of Health at the time that NHS England was created, and I've always been sceptical about this Lansley fantasy, that you could somehow make the NHS separate from the Department of Health and Social Care. I saw first hand man marking duplication of function. So this bill finally puts the nail in the coffin of those complex arrangements of masses of arms length bodies that was created by Andrew Lansley.

So will the hon. Gentleman please agree with me that this is the time to restore stronger democratic accountability

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for our NHS? Yeah. I would gently remind her that it wasn't me who said I didn't want it wasn't me who said I didn't want to go through another reorganisation. It was the former Secretary of State who said that he didn't want to do this because it didn't want to do this because it would be very costly, and we still can't get a clear answer about how can't get a clear answer about how much this is all going to cost the taxpayer.

There are estimates of £1 taxpayer. There are estimates of £1 billion that this will cost. So, you know, there is there are still some serious questions to be answered. And I know that, you know, the hon. Lady talks about democratic responsibility and accountability, and she's right to do that. She's fortunate that she. Well, it depends on your point of view, but it's she's fortunate that she may have a mayor, but in my constituency, in my county, I don't. So when my constituents are going to get a less of a voice in their

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NHS than her constituency constituents do in Shipley, that doesn't seem fair to me. Yes. Thank you very much. Thank the

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Thank you very much. Thank the hon. Gentleman for giving way. On the issue of accountability, does it not make sense that transferring it not make sense that transferring powers from an unelected quango to the Secretary of State, who is directly accountable to this very directly accountable to this very House, is in fact, increasing accountability in the NHS rather

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than diminishing it? When I'm talking about trying to get accountability down to the local area, that's where it matters. That's where my constituents want to see it, because they know that. They know their local services, they know their geography, they know the, the, the hospitals in their areas. And they're the ones that I want to see. Having those voices now. Oh, yes. Very quickly.

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I'm just grateful I'm giving way. I'm really glad that we're having this really important debate on accountability. Isn't there a accountability. Isn't there a danger that with the centralisation of this direction, powers the Secretary of State, that effectively it sort of gives a effectively it sort of gives a signal to MPs, don't engage with your ICB if you want to. If you your ICB if you want to. If you want to get changes to happen, go through the Secretary of State rather than local engagement, because that's where the powers are

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going to lie, as opposed to MPs having having accountability to local MPs. Don't worry.

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Yes. And and this is the bit that it is slightly patronising to that it is slightly patronising to say to someone, read the bill. I mean, clearly he has he's been talking about this in great detail. talking about this in great detail. There is a real concern here, and I do I do think we need some much do I do think we need some much clearer answers to these questions. These are questions that many of our constituents will have.

These are questions and concerns that many of those who who give of their time in organisations to make it a better NHS deserve decent answers to. And I certainly hope that that reflection will be will be taken now at the. At its heart, this Bill is not simply a debate about technology or bureaucracy, but about who does hold control and safeguards the most personal data any of us will ever possess. And this is one of the most significant reorganisations of the NHS in modern political history.

But it is wrapped carefully in a language of managerial simplification now, and perhaps part of it will help. And of course, some reforms are necessary. Conservatives are not afraid of reform, but definitely not. Indeed, if the NHS is to survive. Indeed, if the NHS is to survive the demographic, technological and fiscal pressures ahead, modernisation is essential because technology matters, innovation matters, integration matters, data matters, prevention matters, productivity matters. And yes, accountability matters too. And that is where where we see good work in this bill.

We will back it where we think there are questions that need to be drilled on. We will do so because we want to make sure that this bill works. But there is a difference between Modernisations that is rooted in political realism and announcements designed primarily for political theatre. And too much of the approach we've seen so far is Whitehall talking to itself. Meanwhile, outside of this chamber, reality continues uninterrupted because patients still wait, ambulances still queue outside A and E, the family still worries, the exhausted nurse still works double shift and the GP still battles impossible demands.

And because here is the truth, the NHS does not primarily suffer from a shortage of announcements. It is marked by, frankly, a persistent lack of grip and direction, and the government today increasingly resembles a man frantically changing labels on a filing Cabinet while the building itself quietly catches fire. Now, the government says that abolishing NHS England will reduce bureaucracy, and perhaps it will. But let's not forget that Whitehall sometimes possesses a remarkable historic talent for abolishing bureaucracy ceremonially, before quietly recreating them under another name with slightly different headed paper.

And we need to ensure that does not happen in this instance. And we also have to think about the huge amounts of money. Yes, nearly £202 billion of public money, an extraordinary sum of money. Now we understand pressures rise of of course we do. We understand ageing populations. We understand medical advance increases the costs, and we understand the aftershocks of the pandemic. But when a government spends record sums, whilst at the same time presiding over delays, workforce uncertainty, transformation, paralysis, productivity collapse and public frustration, then eventually the British public are entitled to ask a simple question where has all my money gone? Because the government is not judged by the size of the press release, it is judged by whether the thing actually works.

So now, Madam Deputy Speaker, we must make sure we do everything we can to deal with this and make sure that innovation makes sure that this bill goes through in the way that it needs to, with great scrutiny, because healthcare is difficult, trade offs are real, and workforce shortages cannot simply be rebranded into opportunities. Indeed, I think the public increasingly suspects something very different here. They suspect that too much modern politics has become performance without consequences and announcements without accountability, presentation without delivery.

And that is ultimately why this bill matters. Because if this enormous centralisation of power succeeds, Ministers will claim vindication. But if it fails, if bureaucracy persists, if waiting lists remain stubborn, if workforce pressures deepen, if promised, transformation dissolves into another cycle of reorganisation, then the government will no longer possess anyone else to blame. Not the NHS, England, not local structures, not quangos, not the system. Because this Bill places responsibility squarely where the government claims it belongs on the shoulders of Ministers.

And perhaps that honesty will prove the bill's greatest contribution, because the British people are patient, but they are not naive. They can distinguish between serious transformation and political choreography, and they increasingly understand that there is no technological shortcut around the fundamental challenge facing healthcare. You cannot run a service this large, this pressured and so deeply connected to people's lives and well-being, primarily through presentation. Eventually, every government collides with reality and reality, unlike leadership, campaigns cannot be managed through slogans that, Mr.

Speaker, is the inheritance facing the new Health Secretary. And that is why this House should approach this bill not with breathless excitement, but with very hard headed scrutiny indeed, so that we

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get the NHS we all want to see. Members will have noticed that we have around 50 members wanting we have around 50 members wanting to speak in the debate tonight. So with the exception of the front

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benches, I will be starting with an immediate six minute time limit. Andy McDonald thank you, Madam

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Andy McDonald thank you, Madam Deputy Speaker. May I begin by welcoming the Secretary of State to his place and wishing him well in his place and wishing him well in his responsibilities. He carries on behalf of patients, NHS staff and communities across the country. I welcome this Bill and its intention to improve patient care so investment, modernisation and better integration across the health service. It's also right to acknowledge the progress made on waiting times and waiting lists since Labour returned to government,
18:56
Andy McDonald Portrait Andy McDonald MP (Middlesbrough and Thornaby East, Labour)
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with the overall waiting list falling significantly and long waits continue to come down. But waits continue to come down. But could I also add my voice to others about the appointment of a chair for the Tees, Esk and River Valley for the Tees, Esk and River Valley inquiry? My right hon. Friend gave that a commitment which we were pleased to hear, but were yet to pleased to hear, but were yet to see that chair appointed so that could be given attention. We'd be most grateful.

But I also remain concerned about the continuing impact of historic PFI costs on NHS trust budgets, including the pressures facing South Tees Hospitals Trust. In my patch, too much money is still being diverted from front line care, and I regret that this issue remains unresolved. But the principal reason I rise today is as chair of the APPG on spinal cord injury. Last summer, the APPG inquiry into spinal cord injury services reached a clear conclusion. The evidence points to a more national coordination, not less.

Spinal cord injury is a low volume but highly complex condition requiring specialist pathways, lifelong rehabilitation and coordinated support. Yet our inquiry heard repeated evidence of fragmented services. Postcode, postcode variation, delayed rehabilitation and patients being lost within the system. The APPG has therefore called for a national strategy and a modern service framework for spinal cord injury care and as we intend to hold a lived experience roundtable shortly, I would invite the Health Secretary to come and meet people with spinal cord injury to hear their concerns about the proposed changes to commissioning.

We welcome the excellent constructive engagement from the Ministers. My hon. Friend the Member for Washington and Gateshead South and NHS England officials, but remain deeply concerned about proposals to transfer spinal cord injury, commissioning from national oversight to integrated care boards. Indeed, NHS England's own evidence to the inquiry emphasised national standards, national quality metrics, nationally coordinated coordinated pathways, quality measures and oversight. If national consistency has not yet been achieved under national commissioning, what evidence demonstrate that transferring responsibility to multiple icbs will improve outcomes or equity? What is at stake is not abstract.

When somebody sustains a spinal cord injury, their life changes overnight. They may require specialist rehabilitation, housing support, benefits, advice, mental health support and long term clinical care. Patients and families should not be left to navigate a fragmented system alone. And that's why I welcome the ambition behind the single patient record and Diagnosis Connect. Connecting newly diagnosed patients directly to specialist support reflects one of the APPGs recommendations. Organisations such as the Spinal Injuries Association help people rebuild their lives after life changing injury, and I hope Ministers will consider including spinal cord injury, within the early phases of Diagnosis Connect.

Madam Deputy Speaker, the question is not whether structures change. On paper, it is whether people living with spinal cord injury will experience safer, more equitable and more coordinated care. So I hope the Secretary of State can answer some straightforward questions. If NHS England accepts that national consistency has not yet been achieved, what evidence shows localised commissioning will improve it? How will national standards, benchmarking and quality oversight remain coherent under a fragmented arrangement? Does the government accept that spinal cord injury differs fundamentally from standard population health commissioning because of its low volume, high complexity and cross-boundary nature? And what safeguards safeguards will prevent widening regional inequity if accountability is dispersed across multiple icbs, the APPGs inquiry concluded that spinal cord injury services require stronger national coordination and oversight, not greater fragmentation, and I hope that the government will reflect carefully on that evidence.

We in this country led the world in spinal cord injury provision under the leadership of Professor Ludwig Guttmann after the Second World War and and the remarkable work that he achieved, we need to return to those days of being pioneering and world class. And I'm afraid over the last many years, and I know this is a a a lawyer previously practising in this area, how services have deteriorated, gone backwards over the last several decades. We need to restore those services and bring trust to people who so desperately need to have that reassurance that there is a national system that they will rely upon, and it will address their needs as it currently is.

I'm afraid we are not in that place at all. This is the opportunity to address that, and I trust the

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Ministers will take that on board. Thank you. I call the Liberal Democrat spokesperson, Helen Morgan. Thank spokesperson, Helen Morgan. Thank you very much. Madam Deputy Speaker. Can I start by declaring an interest as a member of the interest as a member of the patient's patient Safety APPG and also a vice president of the Local Government Association, and start by welcoming the new Secretary of State to his place. I very much look forward to working with him constructively through the passage constructively through the passage of this bill, but we all know that our NHS is in desperate need of transformation.

Hospitals are in
19:02
Helen Morgan Portrait Helen Morgan MP (North Shropshire, Liberal Democrat)
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chaos, social care is overloaded, and just getting a GP appointment is a huge challenge for many. is a huge challenge for many. Labour has promised to put patients and communities at the heart of the NHS, but I fear that this Bill does NHS, but I fear that this Bill does not fulfil that promise. The government promised to sort out social care, but two years later they are still only partway through they are still only partway through a three year review. The government promised to treat mental health with parity.

But mental health, with parity. But mental health, which accounts for 20% of the disease burden, is falling just 8.4% of NHS budgets. They promised to protect women's health, but the women's health strategy published this year was significantly weaker than the men's health strategy, which which received 60% more funding for new research. Healthy life expectancy in the UK is stagnating and adult social care is under ever more pressure, putting immense stress on the budgets of councils and other local authorities. The reality of this in rural North Shropshire is that people struggle just to get GP appointments.

12 EFRA in A&E waits have been normal and finding an NHS dentist is becoming impossible. The social care crisis has left Shropshire Council's finances in a dire situation, and real NHS reform Bill would put changes to social care, general practice and prevention at its heart. Instead, this Bill passes responsibilities around Whitehall, centralising more power within the Secretary of State, while chaos reigns following 50% cuts to ICB budgets. Now, early in his term, the right hon. Member for Ilford North promised that another top down reorganisation of the NHS was the last thing he wanted to do.

Yet the abolition of NHS is doing exactly that, focusing on reorganisation at the top while failing to deliver real improvements for patients and staff. Now, it's true that NHS England has allowed Ministers to shirk responsibility and accountability, but this abolition has been poorly planned, leaving both icbs and specialised commissioning in chaos. Instead of the government's advertised aim to create a more community based NHS, the Bill centralises power in Whitehall, giving sweeping Henry the Eighth style powers to the Secretary of State.

These powers carry a real risk that political considerations could influence what should be operational decisions about how the NHS provides for patients in the future, and this is particularly concerning given the current. The current febrile political climate, and the government must ensure that protections are put in place for what may happen in the future. The government has made 50% cuts to Icbs, but this bill gives them new legal responsibilities, different structures and centrally directed spending objectives. It's indicative of a lack of planning that could plunge Icbs into chaos.

Meanwhile, the removal of integrated care, partnership and extension of Icbs to cover multiple local authorities raises unanswered questions about the future of social care planning in Shropshire. The council already spends around 80% of its Budget on social care provision. This has a monumental impact on all services as constant savings have to be found. Removing the pooling of the better care fund between local authorities and Icbs will discourage integrated working between those bodies on social care, giving existing complications over the sharing of costs and social care provision.

The chaos of this reorganisation may only exacerbate the confusion. It's also astounding that the Bill plans to remove the duty of GP representation on Icbs, along with local authorities and NHS trusts, the replacement of council representation with mayors is extremely problematic for the many areas that don't have a mayor, and removes the local accountability needed to ensure true community representation. Like so much labour policy, these changes risk benefiting concentrated urban areas while letting down rural communities like

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those I represent. I will give way. I think she'll be, I'm sure,

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I think she'll be, I'm sure, aware of section four on health inequalities, which I welcome as a rural MP. She'll also, like me, know that access and outcomes are know that access and outcomes are poorer in our communities. Does she agree with me? The government should go further and ensure this

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should go further and ensure this bill explicitly states equality of access and outcomes for rural and coastal communities like North Norfolk. Well, I thank him for his

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Well, I thank him for his intervention and he won't be surprised to hear that. I agree with his point. Icbs are already overstretched and underfunded in North Shropshire both Shrewsbury medical practice, if I can say it, and Prescott surgery in Baschurch are in desperate need of expansion. Sillman is available. Land is in Bath is earmarked for a new site, but progress is being held up by the Esb's inability to agree notional rent and this is a situation replicated across the country.

There's no sign of situations like this being solved by the government's changes. The plan to abolish Healthwatch will ultimately strip patients of their voice. There has been a statutory, independent, patient voice in the health and care system for over 50 years. Over half of patients who experience poor care in 2024 did not take any action, many citing fears that giving negative feedback directly to the NHS might affect their ongoing treatment. And that's why it's so crucial that we have an independent patient voice, rather than leaving the department or the ICB to mark its own homework, you only need to look at the devastating consequences of failing during the Mid-staffordshire scandal and the long list of maternity failings since.

To see just how important it is to have Healthwatch exposing challenges in the health service and listening to patient feedback, and how the CQC can fail in that operation. In Shropshire, more than 200 babies are thought to have died due to maternity failures. In the reviews that followed, the one thing that came up time and time again was that grieving parents weren't listened to. Patients and their families must have a voice. The new system will give no incentive to investigate such issues, which are invisible in the NHS.

Main performance metrics. To see the value of Healthwatch, you need only to look at the Cabinet Office's own King's Speech briefing for this bill, which references a Healthwatch report from May 2025 on missing medical records. To make the case for the single patient record, I urge the government to protect both national and local Healthwatch and the independent whistleblowing routes which empower and advocate for patients. Now, Liberal Democrats welcome the move to create a single patient record the part of this bill that could prove the most transformational for parent patient experience and most importantly, patient outcomes.

We know people are tired of endless NHS admin having to reconfirm their medical histories over and over again to different medical professionals. Patient harm has often occurred where clinicians haven't had a patient's full medical history and different parts of the NHS having access to the same patient information is clearly necessary. However, this must come alongside essential new privacy protections and safeguards for patients, particularly given the understandable concerns surrounding Palantir's involvement with the FTP. We would introduce a health charter to set out guiding principles for data sharing across the NHS, ensuring patients are in charge of their own data.

Now. The bill's references to carers are very welcome, coming with the Secretary of State's duty to promote the involvement of carers alongside patients in decision making around care and commissioning. However, the Bill goes nowhere near tackling the social care crisis and demonstrates a pitiful lack of ambition on one of the biggest challenges we face. As I've mentioned, the chaos caused by the restructuring of Icbs will only worsen the challenges that local authorities face providing care for an increasingly ageing population. We want to transform the NHS so that patients are empowered to live healthier, for longer and in dignity.

The nation's health is stagnating, with an ever widening gap in healthy life expectancy between the country's most and least deprived areas and growing pressure on adult social care. Fixing social care is fundamental to our vision for the NHS. It's the key to providing a better quality of life for the frail and vulnerable, freeing up hospitals and building independence for an ageing population. It also empowers our constituents to live independently as possible in their home and near to their families and communities.

You cannot fix the NHS and move care to the community while ignoring social care. And yet this bill not only ignores it. As I've outlined, the changes to ICB commissioning undermine the structures that are supposed to integrate social care with the NHS. Liberal Democrat plans would give people control, routeing services and communities listening to patients and making it much easier to see. A GP would give patients a right to see a GP within seven days, reverse surgery closures and ensure proper personalised management of chronic conditions and frailty, with guaranteed access to a GP for these patients.

We'd also protect the mental health investment standard so we can rebuild community mental health services, something that this government has failed to do, and empowering individuals with poor mental health by intervening early and accessing care in their community. Our maternity rescue plan will make sure Britain is the safest country in the world to have a baby, offering 1 to 1 midwifery care and empowering women at this most important moment. This health board could have been a moment for real change. Liberal Democrats are clear what a real modernise of the of the NHS would look like.

Our vision for a reformed community based NHS is one where proper care and restored investment in public health ultimately cuts NHS waste and empower people to live healthier and more independent lives. This bill focuses on shuffling responsibility around Whitehall and gives the Secretary of State the role of chief micromanager. The government continues to procrastinate over bringing real change to fix social care and empower patients and save our NHS. In the committee report said this legislation, Liberal Democrats will use every lever at our disposal to deliver the transformation the NHS so desperately needs.
19:11
Zubir Ahmed Portrait Dr Zubir Ahmed MP (Glasgow South West, Labour)
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Doctor Zubir Ahmed. >> Doctor Zubir Ahmed. >> Thank you, Madam Deputy Speaker. >> 21 years ago, when I started my NHS career as a junior doctor, NHS career as a junior doctor, there were Labour governments in every part of Britain and I was proud to have practised in every single nation of our country. The NHS then exemplified the mood of our nation hopeful, comfortable in its own skin and confident about embracing, even shaping its future. And we did shape that future.

The Labour government delivered world class heart attack care, stroke care, cancer care, regardless of where you lived and regardless of your ability to pay for it. We also drove through controversy to secure a smoke free generation, starting in Scotland and then delivering it all across these isles. The success of that legislation, perhaps, is best exemplified in the fact that we now have a whole generation who feel it is their inalienable right to go indoors and never have to ever inhale passive smoke and all the deleterious effects that comes with it.

Yeah. But now also like then, the NHS is holding a mirror up to our society for those that rely on it, there is anxiety and frustration about why so often we don't get the basics right, from grappling with the uncertainty of simply seeing a doctor or a specialist with the anxiety that comes with waiting for a scan or its results. And for those 1.5 million people that work in the NHS, including once idealistic surgeons like me who unapologetically gave our youth to the NHS because we enjoyed our craft so much that sometimes it did not even feel like work.

Those staff, battered by austerity and Covid, hoping for better days. Now, despite the improvements that have been made in the last two years, I know harbour a quiet hopelessness that perhaps it will never be the case that their workplace can be joyful again. Good people resigned to running faster just to stay still and to keep their patients safe and all of that because of a 14 year long Tory government who made choices, political choices to rob Peter, to pay Paul, to fail to invest in our NHS so that in an era of AI, technology and digital transformation, they left highly skilled staff with 21st century clinical skills, with 20th century equipment and the public feeling more adrift than ever from their most prized national asset, R and let's not spare their handmaidens in Scotland, the SNP, who fared no better.

NHS spending getting locked Gedling going up, productivity coming down, no NHS app to book appointments or get test results and lung cancer screening lagging behind and 24/720 first century stroke care being a case of Russian roulette. It is in this mood of cynicism, Madam Deputy Speaker and despondency that this Labour government is charged with the responsibility of modernising our NHS and to show that we dare to go big again, go big on giving more power and control to patients and the staff that look after them, going big on taking the bold decisions, even if controversial, on becoming the healthiest generation that has ever lived and going big on grasping the opportunity that technology presents us.

And that is the path we start on today. It answers the cries of patients and answers the call of those who want to look after them. Take the single patient record lauded in the news today as an exemplar of this bill, a programme. As health Innovation Ministers, I was proud to start off and bring my NHS experience to a simple concept demanded by patients, and the vast majority of people will look after them that there should be a single and comprehensive source of truth about a patient's history when it is most needed.

Most of the public believe it already exists, and yet it has been proven harder than ever to deliver because of conservatism, paralysed by the thought of the worst outcomes, unable to plan for the best outcomes, and a belief that patient safety and data safety is somehow tangled up in the status quo. Well, Madam Deputy Speaker, there is nothing safe about going from one hospital to another where a consultant cannot see your scans about your child attending emergently to an A&E department, with their medical history being unseen, or as recently as happened in my own practice in the middle of the night, when offered an organ donation, having to turn it down because we could not access GP records at the weekend.

And what about data security? Madam Deputy Speaker, the NHS is dependent on thousands of IT systems born out of necessity rather than design. If we were designing it, we would never have done it this way. But we must be now absolutely committed to making sure that data is safe and military grade security prevails. During my time as health innovation Ministers, I was clear, and it is clear from the front bench today that they are clear that NHS data

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is sovereign and must be used for the benefit of patients. Yes.

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So we can no longer afford to look the other way. We have to lean in to arguments and the headwinds in to arguments and the headwinds that say no, not yet or not this much all at once. And we have to much all at once. And we have to say to our citizens, our NHS staff that demand we get the basics right, that we are ready to face down that we are ready to face down those headwinds of the noisy tweet or the vested interests position and say it loudly, yes, right now, and yes, as big as we can because our NHS can.

Patients expect us to, and its users also demand us to go further. This movement, this party was born of difficult times to deliver in difficulty. And this bill definitely and ultimately will

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deliver on that promise. Doctor Ben Spencer. Thank you.

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Thank you. Madam Deputy Speaker. It's a real pleasure to follow the Member real pleasure to follow the Member for Glasgow South West. While I didn't agree with everything in the speech, I absolutely know his passion for furniture services, and passion for furniture services, and I'm very grateful for the work that he did as Ministers, particularly helping advocate for my constituents, which I'll come to during the the main part of my speech, I should start with the standard sort of declarations.

I'm a former NHS doctor, my wife is a current NHS doctor. There's a lot of good stuff and very reasonable stuff in this bill. I'm very much supportive of the abolition of NHS England. I'm glad that this is being taken forward. The single care record makes complete sense. It's pretty crazy that we don't
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Ben Spencer Portrait Dr Ben Spencer MP (Runnymede and Weybridge, Conservative)
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already have a system nationally in place. I think there will be some speed bumps in terms of administration, and the question I have is how is it going to encode sex data, and what is the record going to be used as sex data throughout the the record going forward, given the problems and the the discussion that we had just the discussion that we had just before before that. But for me, I think the the issue is really think the the issue is really around the problem is around accountability.

I have a local integrated care board. I have NHS trusts, one of which is Surrey and Borders, which has been failing in terms of delivering rapid, timely ASD, ADHD assessments for children. And frankly, it's it's a disgrace in terms of the failure of having a speedy assessment for ASD or, or ADHD locally, I've been putting pressure on my local trust to try and change that. My constituents expect me to. My constituents expect me to be able to click some of them that I can click my fingers SNP to make this happen, but of course I can't because it's NHS trust, it's the chief executive, it's the ICB I raised in Parliament here, to the Ministers, to the Secretary of State, and asked him to investigate my local mental health trust, to look at the failings and I'm very grateful.

The Ministers responded back to me, wrote to my ICB, to which I got a response, which is this is within the framework, and it's essentially what what they do is, is up to them. So I'm very limited in how I can actually go about changing this. I get the point about clause 11 in terms of taking a few more powers with regards to Secretary of State being able to direct Icbs. But I really have to say, I think that's a very, very blunt tool, which in reality is not going to be accountability.

I can't quite believe that it's going to work in such a way that I can raise something here, and then there's going to be a directive which forces my ICB to do something to deliver better for my patients. I just can't quite see that actually happening in reality. Or maybe, maybe I'm wrong. Maybe it will, in which case then essentially, Parliament will become a forum for MPs, all of whom their constituents expect us to be able to give directives to NHS trusts and or icbs to come here and raise these issues so that the Secretary of

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State can take a directive forwards. Far better is The ISPs.

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Are directly accountable to local politicians. Now I heard the response. The plan is the ISPs are accountable to mayors. Well, we don't have a mayor. Sorry. And there's no even though many of us have been calling for this. There's have been calling for this. There's no time scale in going. Luke Murphy. East Surrey. I think Icbs need to East Surrey. I think Icbs need to be directly accountable to locally elected representatives in some way, shape or form. The logical group for me would be members of Parliament, since frankly, that's what the public believe and expect.

And I hope that as this bill goes through, this issue about local accountability of Icbs NHS and that that perception is investigated, because I think one of the biggest dangers in all this is the sense that we, as MPs here, are able to deliver the direct changes in terms of day to day clinical commissioning, which, of course, we we have a degree of distance from. And. But at the moment, I think it's very much. I reiterate public perspective and public belief that that is what we are empowered to do.

So we either have to be empowered to do that, or we have to make it very clear or have mechanisms so people can see that it's not the direct control of myself or anyone else here, apart from the Ministers on the frontbench. Of course, in terms of directing NHS care locally, I think patient groups are important because they're important mechanism, but so is important in terms of consultation. I also worry is that when Icbs consult in terms of plans going forward, what's the number that they're consulting? What's the what's the survey? What's the metric? Who is appointing the ICB chair? Who is appointing NHS Foundation trust chair, who is appointing all these members of the quangos? And where do democratically elected representatives sit in these appointment decisions? So I finish on on that point, given the limits of my time.

Accountability is really critical. To get this right accountable. Care models need accountability. I've been raising this in Parliament for many years now, and I hope we can use this bill as an opportunity to give our constituents the accountability

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they need and deserve in the delivery of local healthcare. Wes Streeting.

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Wes Streeting. Thank you. That's a characteristically thoughtful speech from the Member for speech from the Member for Runnymede and Weybridge, and it's a particular pleasure for me to follow my hon. Friend the Member for Glasgow South West, who was an outstanding Ministers in the Department of Health and Social Care and has demonstrated again Care and has demonstrated again today why his expertise and integrity are highly valued on this side of the House. I also strongly supported the speech made by the Secretary of State.

He's hit the ground running. He knows he has my full throated and wholehearted support, and he doesn't need a predecessor being a backseat driver, something I'm sure the Prime Minister feels about 1 or 2 of his predecessors. After recent days, can I also thank the Ministers of State for health for her leadership on this bill and the brilliant team
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Wes Streeting Portrait Rt Hon Wes Streeting MP (Ilford North, Labour)
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of officials who've worked exceptionally hard to prepare the bill for its introduction. It will bill for its introduction. It will come as no surprise to anyone that I strongly support this bill. The latest NHS waiting list figures latest NHS waiting list figures show the biggest cut to NHS waiting lists for 17 years. And as we heard lists for 17 years. And as we heard from the Tories today, they cannot stand it. They cannot stand that stand it. They cannot stand that within less than two years we have done something they failed to achieve in 14, which is lowered waiting lists.

They are shorter than when we came in. Lots done, lots more to do but the numbers are there. Despite record levels of demand, despite strike action by the BMA. We delivered record levels of activity and waiting lists are falling. That is the difference a Labour government makes. And to understand how and why this happened is to understand why this Bill matters. Because those who claim recent improvements in NHS performance are simply the result of more money are making exactly the same mistake that has held the NHS back for years.

Under the Conservatives investment matters. Of course it does. But as the Secretary of State outlined, we're combining investment with reform, embracing technology, cutting bureaucracy, improving productivity and changing how care is delivered. From cutting £1 billion from spend on agency staff funding GPS to treat more patients in the community, equipping NHS staff with the latest AI tools, sending crack teams of top clinicians to bust the backlogs in hospitals with the most patient off work sick. Every single change opposed by vested interests.

But that is why we're seeing more patients treated and better value for taxpayers. That is the difference between managing decline and delivering change. Yeah. But for all of our progress, we know there is so much more to do. Too many people today are still waiting too long. Too many staff are working against systems that make their jobs harder, not easier. Too many patients have to tell their story over and over again. Too much money is trapped in bureaucracy when it should be reaching the front line.

And too often, accountability is blurred between two different headquarters, two different boards and bodies and acronyms that the public neither know nor can hold to account. So this bill is the NHS modernisation Bill, and it addresses every single one of those challenges, giving expression to the principle that the NHS should be run for the patient, not the other way round. The Leader of the Opposition recently claimed we've not kept our promise on abolishing NHS England. In fact, we've already started 7000 posts removed from Icbs, 4500 more posts going from NHS England and the Department of Health and Social Care.

And I know these changes are not easy for people affected, and I never treated them lightly. But abolishing NHS England is about cutting duplication, reducing bureaucracy and putting responsibility for the NHS where it belongs, with elected Ministers who are accountable to the public. Every pound wasted on administration is a pound that could be spent on patient care. That's why we're stripping out unnecessary layers and directing more resources to the front line. And when you hear the opposition from the conservative frontbench, no wonder they presided over such a bloated bureaucracy.

This will save money. But they never once asked how much it would cost to pile on layer after layer, and more and more bureaucracy, saddling the NHS with top heavy management, which frustrated patients and really frustrated staff. Now, some will say there's a contradiction that centralising accountability while giving patients more control over their own data pulls in opposite directions. But that is precisely the point. For too long, power in the NHS has sat in a no man's land, and accountability sink to distant from patients and citizens to be meaningful just far enough away from Ministers.

So there's plausible denial denial ability when things go wrong. This bill takes back power in order to give it away. Accountability for Ministers where it belongs, power for the patient, where it belongs to. So the government must face down powerful producer interests on patient data. Our health data is precious. Two things matter above all else that our data is held securely and that it's used ethically. But the single patient record is one of the most important reforms of the NHS for decades, and it is, frankly unsafe as well as absurd that patients are still being asked to repeat their medical history every time they access a different service.

We've also got to take on the producer interest. We think patient data belongs to them rather than to patients. Our health, our data, our NHS patients should control who can access their data and they should control their own data. So by all means, let's scrutinise this bill. Suggest improvement, but don't slow it down. The NHS hasn't got time to waste, the NHS is on the road to recovery and this bill puts the foot down on

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the accelerator here. I'll now call the chair of the Select Committee, after which there'll be an immediate four minute time limit. Layla Moran thank you, Madam Deputy Speaker. It is a pleasure to follow the former is a pleasure to follow the former secretary and slightly surreal, because, of course, he is very much an architect involved in this bill, an architect involved in this bill, and I'm sure we would have had many, many questions about what he meant by parts of it, but it was a by parts of it, but it was a pleasure to work with him when he was in his role, and I look forward to doing so with the new Secretary of State, too.

Now we all understand what's at stake here. Far too many feel the system isn't working for them. The latest British Attitude survey showed that more than half of people in this country are dissatisfied with the NHS, and that should give us all pause. And when the abolition of NHS England was first announced, I welcomed its boldness because our
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Layla Moran Portrait Layla Moran MP (Oxford West and Abingdon, Liberal Democrat)
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population faces enormous challenges. Healthy life expectancy has not just stalled. In fact, it's has not just stalled. In fact, it's gone backwards. We are getting older and we are getting sicker. So yes, we need to be bold. And there is widespread recognition that the three shifts in the ten year plan three shifts in the ten year plan to community, to prevention and to digital are the right ones and if achieved, if achieved, will be transformative. But there is also among the enthusiasm that I have to a big dollop of scepticism among the public, 25% don't believe this plan will make any difference to them, and we must prove them wrong.

So my message to this government is this focus on that plan. It is the right plan, and achieving it is an enormous challenges. And also, please don't forget social care. But this merger, which could risk being a distraction from the plan, we must remember, didn't start with this bill. It started with the announcement in March 25th, and the effects are already being felt in the NHS. This wasn't in the manifesto, so it came completely out of the blue and many people woke up one morning reading the news to discover that their jobs were at risk.

It's been brutal. As a result, the Institute for government told the committee in our hearing just before recess that there's been a large drop in morale and that's not unsurprising. There's been uncertainty, poor communication and disruption, and I've heard first hand how decisions have been snarled up as key people have left. And we've seen from previous reforms that we must learn from that. Often the savings don't materialise because many of the same people who leave first end up being rehired, a point that the chair of NHS England made to us in our committee hearing just a couple of weeks ago.

So despite my initial enthusiasm, there is much that we need to chew over now in our six inquiries and 131 off sessions that we've done so far, there are clear themes of change, and it's on these that I will be judging these bill, this bill, the very first is innovation. Now pilots and moonshots are good, but should not replace evidence based prevention and joined up thinking. For example, the government's Obesity Moonshot moonshot focuses on weight loss drugs, but it ignores the obese and genetic environment, advertising ultra processed foods and lifestyle pressures.

It's a tackling of the symptom and not the cause. And too often these pilots show promise. But then I'll never scaled up. What a waste. Innovation should be a mindset, not a buzzword. And we should strengthen clause six in the Bill to ensure that the long term is embedded from the outset. Second, and this themes come up already. Patient voice our inquiry into severe mental illness laid bare a system where vulnerable people feel

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like pinballs in a machine. I will, of course, thank. My hon. Friend. For giving way. In my area,

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children. Waiting for ADHD assessments. Many already on the standard pathway for years have been told pathway for years have been told they have waits until 2027 at the earliest. We know this is happening earliest. We know this is happening nationally because Healthwatch told us in their 2024 report. Does my hon. Friend agree with me that hon. Friend agree with me that abolishing Healthwatch, the only statutory independent body holding our NHS to account, will leave the

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most vulnerable patients without a voice, and the NHS marking its own homework? Thank you for your intervention.

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Thank you for your intervention. I do have concerns over Healthwatch. I have even more concerns over the role of each SIB. The issue here is role of each SIB. The issue here is you can't have it both ways. They can't sit at desks nearby, other people who are making decisions and people who are making decisions and at the same time be perceived as being entirely independent. And I think that preservation of the independence is the bit, the independence is the bit, the perception of the independence.

You can't legislate for that. The perception is everything. And that's my concern. But to the co-creation, my concern is that at the moment clause 15 talks about it. But actually getting this right is key to making it work. And we have many examples of where it has been done correctly and where it is often, all too often just a tick box exercise. The third is financial flows and integrations. Now, time and again, the committee is in rooms with local authorities, social care, voluntary sector, all saying they know how to do this for their local area.

And it's the system that gets in the way. Now it's section 75. Arrangements are a good start and should be strengthened, and there is a lot of promise in clause 24 with the neighbourhood health plans. But our concern is over clause 21 because if you remove local authority representation from the ICB boards, what that means is social care is not present in those first conversations. That is critical and needs rethinking. The fourth is data. Now, I spoke recently in my surgery to a woman called Freya Rose.

She described how repeatedly recounting traumatic experiences compounded her own suffering. And so the single patient record could be transformational for her and others who find recounting traumatic experiences difficult. So we welcome clause 47. But we must be really careful about the risks, especially around sensitive data. And on that, the committee will be having hearings on the federated data platform and Palantir, which has come up today. And then the final theme that our work is inequalities. So I am excited about the potential for clause four.

I am proud of the liberal legacy that this NHS is built on. In his seminal report, Beveridge rightly pointed to want disease, squalor, idleness and ignorance as the five giants that needed to be slayed on the road to recovery following World War Two. Obviously we've come a long way since then, but I would argue it is to define. It's time to define some new giants and health inequality must be one. It is self-evidently the moral thing to do. But here's something I think the Secretary of State will like.

It is the economically wise thing to do, because study after study shows that if you tackle inequalities, that is the key to unlocking productivity in the NHS. Simply put, helping those who need it the most helps us all. So this bill needs to do more than just have regard to inequality. I would urge the government to make it its core mission. So I end by simply saying what I started with. I will work constructively to help the government make this the success I hope it wants it to be.

I would urge them to think about the downsides, because there are some and they need sorting out. But above all, it will be judged not by us, but by Chris and Freya Rose, the very patients who deserve to be put at the heart of this legislation moving forward.

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I call Liam Conlon, yes. Can I also start. By, as many others have done in

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By, as many others have done in paying tribute to the NHS, and I know from first hand experience how important the NHS is and how important NHS staff are. And when I was 13 I had an accident which left me unable to walk. For four years I spent so much time on NHS children's wards that I went back a year at school and as a sixth former, I was one of the youngest former, I was one of the youngest people in Britain to have a hip replacement on the NHS and I want to thank the staff at the Royal London Hospital and the National Orthopaedic Hospital who cared for me, and actually it was one of the greatest privileges I've had since being elected of going back to the children's ward I was on last year to open a new outdoor play area for the children on the ward today.

And I'm pleased to see the waiting list for hip replacements come down, and I'm pleased to see opportunities for children to access education in hospital improving. But I want to focus my remarks today specifically on brain cancer and brain tumours. Brain tumours are considered rare, but 12,000 people a year are
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Liam Conlon Portrait Liam Conlon MP (Beckenham and Penge, Labour)
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diagnosed with a brain tumour. Just 1 in 10 of adults diagnosed with brain cancer in England survive five years or more, and it's the biggest cancer killer of children and adults under 40. And behind and adults under 40. And behind these statistics are the real lives of people and families. Take my friend and constituent, Alex Savage. Alex was diagnosed with a glioblastoma in 2021 at just 33 years old, and sadly passed away in years old, and sadly passed away in April this year, aged 38.

He leaves behind his daughter Etta, who is now not even two years old and will grow up without her dad, his wife Anna, his mum Marie, dad Ed, brother Nick and sister Rebecca. Alex was intelligent, warm, funny, fearless and full of life. He spent his final months campaigning for change on brain cancer, working closely with the Tessa Jowell Foundation. A cause close to my heart and I know he will be missed. Missed a lot by the staff there. Alex spoke extensively about how he lived well with brain cancer, but also how severely it impacted his independence and how his family often had to pick up the pieces.

They are a real credit to him and to themselves, but the strain this must have had on them is undeniable. Our improvements to the NHS must be a rising tide that lifts all ships, including not just common conditions, but the rare and difficult ones like brain cancer, to. I believe we have begun to provide answers to this, many of which are covered in this bill today. Firstly, the creation of a single patient record. It's not acceptable to have a health system still operating in the analogue age in 2026.

It was only after the intervention of this government and the previous Health Secretary health Ministers, that the last NHS trust stopped using fax machines. The single patient record is an important step towards the digital age, finally bringing together patients data in one easy to access place. Second, research and clinical trials. If we want to improve the prognosis for patients like Alex, we need to improve the funding and infrastructure behind research and clinical trials. I'm glad the government have committed to taking action on this, increasing access to them, giving greater hope to other families who are suffering.

And third, the Tessa Jowell brain cancer mission. I welcome the government's endorsement of the work of the Tessa Jowell Brain Cancer Mission, who have done so much for brain cancer patients. Closing the postcode lottery and raising overall standards of care. However, as Alex's case shows, we still need further improvement. This means making a sustained commitment to improving outcomes for those with brain tumours, backed by meaningful increases in funding to reflect the incredible burden of this cruel disease. I am proud of the improvements we are making with the NHS.

I know the impact it will have on the lives of millions of people across the country, including my constituency in Beckenham and Penge, but we also need a specific approach to tackle brain cancer. As Tessa Jowell said in her final speech. In the other place, it cannot be put into the too difficult box through funding, improvement in trials and further expansion of the mission model, I am confident we can make progress and I look forward to being a part Parliament.

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Thank you for Sarah Bool. Thank you, Madam Deputy Speaker. Now, as an active user of the NHS myself, I do welcome steps can NHS myself, I do welcome steps can be taken to improve patient experience and care. But the NHS is experience and care. But the NHS is a delicate ecosystem. Mistakes and errors don't just lead to a loss of money, but it can be life changing money, but it can be life changing and it is a matter, quite literally, of life and death.

So it is absolutely essential that we get these changes right. Conscious of these changes right. Conscious of time, I'll just focus on a few points that I want to raise. So it has been mentioned quite a number
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Sarah Bool Portrait Sarah Bool MP (South Northamptonshire, Conservative)
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of times about the single patient records now representing a constituency, South Northamptonshire, where there is Northamptonshire, where there is not one hospital within the actual boundaries. My constituents can be treated at a variety of hospitals, treated at a variety of hospitals, whether that's Northampton, Milton Keynes, Kettering, John Radcliffe, all the Horton. So working across all the Horton. So working across county and across the country, I can see the value in creating a single patient record. So notes are single patient record.

So notes are available and it really could transform care coordination. I had an example of one of my constituents whose wife was almost given medication that would have killed her, because she would have had an allergic reaction because of old notes. But for his presence being there, that saved her life. We can't do this again in this day and age. But as the Royal College of Nursing have sort of indicated, any new system really must make sure it has robust safeguards around data privacy, transparency, access procurement, and secondary uses of data.

Now, I acknowledge that the Secretary of State has put an emphasis on looking at that, but I think we all need more assurances. And even the Royal College of GPS is asking whether the government would provide any assurances around indemnities for GPS to protect against liability, if there are breaches of data protection regulations or instances of mishandling of patient records, if that was to occur. All in all, to have a single patient records, it will only work if it has the confidence of the patients and the staff.

And I think nursing staff have been asking through the Royal College of Nursing, if they will be involved in the actual creation and design of this single patient record to make sure that they it will actually work properly in practice. So perhaps the Ministers could confirm on this. Now, secondly, without careful safeguards, structural changes could have a huge risks or at least undermine some of the most significant advances that we've seen in recent years. Now, many members will not fail to know that I am a type one diabetic, and I will always passionately talk about diabetes.

But diabetes UK themselves have highlighted just some concerns about some of these changes. Now, we have seen some incredible movements in diabetic technology. For example, the development of the continuous glucose monitoring, and recently the hybrid closed loop systems, which I'm standing here today actually wearing and using. Now, it has been central coordination that has ensured that funding agreements are secured and access is prioritised. If you were to shift that purely to local decision making, it risks fragmentation and widening inequalities. Also, there are many different new treatments that are being progressed and treated and created.

For example, I had a ten minute rule bill, which is about trying to do a screening programme for type one diabetes in children, and we need to make sure that this, along with access to emerging immunotherapy immunotherapies, are also prioritised. Now because this is incredibly specialised, it does require expert national oversight and coordination, and it would be inefficient and potentially ineffective if these developments were to be pursued purely on a local basis. And therefore, we want to make sure that we are not going to see any progress falling between the cracks in these changes that are going forward.

And finally, just to touch on the patient voices, it has been mentioned numerous times about the abolition of Healthwatch England, and I know so many patients have to be incredibly vocal about the care that they absolutely need, and often they are not as strong as us at making those points. So it is absolutely vital that we still maintain bodies who can speak on their behalf, and especially that makes sure that young children's voices and that of the youth is actually prioritised.

So I am supportive of some of the changes that are coming, but I do think we need to exercise some care and some caution.

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I call Jen Craft. The NHS is at a critical juncture in its existence and needs radical change in how it is run in radical change in how it is run in order to survive. So I welcome the measures in this Bill to keep the NHS around for generations to come. But I do believe that there are opportunities for the Bill to go further. I will briefly touch on further. I will briefly touch on the situation in my own constituency and in Thurrock, where we have an acute care trust that we have an acute care trust that has been under delivering for decades.

It constantly gets terrible CQC ratings, whether
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Jen Craft Portrait Jen Craft MP (Thurrock, Labour)
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that's well run, whether that's looking at specific departments or whether that is looking at access whether that is looking at access to things like A&E. A recent inspection had two of the inspectors had to stop the work that they were carrying out to that they were carrying out to point out that there was a deterioration in a patient that had not been noticed by the medical not been noticed by the medical staff on duty, the previous Secretary of State, the Member for Secretary of State, the Member for Ilford North, did place this trust into an intervention programme, naming it as one of five trusts which were challenged across the country, which means it will be subject to quite significant intervention by the NHS.

I strongly welcome the measures in this Bill, particularly, I think it is clause seven, which puts a clear emphasis on accountability and on preventing historic patterns of underperformance and allowing the Secretary of State to deauthorize failing foundation trusts, which will strip away some of their independence and bring them under the control of the Secretary of State. In my constituency, we have seen that ongoing interventions have not delivered the health care that my constituents. Need. This might be the final measure that will tick that health trust into working, benefiting from the wealth of expertise and experience within the Department of Health and Social Care.

So I will move on to where I believe that the bill can go further, and that is in the area of C, N, D and delivering for children with disability or extra educational needs. And far too often, and this is a systematic problem. It is not related to individual instances and specific trusts or areas of the country. Health are just not at the table when it comes to commissioning services for disabled children. On meeting the needs of children with additional needs.

And this basically means that there is an onus on local authorities who have a statutory duty to provide services that it is not in their gift to provide. And we hear from local authorities, we hear from schools, we hear from academy trusts, parents, and sometimes even the children themselves, that the absence of health in these discussions is absolutely critical. The main, crucial part of the white Paper that the Department of Health and Social Care can play on delivering the White Paper is on the experts at hand model.

These experts at hand provide an early intervention model so that all children who are exhibiting an additional need in their education are able to access expert advice from a panel of people who make up part of the allied health professions. And we know that there is a huge shortage in this workforce, and it is, again, in the gift of DHSC to perhaps remedy. I would suggest that the bill could go a little bit further. There is a change that moves the committee, the commissioning and the development of a workforce strategy from the responsibility of NHS England to the Secretary of State, and perhaps specifically mentioning allied health professionals and paediatric allied health professionals, would put them on an equal footing with some of what is seen as normal clinical staff.

And I believe one extra way that the bill could go slightly further is putting a duty of partnership and a duty of commissioning on icbs around services and particularly paediatric services in this regard. Currently, there is, like, as I said, this statutory duty on Las, and we have heard time and again that having a similar statutory

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duty on Icbs would help to deliver. Give way. Happily. My friend is making a powerful

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My friend is making a powerful speech and some powerful points that I hear again and again from parents that while different commissioning bodies are arguing commissioning bodies are arguing about who's responsible, children are falling through the cracks. So I do agree with me that we must I do agree with me that we must urge the Secretary of State to go further and to make sure that these cracks.

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cracks. Absolutely, and I thank my hon. Friend for his intervention, and he is completely right. One of the biggest issues with with delivering care for children in the system and disabled children more widely, is the lack of join up between the various services that they should be able to access the single point of access, for example, in this bill, I think is a great way to delivering on the health aspect of that. I know when I hear from my constituents who parent children who have chronic or complex medical needs, they find it extremely frustrating that they are the one nexus that holds all the information that their child about their child's health care and what they need.

And they're quite often battling a number of health care bureaucracies to get their child, their health care and the support that they need. So I believe that with a few tweaks, this bill could be truly revolutionary in delivering the health care and support that disabled children and children with extra educational

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needs finally require. And to make taking the onus and the stress away from those parents. Hey.

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Hey. I now call Steve Darling. Thank you, Madam Deputy Speaker

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Thank you, Madam Deputy Speaker and the NHS. I'm sure, as is the case in many other colleagues, constituencies, is perhaps the most valued service that they receive from the government. And in Torbay from the government. And in Torbay it is the largest employer. And ironically enough, in this world of the government talking about investing in the NHS, we are looking at 300 voluntary
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Steve Darling Portrait Steve Darling MP (Torbay, Liberal Democrat)
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redundancies in Torbay. So rather than seeing the investment that the government talk about, the reality government talk about, the reality is that there are job cuts and many of those are likely to be clinician of those are likely to be clinician job cuts in Torbay. So that's the background that I come from when commenting on on this, I'm going to commenting on on this, I'm going to limit my comments on the really crucial ones. We have had the luxury of an integrated care organisation in Torbay, and it has been vaunted internationally as this is the way forward and I think the direction of travel that the government is going in is very much into integrated care organisations.

As my colleague alluded to section 75. And yet, because there has been the failure of focus on this by NHS colleagues over a number of years, this has been binned in recent months, and we have appealed to the Secretary of State to intervene, and he has failed to do so. So in light of this, Madam Deputy Speaker, how can we have any confidence about greater influence from the Secretary of State when the appeal happened and they said, oh, it's a contractual relationship.

That integrated care organisation has resulted in many people being discharged early, people being cared in the community at grassroots level that we, as Liberal Democrats know, is desperately important. The binning of Healthwatch is disturbing, and I would like to pay tribute to Kevin Dickson, who heads that up in Torbay and in Devon. They only a few years ago identified a situation where domiciliary care workers, people supporting people in their own homes were actually failing them, and that resulted in an investigation and the contract being taken away from that particular provider and those of our society who were the most vulnerable people within our society, receiving support at home, being better supported by another provider.

How can we expect this to be done when we are effectively looking at giving this duty to people to mark their own home work? Finally, Madam Deputy Speaker, I wanted to focus on the better Care Fund. It is bonkers that this is just being handed on a plate to the NHS acute care services, when there needs to be partnership working between adult social care providers and the NHS because it should be driving better care. It says it on the label and it is extremely perverse.

So I hope as this probe, as this bill progresses, common sense will prevail in a number of

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areas. Thank you, Madam Deputy Speaker. I call Paulette Hamilton. Yes.

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Yes. Thank you, Madam Deputy Speaker. As someone who has worked in the NHS for 25 years as a district NHS for 25 years as a district nurse and who was involved in integrated care systems in Birmingham and Solihull since the Birmingham and Solihull since the very beginning, I want to focus my contributions today on three areas contributions today on three areas of this bill health inequalities, patient voice and integrated care boards. Let me start by saying I support the principles of this bill.
19:54
Paulette Hamilton Portrait Paulette Hamilton MP (Birmingham Erdington, Labour)
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My constituents want services that work better. They want care that is easier to access, closer to home easier to access, closer to home and properly joined up. And parts of of this bill help support that of of this bill help support that ambition. I also want the focus on neighbourhood health plans and shifting more care into communities. shifting more care into communities. Some of the best healthcare happens in people's homes, in clinics and through early intervention before through early intervention before problems become a crisis.

That is why the investment in Stockland Green Health Centre, in my constituents constituency in Birmingham matters so much to my, my residents and to me it represents the right ambition, shifting care into the heart of the community, bringing services together locally and making healthcare more accessible for residents in Birmingham Erdington. That principle is absolutely right. My concern is that parts of this bill risk moving us away from the original purpose of integrated care. Integrated care systems were created because health is shaped by far more than hospitals alone.

I am concerned that this bill risks moving us away from that local collaborative model and towards something far more centralised. As a former Cabinet member at Birmingham City Council with governance responsibility for health and social care and public health, and as the chair of Birmingham Health and Wellbeing Board, I know how important local government involvement is in these decisions. Yet under these proposals, somebody in that position would not automatically have a seat around the table that would have to they would have to compete for that seat.

I also believe the bill should protect three things in relation to Icbs genuine, genuine local partnership, a combined focus on health inequalities and prevention, and a strong focus on place reflecting the needs of local communities like mine. Madam Deputy Speaker, one of my biggest concerns in this bill is the reduction in independent patient representation, including the abolition of Healthwatch structures. If patient voice is weakened at the same time as local representation is reduced, there is a real risk that health inequalities becomes even less visible within the system, and we cannot allow that to happen.

Madam Deputy Speaker, the ambition to improve to the ambition to improve joined up care and strengthen community health care is the right direction of travel. I simply ask the government to take a close watch on local representation and patient voice. As these changes are implemented, patient voice is not being lost and increase in health inequalities because icbs should not be used as a vehicle to re-organise NHS management

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structures. Thank you, Madam Deputy Speaker. I'll call a speaker this side and then I'll be going down to a and then I'll be going down to a three minute time limit. Saqib Bhatti thank you, Madam Deputy Speaker, and it's a pleasure to Speaker, and it's a pleasure to follow the hon. Member for Birmingham Erdington, not least because I actually agree with a lot of what she just said, especially of what she just said, especially around accountability and the impact on integrated care boards, but also around the impact on
19:57
Saqib Bhatti Portrait Saqib Bhatti MP (Meriden and Solihull East, Conservative)
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but also around the impact on Healthwatch, which I'll try and do quite swiftly in the time allocated to me. I campaigned for the Icbs because when I was a new member of Parliament, the I had to deal with the clinical commissioning groups. And actually what I found in the summer of 2020, the CCG that I was dealing with at the time told me that I was going to get two new urgent treatment centres at the at the cost of about £1 million each. And then a month later, I had a call with the same CCG and actually they denied ever having said it to me.

And luckily one of my staff members had been on that call, but I went to see the Health Secretary at that time and I thought, this, this is not possible. I'm not a health expert, but I have been in business and accountability and transparency really do matter, which is why I really supported the Health and Care Act of 2022 and the introduction of Icbs. And the consequence of that was much more local accountability and delivery, which is why since 2020, we've seen the introduction of an urgent treatment centre at Solihull Hospital, a locality hub, state of the art surgical units with robotics in there as well.

A community diagnostic centre with the second largest in the country, which was opened not. It was open under this government actually, but was allocated and instigated by the previous one. And so I I'm a big, big advocate for transparency and accountability, which is where I have great concern about this legislation. I have great respect for the Ministers, but I hope she'll appreciate that this cross-party concern on this is very, very valid, because I do think there is a bit of a power grab going on here, and I think the central pillar of this bill is to centralise those powers.

And despite the Secretary of State who I would welcome if he was in his seat, despite him saying that this is not about politicisation, it is I think it is inevitable that that centralisation of power will be a politicisation. And in fact, the integrated care boards in the form that we created, actually reduce the politicisation, politicisation. I won't stress that more than what the previous member said, actually, because I was totally in agreement. I'm just going to come on to Healthwatch.

I, I'm going to start with a compliment to the health department because I wrote to the Health Department last year on the 12th of September, and then on the 15th of September last year, I had a response, which is pretty good going, I think, and long may that continue. But I think my compliments may stop there, because I do. I do have great concern about the abolition of health. Healthwatch and Healthwatch. While the Secretary of State kept talking about integrating into Icbs, the response I had from the Ministers clearly says that this is.

The changes will close local health watches. It is. I don't share that the wording of integrated. There's a new mechanism that's being created that will take away patient voices and patient independence, and I think they play a really important role. They play a really important role in gathering local intelligence. They play a really important role in making sure actually, with the previous member talked about inequality, I have great concerns. I have two of the most deprived wards in the country in my constituency.

I think Healthwatch plays a really important role in giving voice to the voiceless, and I was not reassured by the Secretary of State in any way whatsoever that that would be repeated as those powers were taken into the ICB or centralised into the Department of Health, where the Secretary of State would now be an important arbiter. One question I wanted to ask the Ministers as well was in in that inequality, of course, we see huge amounts of digital exclusion, and that is where Healthwatch actually plays a really important role.

Those when I talk about the voiceless, it's those people who don't have the strength or confidence to address those issues. So what work has a Department of Health done in that way in regard to the digital digital excluded? But there's a really important question. I really share those concerns around accountability and transparency. I hope the Ministers can answer those.
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Daniel Francis Portrait Daniel Francis MP (Bexleyheath and Crayford, Labour)
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John Grady Daniel Francis. >> John Grady Daniel Francis. >> Thank you, Madam Speaker. And at the outset, can I echo the comments from my hon. Friend from Thurrock and his fellow said parents, I and his fellow said parents, I think we would both press for those measures and that she has pressed for. I will declare my interest as chair of the all party parliamentary groups for access to disability equipment and for wheelchair users, and wish to speak about some of those issues, predominantly on clauses 15 and 16, and how ICB commissioning needs to be considered in relation to carers and disabled people.

The report, published last October by the APPG for access to disability equipment entitled Barriers to Accessing Life Saving Disability Equipment, made recommendations which I believe need to be considered when bringing the bill forward. The main recommendation centred around a national strategy for community equipment with consistent national standards and ensuring accountability at every level, and we see disparities that exist within ICB areas, not just across different ICB areas. I know in my part of South east London, you can look at contracts within Bexley, Greenwich, Bromley, three neighbouring boroughs in the same ICB, and yet you'll receive a completely different service level.

You know, my daughter is a wheelchair user. She will be in a class with a school class, with children from those other boroughs, neighbouring boroughs. And despite being in the same ICB, they will have to completely different commissioning contracts and different levels of service. And that's something we really do need to look at at that postcode lottery across Icbs. But also, as I say, within Icbs and getting the commissioning of disability equipment right is crucially important to streamline processes, reducing delays and preventing unnecessary hospital stays.

We know that hospital discharges, for instance, there is no timescale for equipment, so we see the timescale set out in national strategy for the 18 weeks for wheelchairs, but not for disability equipment, and that therefore leads to delayed discharges but also leads to unnecessary operations in many regards for people, for instance, with cerebral palsy who don't have the equipment they require. And there's evidence that providers in the disability equipment and wheelchair area very clear evidence, and that we'll see again in the months ahead.

Bid the lowest price for contracts. And that creates a cash flow issue for themselves, as they then have to slow down the ordering and provision for equipment. And that has great knock on effects for NHS, as I say, both in operations and discharges. That's why our APPG has called for streamlining of communication channels between local authorities, health bodies and government departments to ensure there's a more joined up approach. And lastly, I know my comments are I've got very little time, but equally also the issues about recycling of equipment, often when ICB will have the equipment that a patient in a neighbouring ICB requires because they've recycled it, but they can't pass it on because of different contracts.

And we saw that matter to a great extent last year with the collapse of NRS in the disability equipment area when that contract collapsed. So I welcome the bill, but I do believe it can go forward to strengthen the needs of carers and the disabled.
20:04
Gideon Amos Portrait Gideon Amos MP (Taunton and Wellington, Liberal Democrat)
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Gideon Amos thank you, Madam Deputy Speaker. There are welcome elements in this bill, such as creating a single patient record, enabling care integrated care boards to become commissioners across the wide area. As examples, across the wide area. As examples, however, I cannot support the weakening of patient voices nor removing local authorities from oversight of health trusts. And I pay tribute to Jill Kenniston and her team at Somerset Healthwatch for all the fantastic work they have done and in moving to that single patient record, we need to prioritise privacy and rethink putting the American firm Palantir in charge of our data, with its founders like Thiel, opposing democracy and denigrating our NHS as part of a Stockholm syndrome.

My constituent, whose family member was brutally murdered, is rightly horrified that victims NHS records were shared unlawfully online with NHS workers. Repugnant voyeurism. She called it Madam Deputy Speaker. She was right to do so, and I hope the Ministers will echo the apology of the trust and condemn that kind of behaviour. However, none of the reforms that this bill brings forward will have a positive impact on patients or staff in Taunton and Wellington who use the maternity and paediatric department until and unless the promised new unit is brought forward.

One of my constituents, Jeff, told me of their grandson, Ryan, who was admitted to the ward a couple of weeks ago. The lack of air conditioning means temperatures exceeded 30 degrees there over the last week. No wonder medical staff have fainted in this heat in in looking after mothers and children who are baking in single story, flat roofed buildings put up for the United States Army as a temporary measure during the Second World War and never replaced. As my constituent Jeff put it, walking down the court and I quote, walking down the corridor of the old building is an embarrassment.

There are literally sheets of plastic attached to leaking ceilings running into guttering in the corridor. I don't need my architectural training Madam Deputy Speaker to tell me that guttering should be on the outside of the building, not on the inside. It's not surprising. Therefore, the the previous Secretary of State, when challenged on BBC Somerset only a month ago, promised that he would speed up the Musgrove Park Hospital project if he could. So I hope the new Secretary of State will honour the promise of his predecessor to meet with me to discuss doing just that.

I know the bill is based, at least in part, on the mission to move from treatment to prevention. The right ambition, of course. Because of its major teaching hospital status, Taunton has a big medical community who know a thing or two about prevention. And I'd just like to highlight two areas where this bill should be going further on prevention, on prostate cancer. I hope the government does not decide to hold back from widespread screening, as the recommendation is before it to do so.

As a member of the family, my constituency recently hit by the disease, told me I am a recently retired doctor. I do not believe the statistics published, with the emphasis being placed on Overinvestigating patients and has addressed this causes. This pales into insignificance compared to a missed diagnosis. Finally, Madam Deputy Speaker more should be done to reform the dental contract

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unless the bill adds changes to more NHS dentists, social care reform and best prevention. I call Sonia Kumar.

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I call Sonia Kumar. Deputy speaker. Today we stand at a defining moment for our healthcare system. moment for our healthcare system. We face a ballooning NHS Budget and a social care system in crisis. We a social care system in crisis. We ask ourselves what must change to reduce deep rooted health inequalities, to improve patient inequalities, to improve patient centred care, to remain financially sustainable. It was designed to
20:08
Sonia Kumar Portrait Sonia Kumar MP (Dudley, Labour)
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treat acute illness and to provide healthcare free at the point of use, healthcare free at the point of use, regardless of income, background or status. Medical and scientific progress has transformed healthcare. People are living longer than ever before, often managing multiple before, often managing multiple long term conditions that once would have been fatal. The NHS was would have been fatal. The NHS was founded on a simple but powerful principle equity. Yet health outcomes remain profoundly unequal. Research consistently shows that where someone is born and the social economic conditions they grew up in can determine how long they live, sometimes by more than a decade.

The wider determinants of health, income, housing, education, employment shape outcomes long before illness appears. And now we must embrace the global technological revolution. From artificial intelligence to robotics, we must harness this to improve patient centred care use. Well, technology does not replace humanity in medicine. It restores it, giving clinicians more time to care. Yet we should go further. AI and data analytics should be used not only to treat individuals, but to stand communities, design health care around real conditions in which people live in.

A true, systemic approach means knowing not just that patient has a condition such as blood pressure, but understanding why the environment that shapes it, rates of poverty, unemployment, housing conditions, education levels, access to green spaces, the density of fast food outlets and accessibility to affordable health care services per capita head. This is the reality of health inequalities complex, interconnected and predictable. It requires a whole systems approach, bringing together the NHS, local councils, hospitals, charities and grassroots organisation having a full mapped way of the communities.

What they look like would provide made for tailored healthcare services delivered to the population. Because healthcare and and NHS does not need reform, it needs an ecosystem map and I want to call it the health bio system, a system where health is shaped not in hospitals, but in homes, schools and streets and workplaces. As Atlee once said, we have been

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elected not to make a new old system and patch it up to make a new one. I call Bernard Jenkin.

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I call Bernard Jenkin. Thank you. Very much, Madam. Deputy Speaker, and I very much welcome the idealistic vision that welcome the idealistic vision that the hon. Lady for Dudley sets out for us. But I'm afraid I think that's very far from what's in this that's very far from what's in this bill, because I shed no tears like my hon. Friend for Runnymede and Weybridge for the demise of NHS England, which was never an independent organisation of politics. It always looked upwards at the political leadership and did what the Ministers wanted, and it
20:11
Bernard Jenkin Portrait Sir Bernard Jenkin MP (Harwich and North Essex, Conservative)
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was created as an unnecessary, unnecessarily complex organisation. But I do ask myself whether, But I do ask myself whether, reasserting the principle unspoken in this debate, that somehow the man in Whitehall does know best is man in Whitehall does know best is not reverting to the previous failures of the system, when we failures of the system, when we need to be looking for a much more organic and local system. And I, I organic and local system. And I, I stand up in this debate, really to lament the demise of SIB as proposed in this bill.

It is a profound mistake. It represents a downgrading of safety as a priority in this government's health policy, because EHCP is the only organisation that can independently investigate safety incidents in the NHS and is not conflicted by any other function or role. It doesn't compromise any other functional role in the NHS, and yet the government's decided to get rid of it. It's not going to save any bureaucracy. It's a tiny organisation that costs a few million pounds and yet is pioneering a new system of safety management in the NHS that the NHS culturally barely understands.

What we forget that NHS reform is really about people and leadership. It's not about management structures and organisational structures, and EHCP was one of the catalysts that was beginning to transform attitudes towards safety and was a safety valve for clinicians and patients and their families, so that the one place they could go to to tell their story without fear or favour

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in a safe space. And it was very Friend. I thank my hon. Friend, for

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I thank my hon. Friend, for giving away from a passionate speech that he's delivering. Is he reassured in any way whatsoever by the changes that will help

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the changes that will help strengthen patient voice, as the Secretary of State alluded to? Well, no. The abolition. Of EHCP is an example. It was

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Of EHCP is an example. It was the one organisation that could independently hold any part of the system to account. If these functions are transferred to CQC, it will be compromised in its independence, and it's indeed explicitly intended to be compromised. Because if you read the review, which the government sets great store, the review itself is a flawed and dishonest document which misleads the public for what it is actually by what it's actually saying. It's not a it's not about patient safety, the review.

It's about it's far more emphasis on quality to lives, quality and safety, which are not the same thing, even if many people believe them to be so. And the concern, I think, is reflected in the fact that there are too many recommendations flying around and too much resources being diverted to recommendations that the NHS doesn't want to implement. But all those recommendations are coming from this plethora of public inquiries that Secretaries of State keep calling. Surely we want to replace the public inquiry system with something much more effective that, as we did in rail accidents, remember the Ladbroke Grove rail crash? We replaced public inquiries with the Rail Accident Investigation Branch of the Department of Transport.

Now, there hasn't been a public inquiry into a rail accident since the Ladbroke Grove inquiry. We have we have the Rail Accident Investigation Branch. There hasn't been a public inquiry into an aviation accident since 1972. Because we have the AAIB, why can't we have the same principle for safety and healthcare instead of this ridiculous dash review, which is full of falsehoods and misleading, misleading statements? And I will give you just one. It says that the SIB was not able to retain the maternity programmes because Health Care Act 222 does not make provision for maternity investigations in EHCP.

Well, that was wrong. It had to give them up because it didn't have the capacity to do them.
20:15
Lizzi Collinge Portrait Lizzi Collinge MP (Morecambe and Lunesdale, Labour)
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Lizzi Collinge thank you, Madam >> Lizzi Collinge thank you, Madam Deputy Speaker. Firstly, I must declare that my husband works for NHS England, which is a bit awkward NHS England, which is a bit awkward if I'm honest. But today, Madam Deputy Speaker, I want to speak to a few different aspects of the NHS modernisation Bill, including the single patient record, the independence of the Health services safety investigations body known as SIB, and possible changes to the make up of NHS Foundation Trust boards.

Now I very much welcome the introduction of a single unified patient record accessible to patients and clinicians in one place because too often patients are forced to carry the burden of holding together their own medical history. I've heard the same story from countless constituents arriving at appointments with records that they've pieced together themselves, rehashing their medical history over and over again to each new clinician. Now, that clearly doesn't work for the patient, and it doesn't work for the clinician either, because when clinicians don't have access to the full picture, decisions are made with incomplete information and the right diagnosis or treatment might be missed.

Or even worse, an unsafe care decision could be made. Now, the single patient record addresses long standing issues in the NHS, fragmented records, poor communication between services and this is an opportunity to make things work that much better. But of course this needs to come with strong safeguards. People quite rightly want to know that their personal private information will only be used for proper purposes and that it will be kept secure. So I would urge the Secretary of State to take full notice of the science, Innovation and Technology Committee's views on this, but in other ways it can make our data more secure.

Recently, I got a letter to my last house, but one containing personal information that's not secure at all. So I just want to talk quickly about the abolition of EHCP and its responsibilities. Moving to the CQC. Now there is a fragmented and confusing patient safety and regulatory landscape, but the independence and the appearance of independence in patient safety investigations is very important. So I would like really strong reassurances on that point from the Ministers that there will be still an independent investigative function that patients and staff can have confidence in.

Harmed families have told us just how important this is. Now, finally, I want to flag changes to the make up of NHS Foundation trust boards. Now the Bill appears to remove the requirement for registered nurses and doctors to be represented on trust boards. Now, I'm hoping this is an oversight that can be examined and rectified at committee. But Deputy Speaker, For all its faults, the NHS is there for us right from the beginning and right to the end of our lives, and for the most difficult moments in between, from the birth of our children through every broken bone, every anxious wait in A&E, we are supported by the NHS and its staff.

But if we want it to remain for future generations, we have to be willing to modernise it. We have to be willing to reform it and make sure it's fit for the way people

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live today. Thank you. Shockat Adam thank you, Madam Deputy Speaker. We all cherish the NHS and I think we all have a duty NHS and I think we all have a duty in this chamber to ensure that anybody that does not have the basic principle that care should basic principle that care should follow need and not wealth, must be nowhere near a jewel in our crown, nowhere near a jewel in our crown, the NHS. I would like to begin with primary care, or indeed the inequality in primary care, because they are absolutely glaring.

they are absolutely glaring. Practices in the most deprived areas carry on average, 300 more patients per fully qualified GP than those in the least deprived, a gap that has grown by 50% since
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Shockat Adam Portrait Shockat Adam MP (Leicester South, Independent)
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2018. In less than my constituency, my home, there are 1985 patients my home, there are 1985 patients per GP, significantly above the national average. Now, the Bill introduces a statutory duty to introduces a statutory duty to reduce health inequalities and neighbourhood health plans in clause 24, but a plan without the clause 24, but a plan without the workforce to deliver deliver. It is a plan in name only. I must also declare my interest as a practising optometrist and indeed in this bill we have clause 14, which gives integrated care boards new responsibilities over primary care services and the Bill transfers.

Commissioning of NHS sight tests from a national framework to individual icbs. I completely understand the logic of localisation, but I have already seen what happens in practice in Coventry and Warwickshire Community Urgent eye care service that was diverting over 13,000 A&E attendances per year was withdrawn at the end of 2025. In Hampshire, community glaucoma schemes have been moved back into hospitals. This is the postcode lottery in action. Speaking about glaucoma, it affects approximately 700 000 people in the UK, with around

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Half of the people walking around undiagnosed. It causes irreversible sight loss. It increases the risk of falls. It. It carries serious long term costs for both the NHS and social care. And we now have the technology to address it more efficiently than ever. The Istent inject device can ever. The Istent inject device can be inserted during routine cataract surgery in a single procedure, treating both conditions simultaneously. This is exactly the kind of innovation the ten year health plan calls for.

Yet uptake is inconsistent because there is no national commissioning guidance. I urge the government to ensure that the single patient record supports consistent clinical decision making across the glaucoma pathway and that icbs are required, not merely permitted, to commission those procedures. The Bill also abolishes NHS England, as we have heard much about it. But what I would like to say. History gives us cause for concern, especially when it comes to private finance initiative arrangements, because that has cost the NHS tens of billions of pounds over decades.

Finally, I'd like to speak about the Palantir question. The creation of a single patient record is absolutely welcome, but the vessel matters as much as the vision. The 330 million NHS Federated Data Platform contract, awarded by the previous government and inherited by this one, raises serious, unresolved questions and it must be addressed.
20:21
Rachael Maskell Portrait Rachael Maskell MP (York Central, Labour )
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Rachael Maskell Madam Deputy Speaker, The National must determine the what and therefore determine the what and therefore bringing together NHS England into the Department is the right decision. However, as many members have said today, it is the how. How we do this at a local level determines the outcomes that we see. And of course, with such huge inequalities, we have all spoken across about our constituencies today, how we deliver that, particularly that third shift on prevention, is really important.

And therefore seeing the right integration, the right systems and the right focus will bring our health service together at a local level. And I agree that the accountability processes are not in the right place under this bill, and I agree with the Member for Runnymede and Weybridge. We need to ensure that us in this place have that connection to the national and the local, whilst also integrating with those held publicly accountable from our councils and also combined authorities. But also the focus needs to be there as well.

And because we don't have common terminology between our commissioners and providers, we see people looking both ways to try and bring about a system which cannot have the capacity to deliver in such ways. So we need to have that bringing together of services to focus on a population health approach. And this bill doesn't do that. And I really think we need to think through what we're trying to see as outcomes, because I've lived through so many reorganisations and it's not the reorganisation, whichever delivers the satisfaction outcome.

And of course with ICB so stripped back now at this point, not being able to communicate with us as MPs, not having the resources to make decisions, that I really fear that that delivering the how will become harder under this model. But also we need to ensure that local accountability comes from our communities. And that takes me on to the issue of Healthwatch. We called them community health councils, abolished in 2003. We replaced them with public and patient involvement forums, replaced then by local involvement networks, and then Healthwatch soon to be scrapped.

If it didn't exist, we would invent it because Healthwatch has the independence which the new structures doesn't, giving patients and people confidence in a system that they can raise their voices, that their voices will be heard, and systems held to account. So I oppose clauses 64 and 65 with respect to schedules nine and ten, and ask government to reconsider and also take on board the questions that have been raised about our systems of being able to hold investigation. And he has done that well, and I think its role should continue.

And the reasons why I say this, if I look at what's happened for a decade of raising concern in this House, I do welcome the former Secretary of State committing to a public inquiry. But we don't have a chair and we don't have terms of reference. So it's really important that we put the right structures in

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place to hold the system to account. Adrian Ramsay thank you, Madam Deputy Speaker. The government Deputy Speaker. The government presents this legislation as technical restructuring. NHS England configuring reconfiguring England configuring reconfiguring the integrated care boards. It also says it wants to devolve power from Whitehall and give patients more Whitehall and give patients more control over their care. But there is a mismatch between this presentation and the contents of
20:24
Adrian Ramsay Portrait Adrian Ramsay MP (Waveney Valley, Green Party)
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the bill. While some responsibilities are being devolved, other powers are being drawn up to the Secretary of State with greater control over spending, appointments and key operational decisions, and there are serious concerns about how the patient voice is to be treated. And hearing that voice is essential if we are to redress inequality and replace the negative health impacts of austerity, bad planning, poor housing, weak transport and divisive social policies. With this bill, we have the chance to address the totally unacceptable 16 year age gap year gap in life expectancy between different postcodes in the UK.

I therefore urge Ministers to amend the Bill to include clear legal frameworks and across government strategy to mirror duties on strategic authorities for tackling health inequalities. Inequalities. I see in my constituency of Waveney Valley, where those without the means to pay for a private dentist endure horrible pain and suffering, where children go without care. Inequalities that mean men in the most deprived areas can expect, on average, to live 11 years less years in good health than those in the least deprived areas.

And it's a real concern that the bill would permit the Secretary of State to vary the proportion of public and private provision of health services, if they consider that to do so is in the interests of the health service. How might this power be used in the hands of a pro privatisation? Secretary of State for health? Turning to the issue of patient voice, it beggars belief that, as drafted, the bill abolishes the statutory duty underpinning local, independent, patient and public voice, including the entire network of Local Healthwatch organisations.

This must be rectified. We need independent challenge and without it the accountability is risked. Healthwatch Norfolk pointed out that they have a legal power to visit health and social care services and see them in action, but this bill doesn't mention this statutory power, nor how it might sensibly become the responsibility of the ICB or the local council. What will happen to it and helps Healthwatch Suffolk point out that recognition of an independent voice for patients has been a principal supporter by governments for 50 years.

But if this bill passes into law unamended, it will end that recognition. And finally, Madam Deputy Speaker, turning to the single patient record, ensuring that the different records in the health system are in one place, that patients don't have to repeat their stories is a really important principle. But that record must be safeguarded. And so I urge the Ministers to rule out awarding Palantir the contract for developing the single patient record, so we can ensure that there are clear safeguards in place.

Thank you. Lewis Atkinson thank you, Madam Deputy Speaker.
20:27
Lewis Atkinson Portrait Lewis Atkinson MP (Sunderland Central, Labour)
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History of the NHS. accountability, and that a range of different mechanisms have got a role from patient voice, patient choice, performance management, centralised performance management and planning, democratic challenge, competition and collaboration each have a place and it's for the government of the day to make a judgement about the right blend of mechanisms that it has to pursue its objectives. Overall, I see this health bill as a good attempt to do so, given the NHS that this government inherited and its ambitions as set out in the NHS plan.

There was undoubted duplication between DHSC and NHS in returning to the situation before 2012 of direct departmental oversight of the NHS is not a radical step. There are, of course, costs to this transition and unfortunately I do think in morale terms these costs were somewhat exacerbated by the regretful manner in which the original announcement about NHS abolition and ICB changes were made, which did not do justice to the commitment and professionalism of impacted staff. But that doesn't change the fact that the government's overall diagnosis is correct that since 2012, reforms since the 2012 reforms, accountability and has been muddied and a total reset of regulation is required to empower NHS providers to meet the urgent health needs of the population within the resources available.

However, I do echo that there are significant questions about the role of Hcid in this, and I hope that can be resolved at Committee stage. The government has been clear that it sees the role of Icbs in the future as strategic commissioners, and that capability needs to be developed. And I just want to echo the points of I. My right hon. Friend the Member for Middlesbrough and of Middlesbrough and Thornaby East, that that particularly needs to be done in relation with care in relation to specialist services.

That also needs to be resolution about how the development of neighbourhood health services will be strategically led. Icbs must retain the capacity to work at place level, and I join others in questioning the proposal to remove local authority representation on ICB boards. Combined authority representation does not suitably replace this. Mayor's responsibilities are entirely different and do not include, for example, anything to do with social care or public health. That rightly sit with councils and I think we need that hardwired into ICB board membership.

I want to end Madam Deputy Speaker on an area of health care subject to manifesto commitment, which is not, as it stands currently in the bill, delivering parity of esteem for mental health. It's unconscionable. Unconscionable that waits for NHS mental health services are significantly longer than for physical health waits, and there's as yet no specific commitment to bring them down. The 2022 Health and Social Care Act introduced a duty on the Secretary of State to report annually to Parliament on NHS mental health spend.

I do wonder that as part of this bill, if there would be scope to widen that duty to include reporting the difference of waiting times between physical and mental health, and to make some progress on the very

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welcome Cross-governmental mental health strategy that's recently been announced. Freddie Mierlo thank you, Madam

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Freddie Mierlo thank you, Madam Deputy Speaker. All too often in my role as a local MP, I have been frustrated by the buck passing frustrated by the buck passing within the NHS. My local ICB cuts a service pleading no money or service pleading no money or refuses to fund a new one. It tells me to ask the government. Government tells me it's a local Government tells me it's a local decision for the ICB and the cycle goes on. So with this bill, I welcome the accountability conferred onto the Secretary of State, but I'm slightly gobsmacked that they've agreed to it.

Every
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Freddie van Mierlo Portrait Freddie van Mierlo MP (Henley and Thame, Liberal Democrat)
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backbencher should be rubbing their hands with glee at this. This legislation makes the Secretary of State personally responsible for commissioning arrangements in all CVS. I am looking forward to the day this bill receives Royal assent to sending them a letter listing every change I want him to make, every change I want him to make, because my ICB has one of the worst offers on IVF. It has been far too offers on IVF. It has been far too slow to adapt to new dynamics in ADHD and autism.

It's left commissioning gaps in palliative care and closed down step beds, and now it wants to close down cam services. But I make this prediction. The office of the Secretary of State for Health and Social Care will balloon under this legislation, because every backbencher will be appealing to them to make sure that they get their local commissioning arrangements sorted. This reform is, of course, fully in line with the UK's overly centralised Whitehall system, but not in line with the government's supposed devolution agenda.

Mayors could be the answer to this, but the government has been too timid in the role of mayors within the system, merely sitting as members of the ICB. What of areas slow to get mayors? Finally, whilst this bill addresses Icbs, there's no reform of the sclerotic, slow to act Jcvi or National Screening Committee that have been painfully slow to act on spinal muscular atrophy screening. I'd like to turn. With the time remaining, I have to. Patient records to raise a serious concern whilst welcoming the single patient records overall in my constituency.

I was recently made aware of a case of a patient record being accessed multiple times, unrelated to their care. In fact, they were not receiving care at the hospital at the time. Instead, they were campaigning on maternity care. Clinicians had no business looking at the records. So whilst the single patient record of the scope of this kind is welcome, it opens up abuse of data privacy on steroids. So what steps will be taken to protect data and confidentiality? Finally, I'd like to cover the changes on how NICE recommendations are implemented.

NICE. So NICE trust trusts have 90 days to implement nice technology appraisals, yet this bill confers to them the. The Secretary of State the right to change that. How will that be handled? That should definitely be further seen in committee. Thank you.
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Alex McIntyre Portrait Alex McIntyre MP (Gloucester, Labour)
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Thank you, Madam Deputy Speaker. In my constituency. >> Of Gloucester, since the general election, there are ten 000 fewer people stuck on NHS waiting lists. We've got the green light for two We've got the green light for two new NHS dentist practices, and a new GP surgery is being built in Hucclecote. But Madam Deputy Speaker, now is not the time to pat ourselves on the back and say job well done. It's not even job half done. We must go further and start to deliver change at the pace that my constituents expect.

Too many people in my city still struggle to see their GP or dentist when they need to. A place on excruciatingly long waiting lists, particularly for mental health, and have to battle just to get a diagnosis. We have to go further now. I'm pleased to see the creation of the single patient record. I hear time and time again from constituents who are fed up with having to explain their story several times to different medical practitioners. Keeping records that don't speak to each other just doesn't make sense in the digital world that we now live in.

It's inconvenient, frustrating, and most of all, it threatens patient safety. I'm also grateful to the government for taking the bold decision to abolish NHS England. It's clear that the model hasn't worked and does not provide the value for money that Gloucester residents deserve. We are facing a health crisis in the UK, with significant gaps in life expectancy across the country. In Gloucester, if you live in Abbeymead like me, you're likely to have a whole decade longer than someone who lives just three miles down the road in Kingsholm.

That's just not acceptable and highlights the entrenched health inequalities found in constituencies like mine up and down the country. Deprivation, poverty and lack of adequate healthcare are harming life chances in every part of our United Kingdom. I therefore urge Ministers to meet with the charity Health Equals and consider their proposal to strengthen the requirement for the Secretary of State to tackle health inequalities. The Bill should also introduce a duty requiring all Ministers across government to consider the impact of major policy decisions on health inequalities.

Speaking of Cross-governmental missions, I read with interest the report from Alan Milburn last week in relation to young people not in employment, education or training. He sets out in damning detail the impact of the failure of the conservative governments to properly invest in mental health services. Today, mental health conditions account for 20% of all ill health in UK, but only 9% of NHS spending. Our committee has recommended making the mental health investment standard a statutory requirement, and the government should seek to make that amendment.

I would also ask the government to consider amendments which confirm our commitment to tackling the obesity epidemic in this country. I and several other committee members were concerned to read press reports that the government was considering scrapping measures, including the ten year plan to tackle the obesity crisis. Can I ask the Ministers to confirm at the Dispatch Box today that the Department of Health will not bow down to pressure from the supermarkets and large food manufacturers to scrap our important work on obesity? We spend billions of pounds every year on tackling obesity related illnesses, while food manufacturers and supermarkets lobby to avoid scrutiny.

Of course, we need to do more to tackle the cost of living, but the food lobby's argument that we need to choose between the cost of the weekly shop and tackling the fact that 1 in 3 children today are overweight or obese is disingenuous at best. This bill is great, but there is more that we can do to tackle mental health waiting lists, to tackle obesity, and to tackle Gloucester.
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Andrew George Portrait Andrew George MP (St Ives, Liberal Democrat)
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Andrew George Madam Deputy Speaker is an enormous pleasure to Speaker is an enormous pleasure to follow, my hon. Friend, in the sense that she is also a fellow member of the Health Select member of the Health Select Committee. It was referred to earlier the the 2012 act, and of course, I was one of the few people course, I was one of the few people in this House at the time of the passing of that of of that act. And I have to say that that having been in a sitting on the coalition benches at the time, and someone who eventually voted against the second and Third Reading of that act, I did so for reasons because it broke the coalition agreement.

We agreed at the time that we would there would be no top down reorganisation, but there was to be the biggest reorganisation that the NHS had ever seen. And although the Liberal Democrats made it significantly less bad, and I congratulate all those who are involved in it, there was still there was still there was still. There was still far too much that actually. You know, damaged the NHS at the time. And I welcome this bill as it is. It is addressing some of those those deficiencies with regard to the points which were made by the the the right hon.

Member, the Member for Harwich and and Essex East II. I strongly agree that the whether it's the abolition or the merging of the Health Services safety investigations body into CQC or the abolition itself. Yes, I will give one yes.

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Of the bill said H shall be abolished. It's going to be

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abolished. So to the right hon. Gentleman, I mean, certainly in in the in the I mean, certainly in in the in the representations made by both the CQC and H itself, there seems to be reference to the amalgamation within within the C, the the CQC but the point is that that, as he rightly says, there is a really important role played by by H which could be lost as a result of this. It is. It is a vitally important safety safety agency, and its independence is really vitally important.

There needs to be a safe space that gives those working in the service confidence that they can whistleblow confidentially to that service in order to to improve and protect and enhance patient care. And, and there is a major risk, as the evidence has shown in in that in that the there will be protected the the protected disclosure of important legal information could in could in fact be a be compromised as a result of the of this. Yes. So in terms of my second point, a lot of people have referred to reducing inequalities in clause four, and I entirely agree.

And certainly if we're talking about reducing inequalities, I hope that the Ministers will also look at geographical inequalities as well, because there are places like that in my constituency where those who, particularly facing a special emergencies query stroke patients, where as a result of clinical improvements and subspecialty developments, those services are moving further and further away. So, so where mechanical thrombectomy, for example, in 10 to 15% of stroke cases are required, for example, in West Cornwall, they need to travel 80 miles to Plymouth in order to be able to get that service.

And that is a geographic inequality, which actually is reflected in other areas of of subspecialty throughout the the service itself. In clause ten, there is reference to causing a variation in the provision of health services by public and private sector. I'd be interested in the Minister's explanation, whether that's to protect the public sector or to protect the the. The private sector and others referred to the Federated Data Platform was an excellent speech by my hon. Friend the Member for Newton Abbot on the 16th of April.

I hope that the Ministers will look

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at that. That debate. Thank you. I do, of course, very much welcome this Bill and the welcome this Bill and the modernisation will bring to deliver. The change that is needed does require fundamental redesign of NHS structures and practices. Without a willingness to make the big changes, we will never deliver on the aspirations of the NHS ten year aspirations of the NHS ten year plan. But at the same time, NHS staff and patients need to see a change now. We cannot reasonably expect our residents and frontline
20:41
Andy MacNae Portrait Andy MacNae MP (Rossendale and Darwen, Labour)
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expect our residents and frontline workers to buy into this long term vision for the NHS when they face so many issues with services now, so I would like to briefly ask the Secretary of State how this bill and the ongoing change will impact some of the areas of most concern to, for instance, my residents in Rossendale and Darwen, and top of the list for us would be Blackburn A and E. This is one of the busiest in the country, and I fully recognise the work being done by brilliant doctors and nurses to try and manage the demand.

But nonetheless, the indignity of corridor care remains a blight. Almost every week I hear of patients spending hours and hours in the corridor, not knowing whether they'll be seen, often in discomfort for the exposed, anxious and unsupported ending. This sort of experience, I believe, is a crucial test for NHS modernisation per se, and only when we see the end of corridor care in Blackburn A and E and others will the residents of East Lancashire feel that something has really changed for the better, and this Bill is also about improving patient safety, as we've heard, and includes some significant steps.

But again, what about the practicalities? For years now have been stuck in a vicious circle of investigating shocking cases of patient harm and system failure, making numerous recommendations to improve safety and failing to implement them, and repeating the same mistakes. We must break this cycle and it simply can't be about only simplification. It does require bold action as well. For example, as we've heard many times in this place, we have a crisis in maternity safety, and soon Baroness Amos will deliver a report of a national investigation.

This is likely to identify a requirement for some really fundamental systemic and cultural change. There will also be areas outside the remit that need to be addressed, such as the role of the regulators in a fit for fit for purpose patient safety landscape. I wonder, therefore, if the bill goes far enough and if there will be a need for amendment after Baroness Amos reports, and perhaps the Ministers or Secretary of State will share some thoughts on that. And finally, I'll touch on prevention. The move from sickness prevention is one of the three big shifts of the NHS ten year plan.

It's surely the key to a health service that's sustainable in the long term. Whilst the bill makes some reference to prevention, a lot of it frankly feels pretty peripheral and leaves some key questions unanswered. For instance, how, in a practical sense, are we enabling Icbs to support prevention at a local level at a scale that will make a difference? How are we driving prevention agendas across government departments? For instance, are we doing enough to ensure healthy lifestyle habits are developed in early years and at school? Why are we not putting social prescribing of proven interventions, such as exercise programmes, on the same financial footing as pharmaceutical interventions and so on and so on? So I suspect that Committee stage will be crucial in making sure this bill matches its aspirations, and I look forward to Secretary of State thoughts on how we can balance long term modernisation with delivering change today.
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Martin Wrigley Portrait Martin Wrigley MP (Newton Abbot, Liberal Democrat)
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Martin Wrigley thank you, Madam Deputy Speaker. Deputy Speaker. >> I'll focus on two things. The changes in data privacy and access in this bill to support a in this bill to support a centralised single patient record and the abolishment of Healthwatch Healthwatch Healthwatch is not the same as the other regulators. It should not be amalgamated. You can only amalgamate regulators if they have a single purpose and a single viewpoint. Healthwatch today isn't a regulator, it's a patient advocate and there are no others in the system.

Without Healthwatch. The remainder of the checks and balances come from the medical profession and the health establishment, and we've seen cases where that goes wrong. Healthwatch guards against that. It's a vital body to speak up for the patient rather than the NHS itself. I will give way.

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Thank you very much for giving way. And I've had a look at the parliamentary record, and Healthwatch has been mentioned over Healthwatch has been mentioned over 100 times over the last five years. One of the key areas of focus is actually its reporting and the insights that it provides to members of Parliament like ourselves. I wonder whether he agrees with me that whatever

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agrees with me that whatever replaces Healthwatch must retain that research focus. I thank the hon. Member for his intervention. Absolutely agree. We heard earlier, Kevin Dixon of Devon gives us excellent reports on what's happening with Healthwatch. The modern NHS must run on data, but critically on data that carries the consent of patients. Single patient record is undeniably critical to see the data of patients all in one place, but it must be built from a patient's point of view, not from a centralised data analysis point of view and with privacy by design.

From day one, we obviously need GPS to see hospital data, vice versa, and ambulances to see everything they need to help. But we do not need the new regulation to do this. The single patient record already exists in a federated model in Greater Manchester, Merseyside and Shropshire, and more trusts already run with this interoperable access for care services, GPS and hospitals. Government admits this but claims it is partial and fragmented. They also claim that the data will remain in the systems where it currently exists.

However, they are asking in this bill to remove all protection of patient data. When you look at paragraph clause 47, paragraph two, sections one and three, we have to trust somewhere below primary legislation that it will all be OK and we trust the regulation. This is a big tech approach to deliver an overreaching, centralised system rather than a distributed, interoperable solution. NHS England has ignored and discounted UK sovereign systems that can and do provide what is required, along with patient trust systems built over years with focus on patient treatment and defined use cases, could be rolled out today, with no change required in the law.

And privacy by design. Built in from day one, Greater Manchester and others has had this single patient record capability and has the hard won foundation of trust. Madam Deputy Speaker, I will be placing amendments to remove the relaxation of data privacy from this health Bill. As we can see that it isn't necessary if NHS England does not follow the Palantir advice, but instead follows what is actually proven to work. Perhaps what has been proven in Greater Manchester, Merseyside, Shropshire and many more.

Perhaps this is an example of what has worked in Manchester that might

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work everywhere. Thank you, Madam Deputy Speaker. The NHS does indeed need reform, The NHS does indeed need reform, not least after the years of conservative underfunding, fragmentation and neglect. Now, fragmentation and neglect. Now, firstly, I strongly support the government's commitment to shifting government's commitment to shifting NHS from sickness to prevention and as co-chair of the APPG on Smoking and Health, I was proud to support
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Mary Kelly Foy Portrait Mary Kelly Foy MP (City of Durham, Labour)
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be built into the machinery of the NHS and that must apply to mental health provision too. My constituency office deals with huge volumes of casework involving people waiting too long for support, people waiting too long for support, families in crisis and vulnerable people being passed between services. Secondly, on patient services. Secondly, on patient safety and patient voice. In County Durham, we've seen the devastating consequences of failures in breast cancer care at County Durham and Darlington Foundation Trust, and I pay tribute to the brave women who have spoken out after unimaginable distress.

And their experience was in sharp contrast to the excellent cancer care that I received only 12 miles away in a neighbouring hospital. So I hope that clause four addresses the postcode lottery in quality of care. And I also think of a husband who lost his wife and two sisters who lost their mum after tragic failings and what should have been routine care. And their fight for justice continues. And this bill must not weaken independent scrutiny or make it harder to raise the alarm when things go wrong.

And I want to briefly raise dentistry as co-chair of the APPG, I know that access to NHS dentistry is one of the clearest examples of where the system is failing constituents. Dentistry is public health, and Ministers must explain how Icbs will be held accountable for NHS dentists care. And finally, on the single patient record, there is real potential for better joined up care, but patients must have confidence that their information is safe, confidential and used in their interest.

And that means safeguards on NHS data, including the role of private technology companies such as Palantir, and transparency around access by private providers and consultant partnerships, including LPs. And the point of reform is not to move boxes around Whitehall. It's to make sure that when people in County Durham and across the country need care, they can access

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it, trust it and be listened to. Thank you. Madam Deputy Speaker.

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Madam Deputy Speaker. We all of us here want to see a better NHS, but there is a profound better NHS, but there is a profound contradiction at the heart of this bill. The government is handling bill. The government is handling handing Icbs more responsibility and authority with one hand while cutting them off at the knees with cutting them off at the knees with the other. Icbs are being merged, clustered and completely reorganised, with no idea of what the landscape will look like in six months, let alone six years down the line.

In my constituency of
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Dave Robertson Portrait Dave Robertson MP (Lichfield, Labour)
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Thank you, Mr. Speaker. We're obviously here tonight to talk about a very large piece of legislation, but in my remarks, I'd like to focus on just one part of it and the changes that the government wants to bring in around the planning for the future in the NHS, because that is so very neat. And there is possibly no worse example of where it's going wrong than in Burntwood in my constituency. Almost 20 years ago, a new doctor's surgery was planned for the town, and the NHS at that point was very good at knocking things down.

But when the coalition rode into town in 2010, all the funding for the replacement was cut. And here we are almost 20 years later and there is no replacement. The detriment to the town has meant that for well over a decade, people have in Burntwood have had to see their doctor in Portacabins, on the car park of the leisure centre, and in all of that time nobody has stepped up to right that wrong. We thought there might be light at the end of the tunnel in 2023, when we were promised a replacement by the end of last year.

However, before that happened, some pen pusher at NHS England decided that the existing surgery in that temporary structure had to close 5000 patients distributed to other surgeries in the town. That's a town of 30,000 people. So a significant number just just dispersed. Just dispersed. It'll be fine. Don't worry. We'll just disperse them. That dispersal was so traumatic that actually an existing surgery has had to pick up the same temporary structure and is structure because the replacement is still not here.

It wasn't delivered by the end of 2025. We do not have the planning application yet. We are yet again promised that this will be here by the end of next month. Now, I'm very aware that the Reform County Council inherited that from a conservative county council. They inherited that promise, but they didn't seek to talk to the people in Burntwood. They didn't seek to explain why it wasn't going to be met or it was going to be met. They just blew past it. They broke the promise with very little expectation.

We've now got another one and it must be met because so many people across that town have seen so many broken promises, so many false dawns. They are failing to believe that it will actually come good. And this entire saga really reinforces exactly why this bill is needed, why these changes are needed. Because I don't want any other community in any other constituency to be so overlooked and so forgotten. The way that Burntwood in my constituency has been for so long,

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a. Madam Deputy Speaker, reducing. Duplication, streamlining. Priorities.

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Priorities. Getting resources close to frontline care. These are reasonable aims. My concern is that in pursuing simplification, this bill makes a series of choices on patient safety that it's not clear patient safety that it's not clear to me have been fully thought through and risk repeating mistakes. This country has paid a very high This country has paid a very high price to learn from through successive inquiries. Mid staffs, Morecambe Bay Shrewsbury Ian Paterson you could name more. Parliament has repeatedly
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Ian Sollom Portrait Ian Sollom MP (St Neots and Mid Cambridgeshire, Liberal Democrat)
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recognised that the NHS cannot be relied on upon to scrutinise itself. Each found the same pattern concerns present within the system but not acted upon. Problems but not acted upon. Problems developing in isolated services, and a culture in which those who raised concerns were treated as the raised concerns were treated as the difficulty, rather than as sources of vital information. Yet this bill's general approach is to bill's general approach is to remove independent scrutiny rather than improve it. Now, Madam Deputy Speaker, I am not arguing that all the bodies that have been created Healthwatch, the National Guardian's office which had been absorbed into NHS England, which will now be abolished, who have worked exactly as intended.

In fact, I've been working with families and others affected by failures at Cambridge University hospitals that particularly suggest they've not published independent investigation commissioned by the trust there found 32 missed opportunities to identify and address concerns about paediatric orthopaedic surgeon. Between 2012 and 2024. Children

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give. Way.

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Way. The excellent question because the review accused her of exceeding the review accused her of exceeding its remit and that is in fact, completely wrong in law, and it was completely wrong in law, and it was always intended to look at systemic always intended to look at systemic problems across the system. The new investigation function in CQC will not be able to do that because it

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will not be independent. Well, and I think CQC and Exeter

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Well, and I think CQC and Exeter themselves are expressed concerns about how those two organisations might be brought together. I think might be brought together. I think the fact that a a I b is separated from the CAA is the model that was from the CAA is the model that was was created for a good reason, and you made some good points about the statistics around that earlier. Just returning to the case I was talking about, though, a clinician at the at the trust who did raise concerns formally in 2015, was simultaneously subjected to disciplinary proceedings and told by the trust that they did not want to hear any more complaints.

I wish I could say that I hadn't heard similar stories from NHS staff several times in a little under two years as an MP, but just because there are some flaws in those independent systems for the NHS is not a reason to remove the independence that's. That would represent a return to conditions that so many of those inquiries warned us about. And I think patients would rightly question whether lessons have really been learned. So as the Bill proceeds to committee, I would urge the government to use the process to ask a simple question about each body that it proposes to absorb or scrap, not just whether the function will still be performed somewhere, but whether it will be performed with genuine independence from the organisations that it scrutinises.

That independence has been hard won, and I hope Ministers will reflect on that carefully before legislating to remove it. Thank you.
20:58
Beccy Cooper Portrait Dr Beccy Cooper MP (Worthing West, Labour)
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We're going to make it very difficult for everyone. debate. Doctor Beccy Cooper. >> Thank you, Madam Deputy Speaker. I will try and keep my remarks brief. The NHS is one of the single brief. The NHS is one of the single most unifying institutions in our country today. It's a huge employer, a major source of pride and a safety net for us all at our moments of greatest need. But we all know that it has been creaking under significant strain for some time now, so it is good to see new life and new energy.

A ten year plan. And I welcome this NHS Bill as a response to some of the purpose outlined in the strategy. There is a lot of detail in the Bill that has been covered by colleagues already, and will doubtless be covered further in Bill committee, so I will limit my remarks to single patient records and the role of public health in this bill. Firstly, I am fully supportive of a single patient record finally being realised. Our health and care system should revolve around patients rather than patients revolving around it.

It is over 20 years since I was a junior doctor, but I still remember mine and my patients frustration when I once again had to ask them for their clinical history after they had already told it to their GP, the paramedic and the triage nurse. This endeavour has been tried several times before. The financial cost of NHS digital and the litany of platforms, software and systems that have been tried and abandoned provide a wealth of lessons learned to ensure that it is successful this time, which is, let's face it, long overdue.

Public trust is very important for health data systems, and we could consider new safeguards, such as a public interest test for sharing data or bringing back requirements to report to Parliament. The NHS must ensure that the technical know how is sound, as well as being fleet of foot. So the role of public and population health in this NHS Bill. Public health must be front and centre in order to provide the right health services in the right place, at the right time, at an ICB level, an integrated care board level, there is now an explicit requirement for population health considerations to be understood.

Integrated care boards will be responsible for commissioning the vast majority of our local NHS services, and therefore need to know what the population health need is. This has been demonstrated in my own ICB area of Sussex over the past couple of weeks. In the discussions about proposed sites for neighbourhood health hubs, it became clear that the population needs of my particular constituency in Worthing West had not been entirely understood when considering sites. There is a large area containing several villages with an ageing population and limited access to transport that had not hit their radar in terms of neighbourhood health hub requirements.

And to be clear, this is not about blame. Anyone who thinks that planning for population health needs is straightforward is very welcome to sit the public health exams in epidemiology and statistics. Expertise is there to be utilised and we should draw on it. I therefore suggest that we should make a statutory appointment for a Lead Director of Public Health to represent the area covered by each integrated care board. Finally, in order to guard against a focus solely on reorganisation, we must have sitting alongside this NHS Bill and as a key focus of the ten year strategy, a whole government approach that recognises health as a strategic and shared asset for the wellbeing.
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Navendu Mishra Portrait Navendu Mishra MP (Stockport, Labour)
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Navendu Mishra thank you. >> Navendu Mishra thank you. >> Madam Speaker. Can I declare an interest as the chair of APPG for cancer and donations from trade cancer and donations from trade unions to my constituency Labour Party? I welcome the Bill to modernise the NHS, but in Stockport, our local hospital Stepping hill needs a lot of modernisation in terms of the building is quite old and lots and lots of problems have presented itself over the years. I'm grateful to the Ministers for meeting with me a few weeks ago to talk about Stepping Hill and the former Health Secretary, and I have also had several conversations about the Stepping Hill estate.

I urge the government to work with, with with myself and the other MPs in Stockport to to have a long term solution for Stepping Hill. I am, of course, very grateful to all the doctors, nurses and volunteers at Stepping Hill Hospital. I do want to mention Icbs as they feature quite a lot in this bill. My experience of Greater Manchester ICB for. I want to thank British Fertility Society and the Fertility Alliance, the charity, for all they've done on protecting access to IVF.

In particular my local councillor Carl Wardlaw and his late wife Jody Wardlaw. I want to thank them and place on record my gratitude to them for all the work they did on protecting access to IVF. The Greater Manchester ICB did a on levelling down the offer for NHS funded IVF treatment across Greater Manchester to just one cycle in each borough, including mine of Stockport, and 74% of respondents completely disagreed or disagreed with the proposal to level down to one cycle. Only NHS Greater Manchester ICB just proceeded with this.

They did the consultation. I'm not sure how much time and money they wasted on it, but they just proceeded with the levelling down offer of just one cycle of IVF. So my experience is very, very poor. Can I also place on record that many, many constituents have written to me about their concerns regarding Palantir and access to their data? I know Unison Union has also raised significant concerns about the damage done to public confidence by government data initiatives, by the use of organisations such as the spy tech firm.

I have very limited time. On a more positive note, as we're talking about NHS, I'm always keen to encourage more people to donate blood. I've been donating blood myself for almost ten years. Can I place on record my thanks to everyone at the Plymouth Grove Donor Centre in Manchester. In particular, I want to thank Conor, Phil, Vivian and Dorcas who always look after me and can I ask the government to do more to promote blood donations? In my closing remarks, I welcome. I welcome more more democracy and accountability for the NHS in terms of the reforms the government is bringing in, but we must make sure that health inequalities are addressed and reduced.

In the richest part of my constituency, you can expect to live almost nine years longer than if you live in the most deprived part of my constituency. Thank you, Madam Speaker.
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Peter Prinsley Portrait Peter Prinsley MP (Bury St Edmunds and Stowmarket, Labour)
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taken to the nearest hospital late on a Saturday night. The doctors had no access to his medical notes and no answer when they called the and no answer when they called the hospital in London, so they were puzzled. This is a situation familiar to doctors. Patients are incredulous when they're told that we're unable to see all their medical records. Surely everything medical records. Surely everything is on the computer now. As a surgeon, before becoming an MP, I worked in at least three different hospitals.

No compatibility between the records, which meant that transferring care was complicated and hazardous. I'd be asked to advise on a patient from another hospital, relying on a dictated note from the referring doctor, but I couldn't access the clinical records. The results of the investigations, such as the pathology tests, the scans, or, crucially, the operating record consultations delayed. As I stared at creaking computers, numerous software programs, each individually, individually, protected by ever changing and forgettable passwords that slowly booted up. This obviously needs to change now.

I would link the NHS number to unique single patient record. I would give ownership of the record to the patient and let the patient be the custodian and the gatekeeper. This is the truly revolutionary idea. If you can easily take a look at your medical record with appropriate physician safeguards, you could monitor everything your blood pressure, your heart rate, and perhaps there'd be an incentive to look after your health a little bit better. Now imagine for a moment the power of anonymised medical data.

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



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But it must be sure. As the hon. Member, that all the

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As the hon. Member, that all the features he's asking for are available to people within the Greater Manchester area. And exactly those things are there and exactly those things are there and it's there and works today, even down to the remote monitoring he mentions.

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mentions. I'm grateful for that intervention. I am aware that in various bits of the country, such various bits of the country, such systems do exist, but what I would like to see is a single patient record which was genuinely single, so that when my hon. Friend who's sitting next to me writes something in the record, I see it. And when I write in my record, he sees it. So we have no letters that are passing to and to and forwards between us.

That's why I'm sure that legislating for the mandatory single record is what we must do. And as a surgeon who's worked for 40 years in the NHS, I will do everything I can to help.
21:07
Simon Opher Portrait Dr Simon Opher MP (Stroud, Labour)
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Simon Opher thank. >> You, Madam. >> Deputy Speaker. >> It's a pleasure to speak in support of the health Bill, which I believe really does have the power believe really does have the power to transform patient care in the NHS. Now, I think the House is aware, particularly after the last speaker, that I also have a vested interest. I'm actually a working GP in the NHS in Stroud for at least the last three decades. And in fact, I did a surgery last Friday and I excitedly told the other doctors, we're going to have a single patient record.

To which they said, instead of being, they said, it's about time. And those of us working NHS have been calling for a single patient record for absolutely years. So it's about time a patient can tell their story just once. It's about time a GP knows what a consultant saying and what a consultant. A consultant knows what a GP is saying. It's about time when a patient gets admitted to A&E, they know what the GP has already done. It's about time that when a patient gets referred to a psychiatrist, they know which antidepressants have been taken.

So my patients are. The previous speaker said, struggled to understand that we don't all know what's going on and in fact, in terms of communication, we got rid of our fax machine in our surgery only last year, in fact. So we are fairly behind. But this bill really does lay the foundations for this to be remedied. So the benefits are huge, obviously, to patients with their medical knowledge at their fingertips. For clinicians for integration, you can't have integration without decent single patient record.

And of course research. I think our data that we have is actually a national asset. And I do fear that a company like Palantir owning our data is actually a derogation of our duty, and we should use this as a fantastic resource. I also very worried about Palantir, their involvement with death in Gaza, infringement of civil liberties under the I in America and indeed in Chelsea and Westminster Hospital. It seems as though the benefits that they said they brought to to the operating theatre weren't actually provable.

So one other thing I'd like to say about this is data is owned at the moment by GPS. And if there's a if there's a spillage of this data, then GP practices are unlimitedly liable. So we must change that. Otherwise no one will become a GP partner. And can I also say that we must be careful that excessive and over the top safeguarding can prevent a single patient record and that will harm patient care. So just very

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quickly going on to the NHS. Take an intervention on the single patient. Record, I will yeah. Would he agree with me that we

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Would he agree with me that we must have a single patient record, not simply federated records from

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other sources? Well, I do agree with that. That is a much bigger job. And at the moment mental health uses a moment mental health uses a different system to the hospital and it would be great to unite it. I agree with that. Whether that's I agree with that. Whether that's possible in the next couple of years, I'm not so sure. But let me just very quickly go on to the NHS. The administrative burden from NHS has been huge. As a as as my hon.

Friend just mentioned with GP surgeries and it's fantastic to get rid of this. Can I also say that the CQC inspections is the little slight little bit here for GPS get these inspections and we have to do these pointless protocols to fulfil the criteria. There's weeks of work. Why don't we have a much more supportive, lighter touch? We're looking at proper data around GP surgeries, which we don't have to prepare for. That would be very, very popular with GPS. So to conclude, Madam Deputy Speaker, I warmly welcome this bill.

It's about time we reduce this ridiculous administration around patients and allow clinicians to properly care for patients. And it's about time we had a single patient record.
21:11
Liz Twist Portrait Liz Twist MP (Blaydon and Consett, Labour)
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Yeah. >> Now, first of all, very much welcome this bill designed to deliver and work with our ten year plan. In that bigger picture, I plan. In that bigger picture, I want to touch on three issues raised with me by my constituents in Blaydon and Consett. The first is the issue of the single patient record. And of course, it makes absolute sense for everyone to be able to access up to date records when a patient is admitted. And I think of the the groups I've worked with who have conditions, for example, who find when they're taken into a different hospital, the the doctors there are not able to access the records of their specialist treatment.

So that's the first thing. But there is a good deal of concern among my constituents and that of others about how that is managed, brought about, and also how the data itself is handled and contracts are awarded. The second issue I wish to raise is Healthwatch, and I understand the government's intention to actually strengthen patient voice through this bill and to raise issues, but there is a real concern that an organisation inside DHSC will not provide that independence.

And will the Ministers commit to look again at how that independent, how that independence can be built in and linked with that ability to pull the levers that that Ministers have talked about and make a real difference for patients. It's getting that balance right. But finally, I want to talk about mental health services and parity of esteem as we move from treatment to prevention services. We need to use this legislation to reinforce that there needs to be that equality of esteem for parity, for mental health services as well, as well as the ability to access that.

So we need to build in preventative measures and access to those mental health services. And I would just like to comment on the point made by my hon. Friend the Member for Worthing West about building in public health issues into the overall health framework. So I think we need to look at re-establishing that public mental health function within DHS under the new arrangements, and indeed within Icbs as well. We need also to link this, of course, to our mental health strategy, which we're awaiting in the very near future.

So I welcome the bill greatly and look forward to seeing those issues addressed in committee.
21:14
Josh Fenton-Glynn Portrait Josh Fenton-Glynn MP (Calder Valley, Labour)
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Josh Fenton-Glynn Deputy Speaker This bill has to be set in the proper context of the mess that we are clearing up from the previous government. The Darzi report laid government. The Darzi report laid bare the state of the crisis in the NHS, and we must learn from that government's disastrous reorganisation because we can't afford to make those mistakes. So I approach this Bill as a critical support of the changes that we have made and that we seek to make. I haven't always given him the easiest time, but I have to pay tribute to the leadership of the Member for Ilford North, both in this bill and in the NHS more generally, waiting lists are down, treatment is up, and we're seeing a real shift to the priorities that we need, from sickness to prevention, from analogue to digital and from hospital to community.

We've seen over an overall reduction in NHS waiting lists of over half a million since July 2024. I also welcome the new Secretary of State to his place, who's got a famed eye for detail which this job demands, but I hope that his background in local government means that he will take seriously the need to get to grips with social care. It is clear that there is a real problem that needs fixing. Over the last decade, the centre of health policy has increased staffing across DHSC and

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NHS England, and local commissioning bodies Has doubled since 2013, from

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Has doubled since 2013, from 20,000 to to 40,000. The Lansley reforms were one of the most high handed acts of sabotage a government has ever committed on the health service. They were meant to reduce bureaucracy, improve to reduce bureaucracy, improve efficiency and save money. And frankly, they achieved none of those things. So I would like raise those things. So I would like raise some concerns about the bill that came up in the recent Health and Social Care Select Committee. I'm just curious as to how the merger in practice will be able to reduce 50% of headcount from NHS DHSC and Icbs concurrently, without causing unintended consequences.

It's something that I'm concerned about and something that I'd like to see more detail on, because particularly when you look at the scale of the changes that we're also trying to make in the NHS. I also want to mention a report that was published in 2012 by the Institute for government called Never Again, which looked at the Lansley reforms. It warned against making redundancies that are quickly undone as organisations try to recognise that essential roles have been lost and end up rehiring the same staff.

The cost of redundancies in this bill are estimated at about a billion. The cost of the redundancies are about half, half of that. But 1 in 5 of those staff ended up being re-employed by the same organisation. The Select Committee heard before, before this that in some areas of NHS it is under-managed. And what I don't want to see is clinicians taking on those roles. So overall, I do support the bill, but we should be clear that the organisation at the centre and at the scale is not simple.

It has to be properly planned, properly, properly co-ordinated and properly communicated. So I welcome the new Secretary of State, but I hope that we can have a bill that makes those changes. We need Sojan Joseph.
21:17
Sojan Joseph Portrait Sojan Joseph MP (Ashford, Labour)
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Thank you, Madam Deputy Speaker. >> Thank you, Madam Deputy Speaker. We have. >> Already seen the difference. >> A Labour government can make in

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A Labour government can make in improving our NHS, and this is the result of the difficult choice this Labour government has made to Labour government has made to prioritise investment in the NHS and our other public services. But I know from my 22 years working in our health service that investment on its own is not enough. That's why I am pleased to see this bill, which is which will reverse the legislation passed during Conservatives and Liberal Democrat coalition, made NHS overly rigid and too prescriptive, increasing bureaucracy and weakening accountability.

This bill is an important part of delivering a reformed NHS by implementing elements of the plan that requires legislation. I particularly welcome the parts of the bill that, looking to amend the National Health Service Act to make provision for establishment of a single patient record. Patients too often receive care that is not as coordinated as it could or should be, meaning that they must repeat their story each time they see a different medical professional. In my own experience, I know that mental health services, mental health patients go to A&E, explain their story to the doctors there, and then they explain the same story to a mental health worker, and then they explain the same story the next day when they get admitted to a mental health ward.

It is a very challenging for professionals and the patients. So this single patient record can be very useful. We have also seen that these patients who are coming from other parts of the country, for example, a patient from Manchester could be admitted to Kent who may not be the doctors and the medical professionals will not be able to access the record of that patient for many days. In some cases, that delays the treatment, so it is going to be a very big step to have a single patient record.

The other area I'm really welcome is the abolishment of NHS England, and my time in NHS has seen layers and layers of management structures and scrutiny by different organisations. It's caused lots of repetition, so I welcome the abolishment of NHS England, but I would like to see that money goes into frontline so that we can recruit many more nurses who can have a hands on care on patients. And finally, Madam Deputy Speaker, I would like to raise the issue, as many other colleagues raised here, about the parity of esteem in mental health services.

So I would like to hear from the Ministers to see that that we have the single record system that's not just implemented in other parts of the health system. It also should be implemented in mental health services. Thank you.

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Josh Newbury thank you, Madam Deputy Speaker. Before I became an MP, I worked in communications in our NHS and in communications in our NHS and combined with numerous stories from my constituents that gives me a view of the NHS at its best, but also where things don't work as also where things don't work as they should. Very few of our constituents think about the structures of the NHS. For them, structures of the NHS. For them, whether it's working right comes down to whether they can see a GP and how long diagnosis and and how long diagnosis and treatment takes.

I welcome this bill because all of us have constituents who've had to give the same information over and over, wasting their time, their clinician's time, and undermining trust in the fundamentals of a unified national health Service. A member of my team told me about one of her family members who suffered a stroke two years ago. He got to A&E at 11 a.m. was diagnosed after several hours, and then at 6 p.m.
21:21
Josh Newbury Portrait Josh Newbury MP (Cannock Chase, Labour)
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after several scans was told he needed to travel to another hospital to see a specialist there, hospital to see a specialist there, he was told the data hadn't passed across, so all of those scans and tests had to be done again. Stories like that demonstrate why the single patient record made possible by this bill is so vital for patients who shouldn't have to patients who shouldn't have to repeat their symptoms, and for clinicians who want to focus on care on the abolition of NHS care on the abolition of NHS England, the government is right to shift money currently tied up in monolithic bureaucracy to frontline services.

But as one of, I assume, very few former NHS communicators in this House, I want to dedicate the time I have left to them. The abolition of NHS comes at a time when icbs are shedding half their staff and busy clustering. It's a time of immense change and anxiety for staff. Recently I've seen a slew of posts from brilliant NHS communicators who are signing off for the last time, or bittersweet celebrations of securing a role. Whilst many colleagues are leaving. Some see NHS communications jobs as a nice to have, but the reality is they are the people who make sure patients from general practice through to discharge know how to get the right care at the right time.

They're the ones who spring into action. When the phone lines go down, they tell the stories of real people working and getting treated in our NHS, which is so vital to encouraging others to spot early warning signs and come forward. Comms in the NHS literally saves lives and that is why when I see comms professionals leaving the NHS, I fear we could be throwing the baby out with the bath water through this important and justified process of change. I pay tribute to every NHS communicator, and I hope the Ministers could say a little about how these legends will be valued and retained.

This bill will do so much to improve the NHS for millions and millions of people in our country, so I will proudly support it. But let's make sure we know the value of everyone who makes NHS work world class. Thank you.
21:23
Luke Murphy Portrait Luke Murphy MP (Basingstoke, Labour)
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Luke Murphy thank you, Madam >> Luke Murphy thank you, Madam Deputy Speaker. I want to welcome the NHS modernisation Bill as the next step in improving NHS. When I next step in improving NHS. When I was elected as the Member of Parliament for Basingstoke, the access to GPS, dentists and mental health services wasn't good enough. There were unacceptably long waits for elective care at A&E. Sorry and at our A and E, and the poor condition of our current hospital building and an overstretched primary care estate.

So I welcome the progress made since my election nationally and locally, through the investment and reform and hard work of NHS staff, we've seen over 3500 fewer people now waiting for healthcare at Basingstoke hospital under a Labour government, more GP appointments delivered across Hampshire than ever before. Money to upgrade the practice at Chippenham. Surgery from the Government's Upgrade Fund and after significant pressure from my office, the local council providing developer contributions for the same surgery of nearly £1.4 million. But we do need to go further.

We've made progress, but there is so much more to do. I wanted to particularly recognise in this bill the important bringing about of the single patient record. Before my dad died at the end of last year, he spent many days, weeks and months over many years in hospital, in diabetic foot clinics, in dialysis units, in far too many intensive care units and wards. And while the single patient record will bring about safer care and more efficient care, the most important thing for me, and as many other members have mentioned, is the reduction of burden, anxiety and stress on both the patient but also their carer.

I remember vividly the number of times being in hospital with my dad, when my mum would carry around a single A4 or several A4 sheets of paper. With his medical history and his medication. And it wasn't just that she had to present it to different parts of the NHS, she actually often had to present it within the same hospital, different times in different units. And rather than worrying about how my dad was, she was worrying about whether she'd brought along that record.

That record. She clearly should be held by the NHS. And I know that many patients will recognise what an advance that will be for both their care and efficiency in hospitals as well. I also wanted to recognise, through the streamlining and abolition of NHS England, that that will put more services on the front line because, as I said earlier in Basingstoke, that is still badly needed to improve GP access to deliver the health centre at Winklebury to ensure there's a neighbourhood health centre across the constituency and to further improve the A and E waits for which there is a plan in place.
21:26
Jessica Toale Portrait Jessica Toale MP (Bournemouth West, Labour)
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Jessica Toale thank you, Madam Deputy Speaker. In his opening remarks, the Health Secretary set remarks, the Health Secretary set out our record in office on waiting times, patient experience and investment. My local area has investment. My local area has benefited from this record level of investment. The beach building at Bournemouth Hospital opened in March 2025, improving maternity, children and emergency care services. Poole hospital this year will become the largest planned care hospital in the country over the past two. Past month, I have been to the opening of two new mental health facilities, representing a £70 million investment in the local area.

One of them, Keystone Building, is a high intensity unit for young people. It is the first of its kind in our region and will stop young people from being sent to Manchester or Newcastle, from Dorset or the southwest. One thing I'm particularly proud of is the commitment to get Winton Health Centre back open. Now secured a £1.3 million investment to do that, it's opening in the summer that will bring care closer to my community and alleviate pressure on our local GPS. Now, I haven't met a person in the health system, education or in the community who doesn't agree with the NHS.

Ten year plans ambition to move health system from treatment to prevention and to get more care into the community. This bill helps us get closer to delivering this ambition for all people. I wanted a particularly talk about three often vulnerable communities. My hon. Friend for Thurrock spoke very eloquently about the experience of children with SEND and their parents, so I'd ask the Ministers to please reflect on how this bill helps with joined up services and accessing specialist care for those young people.

Health bus is a local charity I support that brings direct, nurse led care to people experiencing homelessness. Their core ask has been to have access to System One records and local NHS historic records to better help their patients. I'm grateful for the civil servants who've been helping them to date, but can I ask that particular attention is paid to making sure that the single patient record is rolled out to benefit these communities, who struggle to engage and get support from existing structures? And third, supporting our elderly populations with the care that they need.

I met Lewes Manning Hospice Care this week. They have done an incredible amount of work on the amount of hospital admissions people receive in the last 12 years of life, and are proposing a hospice at home. Hubs to ensure upfront investment can help people spend their last days in dignity. So can I have some reassurance that any frontline services that become available is put into end of life care as well? Finally, when this Labour government came into office, the fundamental promise of the NHS that there will be it will be there for us when we need has been broken, broken by decades of underinvestment bureaucracy, by ditching reforms that we made under the last government.

So I'm proud of the progress to date. I support this bill to improve the patient experience, put more resources into frontline services and to deliver our NHS ten year plan, getting care it.
21:29
Anna Dixon Portrait Anna Dixon MP (Shipley, Labour)
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Ensure the final four speakers >> Ensure the final four speakers get in. Speaking limits are now 2.5 minutes Anna Dixon. >> Thank you, Madam Deputy Speaker. I welcome the government's plan to I welcome the government's plan to make it easier for doctors and clinicians to share critical information in a single patient information in a single patient record, but I would like the Ministers to confirm whether access to patient records could be extended to carers and give them the ability to access information concerning the person they care for.

The NHS often fails to look after our amazing carers, so I would also be keen to see the ICB have a duty to both identify and support the health and wellbeing of our fantastic unpaid family carers and give them a right to a break. Our health service also needs to do a better job of identifying the next of kin of people who die in their care. There are currently 4000 public health funerals each year for people whose loved ones can't be reached, including Ken Bower, a friend of my constituents, Cathy and Richard.

In his memory, they launched the Next of Kin campaign, and I'd invite the Ministers to meet with me and my constituents to see how this could be embedded in the patient record. Ministers should also promote integration between local authorities and the NHS, and I would urge Ministers to implement a stronger duty to integrate health and care services. I welcome the duty to reduce inequalities in access to care, but the Bill needs to go further, and I would echo the calls from colleagues for a cross-government duty to have due regard to health inequalities.

Finally, on the issue of patient safety, as an officer of the APPG patient safety, I know the relevant Ministers has received many representations on this matter, not least from the hon. Gentleman for Harwich and North Essex, and I hope she will provide reassurances that when harm occurs, there will continue to be fully impartial investigation by EHCP and that clinicians are able to speak openly about safety incidents. The health Bill is a comprehensive and ambitious piece of legislation, but on these matters, I hope changes will be considered in committee.

Our ambitious must be bold, our delivery must be rapid and our NHS must be renewed. Thank you.
21:31
Jim Dickson Portrait Jim Dickson MP (Dartford, Labour)
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Thank you, Madam Deputy Speaker. I warmly welcome the priority and I warmly welcome the priority and the additional investment in our NHS over the first two years of this government. In my constituency of Dartford, we are seeing positive change with our newly opened North Kent Community Diagnostic Centre, delivering vital tests and results for residents in a few short days from a great building with amazing staff. On top of that, we are seeing major investment in our local Darent Valley Hospital, with £27 million being spent on a new intensive care unit.

That said, there is still a long way to go to reduce the length of waits in A and E, and the hospital remains in a building prone to problems. As a recent water outage of several weeks, which affected patient care across half of the hospital, illustrates. Above all, we need Kent and Medway ICB to recognise the speed of population increase and ensure there is new primary care capacity to meet it so that GP practices such as Swanscombe Healthcare Centre are able to cope with patient registration numbers and extraordinary 38,000 in their case, health infrastructure must be properly planned alongside new homes and a test of the powers for the Icbs in this bill must be that this happens.

I also warmly welcome the measures in the Bill to provide the single patient record. This new information must drive fully integrated care, the absence of which is causing worse outcomes for my residents. My constituent, Frank Fitzpatrick, who suffers from severe coronary artery disease, a separate condition which affects his oesophagus. And he has also had a stroke. He has recently received severely disjointed care, including discharge without medication or letter, unsafe transport, lack of coordinated follow up to provide physiotherapy or monitor his range of conditions.

The result has been a major worsening of his health and quality of life. We must urgently bring in proper, patient centred care for Frank and so many others. Two final concerns, Madam Deputy Speaker, the winding up of NHS England must ensure more resources are available and decisions are made at or near the front line. And with the abolition of Healthwatch, independent scrutiny must not be lost. We will need to be convinced that the Patient Experience Directorate, alongside the local service User Voice, will be genuinely holding the system to account.
21:33
Amanda Martin Portrait Amanda Martin MP (Portsmouth North, Labour)
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Amanda Martin thank you, Madam Deputy Speaker. I don't think there is a single person that thinks the current recording system is working. Navigating this system, whether a patient, a family member or indeed an MP on behalf of constituents, is a nightmare when it comes to safety and accountability. It's not transparent and this is made harder if you regularly move. So today I would like to speak about the single patient record and what it will mean for the tens of thousands of people in my city who serve or have served in the armed forces, thousands of serving personnel, veterans and their families call Portsmouth home, and many more pass through it at various points in their careers.

Because one of the defining features of military life is mobility. Serving men and women move regularly at short notice, sometimes across the country, sometimes overseas and back again. And Madam Deputy Speaker, often their families move to every new posting means a new GP practice, starting from scratch with a folder of letters, a bag of medication boxes, hoping that the new surgery can piece together a medical history from scraps of paper, or that the patient themselves can remember every diagnosis and procedure.

For a young family, those expecting a baby or waiting for a diagnosis or tests, it is stressful. But for someone managing complex or chronic conditions, it is dangerous. Madam Deputy Speaker Veterans in Portsmouth are also described to me exhaustions of having to re-explain their medical history, including mental health histories that are deeply personal and difficult to revisit every time they register with a practice. This is not good enough, and this bill helps to put it right. The single patient register will mean when a family moves from from Norfolk or Plymouth to somewhere near Portsmouth, their medical records move, too, but it won't work for those who move from Scotland to Portsmouth.

So can I urge the government to work across border to rectify this situation? I also want to acknowledge that that what means for mental health, the mental health needs of veterans are well documented and often unmet. Continuity of care is absolutely critical for those managing PTSD, depression and other service related conditions. Losing that thread every time a file fails to transfer, every time a referral gets lost between trusts could cost lives. So this patient record can hold that thread together. Madam Deputy Speaker, military personnel already sacrifice an enormous amount in service to this country.

The least we can do is ensure that they and their families and their health service keeps pace with their demands. I'm proud to say that this Labour government is delivering a Bill that is for our armed forces, and I'm proud to say that we see you and we see your

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family and your health matters to us. Final backbench contributions. Sureena Brackenridge. Thank you.

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Thank you. Thank you, Madam Deputy Speaker. Because of the shortness of time, I will focus my remarks on the long

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I will focus my remarks on the long single. Patient record.

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Patient record. Many members in this House will have had constituents get in touch with casework, raising blunders and with casework, raising blunders and delay, and stem from fragmented patient records. Patients when they
21:36
Sureena Brackenridge Portrait Sureena Brackenridge MP (Wolverhampton North East, Labour)
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have been in severe pain or at their most vulnerable, being asked to repeat the same medical history again and again to different clinicians, be that in hospital or clinicians, be that in hospital or even in the GP setting. It's frustrating and in some cases frustrating and in some cases distressing, especially if the patient is elderly or with neurological conditions like neurological conditions like dementia. A single patient record will ensure clinicians have the right information at the right time.

Allergies, medications, previous diagnosis so they are better placed to make the right decision quickly. Today we have heard of surgeons who had to cancel operations when patient history had been incomplete and not arrive quickly enough. There is consensus that a single, single patient record will significantly matter in A and E for paramedics at the roadside, and even in routine care, where small details can have significant consequences. But I must also make clear the concerns that many of my residents in Wolverhampton North East will have, bringing together such large volumes of highly sensitive personal data into a single system will inevitably raise questions about cyber security and data protection.

We also know that patient data in the UK is extremely lucrative to some. Many will be acutely aware of international interest to get hold of her data rich NHS to profiteer. So can the Ministers set out in more detail what safeguards will be built into the system from the very start to guard against cyber attacks and unauthorised access, access and how this will be controlled? What oversight will exist to ensure public confidence is maintained? If threats evolve.
21:38
Caroline Johnson Portrait Dr Caroline Johnson MP (Sleaford and North Hykeham, Conservative)
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And call the shadow Ministers, Doctor Caroline Johnson. >> Yes. >> Thank you, Madam Deputy Speaker and before I start, I must declare and before I start, I must declare an interest as an NHS consultant paediatrician, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health, and some. As someone who has been moved to the back of a waiting list after agreeing at the third time of asking for a consultant review. And finally, I still do need it, but it will have to wait a bit longer.

Madam Deputy Speaker Churchill once said, healthy citizens are the greatest asset any country can have. Good health is perhaps the most important asset any individual can have, and I'm sure that across the House we all want the very best healthcare and most efficient NHS for our constituents. So I'm confident that this bill has been brought to the House for the very best of intentions. But does it achieve its goals? In general, organisational restructure involves some sort of assessment of where are we now, followed by a vision of the future, what it should look like, and then a focus on how to get smoothly from A to B? Now, the government did start with a review of the current system.

They called it the independent investigation of the NHS in England, though the House should note that it was independently conducted by a former Labour Ministers. Let's look at what Lord Darcy said in his report. He said a top down reorganisation of NHS England and integrated care boards is neither necessary nor desirable. The then Secretary of State, the right hon. Member for Ilford North, seemed then to agree. He is reported as saying in September 2024 that a top down reorganisation was the last thing that he wanted to do.

Within six months he seemingly changed his mind and of course that is allowed to do. But it is regrettable, Madam Deputy Chair, that, having begun, the last thing he wanted to do, such little progress has been made on his promised first act, such as the roll out of fracture liaison services. So many other promises are delayed, undelivered or, in the case of the promise to double the number of medical school places. Somewhat bizarrely denied another of the government's stated objectives is improving the patient experience.

At the moment we have an independent organisation that listens to patients and provides feedback, Healthwatch. Madam Deputy Speaker, over 300,000 people a year share their experiences with their Local Healthwatch to improve services, and this feedback has led to positive change. The government cited Healthwatch in its King's Speech data publication. Against the backdrop of rising clinical negligence claims, concerns around maternity care and even reports of abuse in hospitals, it is clear that more must be done to listen to patients and address the problems.

But this bill abolishes Healthwatch England and effectively ends Local Healthwatch. And what does the government plan to replace it with? A patient experience directorate within the Department of Health? As Councillor Doctor Wendy Taylor of the Local Government Association has warned, this risks health services marking their own homework. And there is another concern. Facts are stubborn, but statistics can be pliable. How can the public ensure that they are getting reality and not spin from government? Ministers keep celebrating falling waiting lists when in fact patients are being removed from the list without treatment because their appointments have been cancelled, because they missed an appointment they weren't told about, because they haven't filled in a form, or because they were called several times, asking if they still needed an elective operation and agreed to see a consultant to check Madam Deputy Speaker.

My hon. Friend for Harwich and North Essex has made a passionate speech about the importance of HSB. This bill seeks to abolish the Health Service Safety Investigation Bureau. It provides a safe space modelled on air accident investigations, which, through the avoidance of blame and liability, is able to get to the truth and prevent future tragedies. And why? Well, apparently it abolishes EHCPs to simplify the patient safety landscape and reduce the number of organisations. In response to criticism, they have attempted to provide reassurance by saying that each SIB will maintain autonomy within the CQC.

But the government can't have it both ways. Is it being abolished or is it being hidden within the CQC? Either way, the new unit within the CQC will face a number of challenges the undermining of confidence in safe spaces because it's within a regulatory body, the undermining of its independence. Because Ministers have now signalled their intent to direct the vast majority of investigations, and because the National Quality Board will prioritise any recommendations they make. We will also have a CQC board without full oversight of what they're accountable for and, somewhat bizarrely, a risk that if the regulatory part of the CQC wants information from the safe space and the other part of the CQC doesn't want to publish it, we could see the CQC suing itself and all of this upheaval to have one less, or at least the illusion of one less organisation.

How on earth does that improve patient safety?

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Yeah. In principle, as many have said, including my hon. Friends for including my hon. Friends for Runnymede and Weybridge and South Northamptonshire, the single patient record is a good idea. Patient information is currently Patient information is currently fragmented across different parts of the healthcare system, and bringing it together could save lives, save time and improve lives, save time and improve prevention. But the introduction of such a system must be well executed. such a system must be well executed.

First, there are practicality concerns. Do patients want their full medical record, including sensitive conditions, perhaps including sexual health records visible to every health professional? The hon. Member for Saint Edmonds talked about the difference between a single patient record that is all of the same type and one that is part of a federated platform, and I understand from Secretary of State that he talked about linking up people ability to see the current system, but there are huge varieties of systems. Even within one hospital, one might have a different system for maternity, A&E, blood results and historical notes and current clinic appointments.

Will the members of staff of the NHS be required to learn all of these for all over the country, or will data be transferred to a new system? Either move has its downsides, but I'm not clear which the government intends. Secondly, there are security concerns. As has been said, the NHS has the most valuable health data set in the world. The government must provide clarity over who controls the data, who is responsible for maintaining its accuracy and how it will be kept securely. Hackers are already trying to gain access to it, knowing that even if it's encrypted, quantum computing will be able to unpick encryption in the years to come, the government must ensure that they are quantum ready.

What role is the National Cyber Security Centre playing in this regard? Madam Deputy Speaker, life in all things is a balance. If arm length bodies are in control of things Ministers are normally responsible for, you do get a democratic deficit, and it's understandable that the government want to recover that. But the powers in this bill to take control of everything risks. As my hon. Friend from Meriden and Solihull East said, a politicised service in which those who shout the loudest get preferential treatment.

But there are those with very rare conditions such as corticobasal degeneration, Wiskott Aldrich syndrome, lafora body disease, Friedrich's ataxia and many, many more who may not have as well funded or celebrity lobby groups acting on their behalf as other conditions do. So how will the Secretary of State ensure that the clinical need drives the provision of services and not resources of the lobby groups, or access to Ministers or the Secretary of State? As the NHS is undergoing a massive reorganisation, I'm mindful of what the Ministers for Secondary Care said previously, she said the reorganisation of health services always distracts from people's jobs, destroys morale and wastes money.

It also stalls progress and takes a lot of staff time, which is perhaps why we have a ten year health plan that took a year to write, why the workforce plan has still not been produced, why the so-called Rapid National Maternity Investigation has not been completed by waiting lists are for patients referred for admission in several specialities. Why we have a glacially slow rollout of fracture liaison services. Why the mechanical thrombectomy service promised for stroke victims by April is not available.

Why there is no response to the huge report where there is a denial of promising an increase in the number of medical school places where doctors are announced, the 16th strike costing millions of pounds in appointments. The government promised results but all they've delivered is disruption, delay and disappointment. Madam Deputy Speaker, I do feel for the current Health Secretary. His predecessor was more focussed on unseating the Prime Minister and he is left to pick up the pieces. But despite our political differences, I do have hope.

Previously, the Health Secretary had insisted that trans women are women. I understand he's now changed his mind. He's listened and he's accepted that biological women are distinct and require single sex spaces in line with the law, biology and common sense. I'm therefore hopeful that the new health secretary will also listen to concerns about this bill, and we can work together in the committee to improve it. As I said at the beginning, Madam Deputy Chair, we all want the best possible health service for our constituents.
21:47
Karin Smyth Portrait Karin Smyth MP, Minister of State (Department of Health and Social Care) (Bristol South, Labour)
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Thank you. >> Ministers Karin Smyth. >> Thank you very much. I was going to say, sometimes it's the hope that kills you, but I cannot say that kills you, but I cannot say it's a pleasure to close on behalf of this government. And can I commend so many fantastic speeches this evening. My friend the member from Middlesbrough and Thornaby East opened some excellent points about spinal cord injury and specialised commissioning, which applies to many, and I do take those comments on board.

My friend for Beckenham and Penge talked about the experience of Alex Savage and his work with Tessa Jowell Foundations, and we thank him for that and mourn his passing. The chair of the Health and Social Care Committee made a number of very valuable points, and I will continue to engage with her and her committee and note the points from my friend from Calder Valley about this bill, my friend from Thurrock, my friend from Bexleyheath and Crayford both talked, and their experience they bring to this place on send and supporting disabled people, and particularly children, and joining up services.

My friend from the Member for Dudley brought her experience about designing services for the future around people and patients. And can I thank my friend, the Member for Sunderland Central, as ever, for his expertise that he brings to this debate another excellent manager from the service in this place, and my friend from Cannock Chase made some excellent points about professionals in NHS England and communications professionals as well. We know it's difficult and we want to make sure that we use their expertise as we go forward.

My friends from Gloucester, Rossendale and Darwen and Stockport talked about mental health, obesity prevention and their local services, and my friend, the former Secretary of State, right hon. Member for Ilford North. I thank him for his support in my work in bringing forward this bill, and I'm relieved that he's still in support here this evening. So that's good to hear. A week is a long time in politics, Madam Deputy Speaker. So as I often tell people you've heard it before, I do have the noble Lord Lansley to thank or blame for me being at this despatch box.

I left the NHS and stood for Bristol South because I could see the coming catastrophe of those coalition reforms. In 2010. Patient satisfaction was an all time high. In 2024, it's at an all time low. In 2010, the last government inherited the shortest waiting list in history. In 2014, they left the waiting list at record high. In 2010, the NHS was efficient and delivered value for money. By 2024, we dropped down in international rankings despite a massive increase in headcount at the centre.

That is the scorecard. That is the scorecard they left for the 2012 elections. And in preparing for this debate, and as I'm sure the opposition have checked, I've looked through my past comments since becoming an MP in 2016. I said that despite being a non-executive director and a manager in the NHS, I couldn't easily navigate the plethora of bodies in the health and care field. And from 2016 it got worse. Each crisis or scandal brought more so-called independent bodies, but no more efficiency, effectiveness or, crucially, safety.

In Public Accounts committee, we were desperately trying to find out and get clarity on accountability for spending. We didn't get it in 2019. Interview. It's on the record. I did an interview with the Health Service Journal. Again, I highlighted how the role of Parliament in nodding through the estimates bore no relation to financial accountability or spending in my local NHS. How it was impossible to follow through on funding allocations for facilities for my constituents, or even understand the decision making of local commissioners, trust boards, regions, NHS England, the Department or Treasury.

And when I sat on those benches, I watched Tory MP after Tory MP chastise his own government about what was happening in their own constituencies, to be met with a shrug of the shoulders to say it's all down to NHS England. The opposition spokesperson talked about ICB accountability. There is none. So many MPs come to me and my surgeries and they constantly say they cannot get a response from them. At the moment, some people can't even get a response for their their emails.

It's shocking. As a member for Lichfield outlined so clearly, their approach was to hand £200 billion of taxpayers money to one body, and more taxpayers money to a host of others charged with delivering monitoring, check in a health system where there's a lot of monitoring and a lot of checking, no end of tick boxes, but crucially, too little delivery of the sort of high quality services the British public deserve. And staff want to give. That cavalier approach changed with this Labour government, and that is why we are bringing forward this this Bill, with abolishing NHS England, devolving commissioning budgets to icbs, putting patient voice at the heart of the new directorate and making local commissioners in councils and icbs embed patient voice and experience in their commissioning, not outsourcing their responsibility and then ignoring it.

The system doesn't work and members know it and IT patients deserve better. This is the biggest transfer of power to local systems we've seen. Madam Deputy Speaker, I believe, most significantly, this government is delivering on giving power to patients, patients who are, frankly, as we've heard, astonished to find in 2026 their records are not joined up in the NHS and appoint. Excellently made by my friend from Portsmouth North about the impact that has on veterans. So while we have a patchwork of local workarounds benefiting a few in Manchester and sometimes in Bristol and in the North East, for example, patients across England have the right to their own record and for their clinicians to have access to the deliver the care they need a point well made by my friend the Member for Glasgow South West from Ashford, the my friend the Member for Bury St Edmunds and Stowmarket given us real examples of patient experience, as the Member for Stroud says, it shows about time and the best impacts that we've heard about patients.

From my friend from Basingstoke on the sad passing of his father. We have heard a lot of questions, quite rightly raised about the single patient record and data from South Northamptonshire Morecambe and Lunesdale Newton Abbot, member for Durham, Worthing West, Bournemouth West and Wolverhampton North East. We do want to make sure we get this right. They should know that while the bill establishes the legal framework for the SPR, much of the detail will be of necessity in secondary legislation, and I can assure the House that all members will have a chance to scrutinise those regulations in due course.

However, we firmly believe that pursuing a single patient record is the right thing to do. What we found is that patients and staff support it, as long as it's built with the strongest safety for security and privacy. We hear those concerns and we will make sure those safeguards are built in. The single patient record will protect personal data by default. It will be considered critical national infrastructure with the highest standards of cyber security and information governance that only the right people can access the right information at the right time for the right reasons.

There will be audit trails who have access to patients data and of course, UK GDPR and Data Protection Act 2018 will apply. The bill does not create new legal gateways for purposes other than direct care. It does allow data to be used for research, population analysis and service improvement, but only where there is a separate legal basis for doing so. Can I pick up on the issue of accountability? This is very important to me personally, and I do agree it's important to get this right and we need to work both nationally and locally.

And I'm old enough to remember the world before 2012. Madam Deputy Speaker, for 60 years, the Secretary of State had overall responsibility and accountability for this service. But I know from I think the comments were well made by the member from Runnymede and Weybridge and Birmingham Erdington and Newark, particularly on local accountability. Let me be clear the bill does put more power in the hands of local organisations, not less. Icbs will be responsible for commissioning a wider range of services, including primary care, and they will hold that large proportion of the NHS Budget.

Over £7,179 billion before. But at the same time the public expects Ministers to be accountable for the NHS they pay for. Therefore, Ministers should have the tools to hold icbs to account and direct the system where necessary. And that's why the Bill provides the Secretary of State with power of direction, but important safeguards around appointing specific individuals directions to intervene, decisions about services provided to particular person, and if a NICE recommendation on a drug or treatment exists. This takes precedence over a direction.

The powers in the bill will ensure the Secretary of State is able to create the conditions for Icbs to succeed with effective and proportionate forms of intervention where necessary. And another major point I think has been made this evening is particularly around Healthwatch. Now, I do think there is an important philosophical point here, Madam Deputy Speaker, about this issue of independence and the perception of independence and effective decision making, and I think we will discuss this in committee, and I think that's important to do so.

But as the Liberal Democrat opposition spokesperson outlined, I think very well, for 50 years we've had these sorts of bodies, and patients are now currently saying the system doesn't work and they're not reporting into it, so it doesn't work. And I did listen carefully to the member from St Neots and Mid Cambridgeshire and my friend from Blaydon and Consett about getting the balance right, and the Member for Dartford. I think these are really valuable points that we will discuss. But currently the patient voice sits isolated in separate organisations.

They criticise the status quo, but they are not able to change it. That's why we want a new director of patient experience in the department to ensure that voices are heard as part of every decision, and locally it's actually the job of the commissioner. I've been a commissioner, a good commissioner. Organisation includes patient voice experience in all their decision making. That's where the difference is made. They should not be outsourcing that decision and that is the difference. But it's a debate to be had.

And I do understand we have to be able to make that point and give people assurance about this perception issue. In particular, we want to make sure that the accountable, the local icbs are accountable for ensuring they're appropriately incorporating this into their decision making. And that does include, as the Member for Meriden and Solihull East, I think, made a good point about digitally excluded people. How it happens is not set in stone. It's our job to set the destination, not exactly how we get there.

So if there's an organisation that locally that can provide a good service for that patient voice and experience, then the ICB could of course continue to contract with them on EHCP briefly, and I hear the points from the member from Harwich and North Essex, and I've met with him and others in Shipley and others I know have raised these issues. It's it's you know, the review is very clear. I do commend people to read it, but it is it is why we are bringing.

The new CQC will combine the regulatory functions with the depth of EHCPs investigatory capability to benefit of both. In particular, I know the safe space is quite rightly raised by the Member for St Ives is important to enable people to share concerns in confidence and. This is safeguarded in the Bill and I understand this perception issue, but we must ensure that that is real. Now. The CQC have also raised some operational issues with implementing the integration of EHCP, and we're working with them to ensure that when passed, the measures will concerned will be implemented effectively.

So, Madam Deputy Speaker, in conclusion, this bill is only one part of our modernisation agenda, but it is a crucial one because for decades, governments have failed to grapple with this fragmentation like capital, like workforce. The problem was put in the too difficult box and left to this government to solve but solve it. We will. The single patient record will finally mean patient. Get the joined up, proactive care they deserve. By voting for this bill, we can have a fresh bill in NHS

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history and I commend it to the House. The question is that the bill be now read a second time, as may that opinion, say I. As Of the contrary, no. the ayes have it, the ayes have it. Program motion to be moved formally.

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formally. Greg Smith. It'd be really good if Ministers didn't cross the path of other Ministers in the middle of business. The question is as on the Order Paper as an opinion, say I. I Connor Rand no. The ayes have it. The ayes have it. Money motion to be moved formally.
21:58
None Portrait Programme Motion: Health Bill: Programme
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I beg to move.
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22:00
Neil Duncan-Jordan Portrait Neil Duncan-Jordan MP (Poole, Labour)
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Poole. When I get off the train at our local station after spending time in Westminster. The smell of time in Westminster. The smell of the sea is what reminds me of how lucky I am to live in such a lucky I am to live in such a beautiful place. The world's second largest harbour, some of the best blue flag beaches in the country, blue flag beaches in the country, and a surrounding coastline that is simply stunning. But you can't eat simply stunning.

But you can't eat the scenery. Madam Deputy Speaker and like other coastal communities, Poole has a number of key issues that need government attention. Since becoming the MP for the area, I've been running a project called positive about Poole, in which I've been asking local residents for their ideas about how we can make our town an even better place to live. This has highlighted the ongoing problems of traffic congestion, lack of youth services and, of course, the lack of affordable housing.

Now average gross median weekly full time earnings in Poole are £764, but monthly rent is around 1400. This means half of someone's wages immediately goes out on their housing costs, not to mention council tax, energy bills and food. Nearly 1 in 4 children in Poole are living in relative poverty after housing costs, further suggesting the impact that high rents are

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having on the cost of living crisis. Will you give way on that point, I will. I thank my hon. Friend for I will. I thank my hon. Friend for giving way. It sounds like Poole is very, very similar to the issues that we have in Cornwall, where we have a chronic housing crisis, and we've been asking for the we've been asking for the Department for MCHLG for several months now for a strategic place months now for a strategic place partnership with Homes England to give us the money to build the social housing and the truly affordable housing that we desperately need.

Does he not agree with me that we need to expand the availability of strategic place partnerships with Home England well beyond mayoral combined authorities?

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Yeah. I thank my hon. Friend for that contribution. Yes, I do agree with contribution. Yes, I do agree with his point. I'm going to develop that further. So towns like Paul are desperate, like my friends at constituency, for good quality, affordable and secure. I would affordable and secure. I would argue council housing for local families rather than what we see is families rather than what we see is the developer led luxury waterside apartments that have sprung up.

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These. I will. When my hon. Friend agree as it. Again, it sounds quite similar to Cornwall, sounds quite similar to Cornwall, where we are from, that a registration scheme, maybe for holiday lets and speeding that up would be something to help deal with all of those second homes and holiday lets that are proliferating holiday lets that are proliferating around our towns, and that maybe if we had that, we could move forwards

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we had that, we could move forwards towards more affordable housing? Absolutely. My hon. Friend is right. In some areas of Poole, there is no one living there. They are all holiday let second homes and so on. I will.

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First of all, can I commend the John Milne for Poole for bringing this forward. He's been a very assiduous MP on behalf of his assiduous MP on behalf of his constituents and he should be congratulated for his contribution. I'm also the MP for a rural coastal area, NICE Strangford constituency. I'm aware of the isolation. There's other things apart from social housing. There's the isolation that many suffer from isolation that leads to more expensive shops, more leads to more expensive shops, more expensive petrol, less frequent transport, social housing scarcity.

Also digital connectivity. Does the hon. Member not agree that there is a clear need from government to understand the greater support is required, not in terms of per head of currency, but taking in the rural isolation difficulties, and that more investment would be the first step to achieve that issue. Thank you.

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I always welcome the contributions from the hon. Member, and I often find myself agreeing and I often find myself agreeing with them like I am on on this occasion, the expensive apartments occasion, the expensive apartments that have sprung up in my constituency and I'm sure in others, are unsuitable for young families in the area, or they're out of the reach of many local people. So reach of many local people. So whilst I support the Renters Rights Act, Rights Act, I think we need to go further and look at rent controls to ensure more fair play.

Now that brings me on to the health challenges that coastal communities face, and the excellent report from the Chief Medical Officer that was published in 2021. In it, he recognised that coastal communities have some of the worst health outcomes in England, with low life expectancy and high rates of major, many major diseases. Whilst these communities are not all the same, many share similar characteristics, which should help form some common policy responses. Fishing or port communities like mine have particular challenges and a national strategy informed by these common experiences will help reduce health inequalities in these areas.

For example, many coastal communities were created around a single industry that has since moved on, meaning that work can often be scarce or seasonal.

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I will. Thank my hon. Friend. For bringing this debate this

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For bringing this debate this evening. Similar to his constituency, but perhaps some of the worst health outcomes in the country. A boy born in my constituency, Madam Deputy Speaker, will live ten years less than a boy born in Hampshire today. That's my son and many sons across Blackpool, a decade lost before they've even started their life. So does he started their life. So does he agree with me that this is not just about additional funding for the NHS, but it's about reducing inequalities in in the housing in jobs market, but also strategic support for coastal communities, where the support for the big cities has been for the last few decades.



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I absolutely support my hon. Friend's contribution. Let's be absolutely clear about this. We are absolutely clear about this. We are not going to get the kind of society that we want until we see society that we want until we see inequality eradicated, and that we have a much more equal society, because I believe with that, we because I believe with that, we will see more compassion, more care and more community. Another place I

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will. I thank him for that. I'm sure he's aware of the Labour Rural Research Group, which recently did a report on rural poverty, and it identified that, on average, someone living in a rural area is spending £39 more per week on transport costs, and this is described as a rural penalty. I wonder whether he would agree with me that there's also a coastal penalty, and ultimately, government needs to abandon its one size fits all approach to the way that we run this country and identify the differences between rural, coastal and urban areas.



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Yeah. My hon. Friend makes a really positive point and something that I positive point and something that I think has been overlooked in government debates up to this day. government debates up to this day. We need to recognise the differences between the various parts of our country, celebrate all those differences, but also recognise the problems, unique problems that they all face. So

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problems that they all face. So life expect. Oh well. Thank you. My hon. Friend and constituency member for giving way. He's right to point out Paul's history as a fishing and port town, but like mine, it is also a tourism town and we have millions of visitors come every year, most to spend a nice time, but some come to drink excessively, start fights and disrespect local residents and our local area, which puts excessive pressure on our police forces.

So would he agree with me that where these seasonal pressures are

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predictable forces like ours, Dorset Police should have fair funding formula to reflect that? Yeah, absolutely.

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Yeah, absolutely. Agree with my hon. Friend and neighbour and I am going to make that point a bit later in my speech that point a bit later in my speech if I can make some progress. Comments. So life expectancy, healthy life expectancy and disability free life expectancy are all lower in coastal areas and the all lower in coastal areas and the gap between more affluent and poorer areas continues to widen. Now, Professor Whitty makes it clear that high levels of deprivation, driven in part by major and longstanding challenges with local economies and employment, are important reasons for the poor health outcomes in coastal communities.

This means we need a new approach to dealing with a gap in life expectancy between those with limited incomes and those with large amounts of wealth. Tackling the social determinants of ill health, such as housing, employment opportunities, access to health care and education are therefore key to bringing about a healthier society. Now, Madam Deputy Speaker, one of the key features that links all of our coastal communities is the water that surrounds us. Poole Harbour is both scientifically and environmentally important and needs to be protected.

The beauty of the harbour lies in the stark contrast between ecosystems that range from intertidal salt marshes and mudflats to freshwater marshes, reed beds and wet grasslands. Visitors will also discover a wide range of wintering, migrating and breeding birds. But most of Dorset's rivers suffer from high levels of both nitrate and phosphate pollution. I will.

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Thank you. And I would say as a member of Portsmouth and Coastal City, we have high deprivation, we have high levels of inequality. But unlike you, unlike your beaches,

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unlike you, unlike your beaches, none of ours are blue flag. It's Martin. Mr. Martin, I don't think my beaches have been think my beaches have been discussed. There's. Well, Neil

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Duncan-Jordan. I think you're absolutely right that the beach is a first class in Poole. Of course, I'm sure if the deputy Madam Deputy Speaker had beaches, they too would be first class. Now, the nutrients that go into the water systems come from a number of sources, including both treated and untreated sewage, as well as agriculture from poorly managed soils, animals, waste and fertiliser. Now we know that sewage discharge has grabbed the headlines in recent months, as well as the nutrients from treated discharges, outdated infrastructure and regular system overflows in stormy weather can result in untreated or partially treated sewage entering our rivers in Poole Harbour.

This can lead to shellfish contamination as well as direct health risks, putting restrictions on the local fishing industry. Now, the Environment Agency monitors water quality at designated bathing sites from the 15th of May to the 30th of September, but not all year round, and only those areas that have been officially recognised as suitable for bathing. But in Poole there are many different types of water users, from paddleboarders to windsurfers and so on, and they are excluded from these forms of oversight.

That's why we need to expand the definition of bathers, monitor all year round, and have a serious conversation about bringing water back into public ownership. Now, finally, Madam Deputy Speaker, I want to consider the issue of tourism and its impact on the local economy and public services. Poole, like most coastal communities, relies on tourism as a key part of our local economy. But with that comes a number of challenges. The local council no longer has a dedicated tourist office promoting the area.

They no longer fund the kind of events on the quayside that would attract visitors, and the idea of a tourist tax or levy is contentious. In my town, government funding also fails to take account

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of the seasonality that was Mentioned by my hon. Friend earlier, with the influx of additional people and the extra additional people and the extra demands the area faces in terms of car parking, public order and even car parking, public order and even litter collection. Both our police and fire services regularly witness

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and fire services regularly witness a seasonal, seasonal surge in. For my friend. I will. I thank my hon. Friend for

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I thank my hon. Friend for giving way and for securing this really important debate in the half term last week in Looe, in my constituency. We saw some really difficult anti-social behaviour with our public services under pressure to deliver. I really welcome the dispersal order that was granted and thank the frontline services for doing so. But in in our communities we need a fair funding formula to ensure the

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services are provided during peak tourist season, and I look forward speech. Hear, hear.

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Hear, hear. I absolutely welcome and support the point made by my hon. Friend. A the point made by my hon. Friend. A fair funding formula properly reflects diverse demands, unique reflects diverse demands, unique demographic complexities and specific geographical challenges faced by the police and fire faced by the police and fire services, therefore long overdue. As she mentioned.

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It is on that point the point of geographical inequalities. As my constituency is West Cornwall and the Isles of Scilly, it's the Isles of Scilly, it's impossible to call on emergency services from the north or the West services from the north or the West or the or the South. And. And the consequence of that is that it's much more expensive and challenging much more expensive and challenging to provide those services in circumstances like that, as in so many other coastal areas, because many other coastal areas, because of that geographic reality.

So does he not agree that actually these things need to be factored into the

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funding formula rather than ignored as they aren't present? Yeah. I absolutely. Agree with.

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Agree with. The hon. Member's point. As I mentioned earlier, the funding formula at the moment is inadequate formula at the moment is inadequate for for communities like ours. I would just say, Madam Deputy Speaker, if there's anybody else who wants to intervene, I've still who wants to intervene, I've still got two more paragraphs to go. I just want to turn to hospitality just want to turn to hospitality finally, which is a key driver of many coastal towns economies that is suffering, too.

In Poole 486, hospitality businesses generate £239 million in annual revenue and employ 5738 local people. But the lowering of the national insurance threshold and the removal of business rate reliefs alongside new re-evaluations on premises, are forcing many of them to consider whether they can carry on at all. My town needs places where tourists can buy an ice cream, have a meal or enjoy a drink. What we don't want to see is hollowed out high streets that only offer vape shops and little else.

We need a vibrant campaign for people to holiday in Britain, and the necessary support for hospitality that brings the high street to life. Suggestions that the government is looking at a NICE pub tax that will hit landlords whose premises are on the waterfront will kill off towns like Poole, and I would urge the Treasury to think again about such a proposal. So, Madam Deputy Speaker, coastal communities may not grab the headlines like those cities with a proud industrial heritage, but there are over 5 million residents living in 169 coastal towns across England and Wales, and they all deserve a voice and a future and a Labour government that recognises the challenges they face and has the policies that will ensure a rising tide lifts all the boats, not just the super yachts.
22:16
Nesil Caliskan Portrait Nesil Caliskan MP, Parliamentary Under-Secretary (Housing, Communities and Local Government) (Barking, Labour)
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Yes. >> Yes. >> Thank you very much, Madam Deputy Speaker, and I'm grateful to my hon. Friend the Member for Poole for securing this important debate. And can I take the opportunity to particularly say I so appreciated the passionate way that you spoke about the area that you represent in your opening remarks with reference to the smell of the sea, which I know will be nostalgic to many. Important point made about hospitality too, and just how important it is for the local economy of the coastal communities and coastal communities are a vital part of our national identity, serving as a key reminder of our national pride and shared maritime

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history. And of course, as I say, yes, of course. I thank my right hon. Friend for

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I thank my right hon. Friend for giving way. It is very important that the coastal communities are recognised for our for our role in the overall identity of the country. But we are also a vital way of But we are also a vital way of developing economic growth in this country and what we. Myself, as the co-chair of the all party parliamentary Group on coastal communities, and indeed many of the colleagues here on these backbenches are asking for, is a coastal economic strategy that identifies the key industrial sectors that can help us grow not only hospitality, which is vital, but also ensuring that we have a year round economy.



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Yeah. And I thank my hon. Friend for making a really important point. making a really important point. And being only week two in my role, I can say that I've already had I can say that I've already had passionate representation from herself and other colleagues who represent coastal communities, and I will, of course, continue to I will, of course, continue to engage with them to talk about the important points that she and others have already made in this others have already made in this chamber and beyond.

The government is committed to supporting coastal communities everywhere to fulfil their potential and to thrive, and coastal communities are a key part of the ambition for our whole country. They play an important and vital role, both for the areas themselves, but also, as I say, for the whole economy and protecting coastal communities, particularly around coastal erosion, is a priority for Mhclg and we will continue to do that. In relation to the important points that my hon. Friend made of the for the local communities and the economy.

I'd like to take the opportunity to talk about LG's commitment to Pride and Place and a number of other programs that the Department is using to directly target a range of economic, social and health related challenges felt by coastal communities. Our £5.8 billion Pride in Place programme will deliver up to £20 million of funding and support over the next decade to 284 communities across the UK, and at least 56 coastal coastal communities across the UK are part of this. They will receive over £1 billion collectively through the Pride of Place programme.

A package of targeted investment will be delivered through each community, developing a plan in consultation with local people that reflects local need and determines where that money is best spent. The programme will help communities improve local infrastructure and play areas, important cultural

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venues, health and wellbeing services, amongst many other things. Give way on that point. Yes.

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Yes. I thank the Ministers for giving way. Just in relation to pride in way. Just in relation to pride in place in coastal communities. Because of our geographical location, we work very our communities work very closely together within the pride of place definition. Community cohesion marks us down in our availability to access Pride in Place. So in Cornwall across six constituencies, even though it's one of the most deprived regions of northern Europe, we have had £0 in pride in place because of our community cohesion.

Does the Ministers agree that this is something that needs to be looked at, looked at? Yes.

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Thank you very much to my hon. Friend for raising an important point. And of course, community cohesion is an important aspect of cohesion is an important aspect of how we allocate money through Mhclg. But I recognise that that is not the only important aspect. And so the only important aspect. And so I'm very happy to meet with him and other members of Parliament who want to talk about how the want to talk about how the allocations of money ensure that we

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do so in a fair and transparent way. Happy to give way. To who? Thank you, Madam Speaker. I'm grateful to the Ministers for issuing invitations to colleagues to meet my constituents. Didn't get fired in place, and I'd be very grateful if she could find some time to have a cup of tea with me so I can make the case to her

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before too long. Always happy to have a cup of tea with colleagues, especially the right hon. Friend, if I can just right hon. Friend, if I can just turn Madam Deputy Speaker to the important points made about holiday lets that particularly impact lets that particularly impact coastal communities. The government has committed almost £40 billion to the social and Affordable Homes programme, which is important in terms of house delivery and affordable homes more generally, affordable homes more generally, and our national planning policy framework.

I'll take this one.

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Would my friend also agree that as well as housing is education that's really missing and vital in

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that's really missing and vital in these coastal communities and often sees our constituencies at the bottom of league tables. Thank you.

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Thank you. Very important point made. And as she will know that education is a top priority for this government, a top priority for this government, which is why we've seen record investment. And I believe that coastal communities will benefit coastal communities will benefit from that commitment. On holiday, I'm going to make a little bit of progress, if I may, on holiday lets in particular. Well, of course short term lets can be hugely beneficial to local economies. The government appreciates that excessive concentration in some areas of the country can impact on the availability and affordability of homes to buy and rent, and members are already highlighted.

Some of the challenges. That is why the government is making progressive changes to the tax system, to protect our vital public services, and to ensure that housing is primarily seen as a home rather than an investment. Those taxation changes will, I think, be important for coastal communities. And alongside that, the government has abolished the furnished holiday lets tax regime, meaning that landlords will no longer be incentivised to by the tax system to make their properties available for short term holiday lets.

This is an issue that has long been raised by those who live in coastal communities. On the important points that my right hon. Friend made on health. I absolutely recognise that some of the greatest health inequalities we have in our country features in our coastal towns, and so I'm delighted that the government has made it a core mission to strengthen, join People experiencing health services locally can experience them in a more integrated way. A personalised, centred approach and areas like coastal areas will really benefit from that.

Joined up thinking and neighbourhood health service approach. Reforming the Better Care Fund in line with the commitments set out in the ten year NHS strategy, are all things that will benefit areas like our coastal communities, who are disproportionately impacted by

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health inequalities. Happy to give way. Thank you, Ministers, for giving way. We can't talk about our coastal communities and health without talking about safety as well, and in particular, water safety. In the last couple of weeks, we've had this hot weather. At we've had this hot weather. At least 17 people have been known to have died through drowning, many of those children and young adults. I those children and young adults. I just wonder if the Ministers will talk to other relevant Ministers about having a national campaign before the summer, when it gets hot once again and children are on school holidays to make sure that

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we prevent unnecessary deaths in our waterways? Yeah. Can I thank my right hon. Friend for raising a really, really important point. Swimming lessons important point. Swimming lessons for children have, sadly, over the past decade or so been become less likely, and the consequences of likely, and the consequences of that is catastrophic, particularly when we consider coastal communities. I know that's representation that he and other members of Parliament have already made. Very happy to take that away and ask Mhclg to further look at it, but also work across government to make sure that we're doing everything we can to support children and also adults, to benefit from the necessary swimming classes so that we can keep them safe and communities safe.

Generally. Can I take the opportunity? Madam Deputy Speaker, to also talk about the need for cross departmental and government working on environmental agency work to ensure that water is clean, not just so that they can be enjoyed by the people that live on our coastal communities, but also those who visit them. It isn't just a nice to have, but it is fundamental to the health and safety of everybody that visits coastal towns. And I will ensure through Mhclg that there is an adequate cross-departmental approach.

And finally, Madam Deputy Speaker, can I thank the right hon. Member for Paul for securing this debate. I know that he feels passionate about the issues that he raised. They go beyond his coastal area, but actually speak to a number of constituencies across this country. The identity of our coastal communities, as I've said, is in, in, in intrinsic to the identity of our country. But I know that each of our coastal communities have a particular identity that is important to their local area, the investment from government to make sure that our coastal communities are properly looked after is not just about the borders themselves, but is more about making sure we support those who live there.

We are reducing health inequalities and make sure that everybody has the opportunity to thrive. Thank you very much.

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The question is that the House do now adjourn as many of that opinion say I. I the ayes have it.
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None Portrait Oral questions: Defence
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