Commons Chamber

Monday 7th September 2026

(began 2 days, 4 hours ago)

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None Portrait Oral questions: Housing, Communities and Local Government
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All All the All the older All the older Anneliese All the older Anneliese Midgley.
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None Portrait Q1. What steps her Department is taking to ensure that the planning system provides green spaces for communities. (901181)
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Number one, please, Mr. Speaker. >> Number one, please, Mr. Speaker. >> Welcome back. >> Thank you, Mr. Speaker. I'm delighted to have been appointed
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None Portrait Q10. What steps she is taking to support high streets in Putney. (901191)
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Fleur Anderson question number ten, please. Mr. speaker. ten, please. Mr. speaker. >> Mr. >> Let's crack on.
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None Portrait Q15. What progress her Department has made on tackling rough sleeping and homelessness in Erith and Thamesmead constituency. (901196)
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But Selby. >> Mr. >> Thank you, Mr. Speaker. Encouraging progress has been made
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Angela Rayner Portrait Rt Hon Angela Rayner MP, The Secretary of State for Housing, Communities and Local Government (Ashton-under-Lyne, Labour)
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Thank you, Mr. Speaker. This government is committed to delivering good growth across the delivering good growth across the country and power in every postcode. We have places able to set their own ambitions and integrate services to meet people's needs. Achieving that requires a fundamental rewiring of the state, giving power held by Westminster and Whitehall back to people and places where they live and work. As we set out in the Cabinet statement on rewiring the state, effective and sustainable local government is the vital foundation of our devolution ambitions, as we are now determined more than ever to devolve power across closer to the people we represent.

It's only right that as this, as the new Secretary of State, I make sure

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that everything we do is working towards that plan to change Britain. Oh, sorry. Sorry.

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Oh, sorry. Sorry. I think we've had this before. I'm pleased. I want to hear this myself. It does affect my

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myself. It does affect my constituency and others. So the last thing I need is you had. Don't get the chance, Mr.

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Don't get the chance, Mr.

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Don't get the chance, Mr. Speaker. The prime. The Prime Minister told the House last week he was prepared to look at local government reorganisation. And he asked me, as his communities secretary, to do that. Throughout this process, the government has listened to representations from members of this House, councils and the public. And I want to be clear, Mr. Speaker, on how critical this is to me, given how important they are to our democracy and the services they provide for local people.

But, Mr. Speaker, there will always be a wide range of divergent views, which means achieving perfect consensus will never be possible. I understand that feelings run high and people naturally have strong views, but in different directions. In that context, in light of legal advice, I want to satisfy myself, firstly, that the right processes in place that is robust and of course complies with the law. And secondly, I want to fully test whether our proposals for local government reorganisation meet the priorities of the new administration and the new Prime Minister, and any additional considerations.

With those two considerations in mind, I have decided to withdraw the decisions made in March this year for Essex, Hampshire, Norfolk and Suffolk and, where relevant, Mr. Speaker, their neighbouring unitary authorities, the government's legal representatives, have notified the court of this step. I have also decided, Mr. Speaker, to conduct a full review of the local government reorganisation programme, including the decisions that were announced in July of this year for a further 14 areas and those two areas where decisions have not yet been taken.

And I ask that reorganisation activity be paused. These 14 areas Mr Speaker are Derbyshire, Devon, East Sussex, Gloucestershire, Hertfordshire, Kent, Lancashire, Leicestershire, Lincolnshire, Nottinghamshire, Oxfordshire, Staffordshire, Warwickshire and Worcester and where relevant, their neighbouring Worcester, Worcester, Worcester and where relevant, their neighbouring unitaries. Mr. speaker, I do not take this lightly. I recognise the huge amount of work that has already gone into progressing reorganisation in each of these areas and I am very grateful for it. I know that many members of the House and many council leaders outside the House will have lots of questions about what this means for them and their communities, and I will try to address these as best I can today.

Firstly, we are working across government on rewiring the state. Following the Cabinet statement. We recognise the effective and sustainable local government is fundamental to our ambitions for a devolved country which works better for and with communities, and we will consider this issue as part of part of our wider approach. And secondly, as an immediate step, I have asked the Minister for Local Government Devolution and regional growth to undertake a rapid review of the current local Government reorganisation programme, including the position of the four areas where we have withdrawn and the further 14 areas that we are reviewing and pausing alongside the two remaining areas.

New councils Mr Speaker for East and West Surrey will be unaffected because they are already established in law and have had their first elections, and are on track to go live in April 2027. And thirdly, I want to be clear in terms of what this means for elections scheduled next May. Elections will go ahead in May 2027 on existing council boundaries. Finally, Mr. Speaker, my department will provide support to council leaders, officers and members representing impacted areas, and the Minister for Local Government has written to leaders and copied members of this House.

I want to assure that all those of you who represent these areas feel fully included in considering their future, and I will update the House at the earliest opportunity. My ministerial team and civil servants from the department are ready, Mr. Speaker, to discuss and work with you. My team will proactively reach out to discuss the implications locally in detail, and my department remains committed to working in partnership with local government, both in this immediate period and in the longer term, and I commend this statement to the House.
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David Simmonds Portrait David Simmonds MP (Ruislip, Northwood and Pinner, Conservative)
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It's refreshing to actually hear it first in this chamber rather it first in this chamber rather than TV. Shadow Minister. David

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Simmonds. Thank you, Mr. Speaker. I'd like to welcome the Secretary of State back to the despatch box and to thank her for the early sight of her statement. I'm not sure this was the triumphal return to the subject of devolution that she had in mind, because our councillors and the communities they represent are looking aghast at yet another shambolic U-turn from this government. Ministers have repeatedly given assurances to this House at that despatch box that have not been honoured, and it speaks volumes for that sense of priority that this far into this administration, only Surrey has proceeded with its reorganisation.

Despite all those assurances, Mr. Speaker, the Secretary of State has already told the House that she is not satisfied that the process that was followed by her predecessor was lawful. Can she tell the House from the despatch box why she is not satisfied that it was lawful, and will she place all the Non-privileged documentation and correspondence relating to this debacle in the public domain and in the library? What assessment can she tell the House she has made, given that the government has agreed to pay the legal costs of councils that have challenged them on this matter, what assessment has she made of the legal costs that will be borne by taxpayers of the consequences of this? You two, given that this government has been banking on millions of pounds in savings, savings that we have challenged repeatedly across these despatch boxes to mitigate the costs, including the massive rise in National Insurance, which has driven many councils to the verge of bankruptcy, what assessment of Treasury colleagues made, and what advice have they given her about how they will need to mitigate this further delay in any of those savings, should they ever materialise, being achieved? She's told the House from the despatch box that elections will go ahead now, Mr.

Speaker, we've all heard that promise being made at that despatch box before and indeed in some cases reversed literally the following day. Yes. So given the promises that have been made, given that all of our political parties have selected candidates who've been campaigning for mayoral elections, for new unitary authorities, which this government promised were coming into being with elections to take place next May, will she give a categorical assurance that those new authorities will be in place, or promise the House clearly that they won't? And will she tell us what the timetable is, if there is one at all, for bringing those new mayoral combined authorities into existence, particularly given the store by which the government has set those as their path for devolution.

And finally, Mr. Speaker, let me ask her. I appreciate she's returned to this role after others have been stewarding it. But will she apologise? Yes, to all of those councillors, all of those local government officials, all of those political candidates and activists, all of those businesses that have engaged in good faith with this government's process, all of whom have been shamefully let down by this betrayal of local democracy.
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Angela Rayner Portrait Rt Hon Angela Rayner MP, The Secretary of State for Housing, Communities and Local Government (Ashton-under-Lyne, Labour)
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Yes. >> Yes. >> Well, Mr. Speaker, I welcome the hon. Gentleman to his place and thank him for his constructive thank him for his constructive comments. Look, it is disappointing that I've come to the House and made this statement, and I recognise the work that local authorities, that members of this House that others have put into the. Getting us to this point. But, Mr. Speaker, when I took over this role recently and the Prime Minister asked me to look at this again, and upon receiving legal advice, I wanted to satisfy myself as the Secretary of State, that the process was robust and legally sound, and therefore that is why I have made the decision today, and I understand why hon.

Members will be disappointed in that. But that is why I made that decision. In terms of legal costs, which was asked of me, legal costs will be determined in the usual way. The government you know, local government reform is often contested in courts and it's right and part of our democratic system that important issues can be challenged. And the government engages legal advisers to defend decisions whenever challenges are brought and does. And that does bring costs. He asked me about the savings that are made.

I'd just like to say that the, you know, the government has made savings in the past on local government reorganisation. But for me, Mr. Speaker, it's got to be about not savings, but about the outcomes for people in their local area. And that's what's driven reorganisation. From my point of view. And in terms of the how how the new mayoral authorities and what will happen, I'm really clear, Mr. Speaker, that it has to be done. Correct and right. And I, as Secretary of State, have to, in good conscience believe that I have dot every I cross every t and that's why I'm making the decision I've made today.
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Angela Rayner Portrait Rt Hon Angela Rayner MP, The Secretary of State for Housing, Communities and Local Government (Ashton-under-Lyne, Labour)
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Well, my hon. Friend is absolutely right to raise the opportunities with devolution, and the Prime Minister is really clear that that's what the government ambition is to ensure that every area in England has, or is in the process of establishing a strategic authority by the end of 2027, with strategic authorities in place everywhere by the end of 2028. This process that I have put in place today is about making sure that we have a rapid review and we make the right and correct decisions on reorganisation.



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Liberal Democrats oppose Preston Zoe Franklin. Thank you, Mr. Speaker, and I thank the Secretary of State for thank the Secretary of State for advance sight of her statement. I have almost lost track of the number of times I have stood in this chamber and warned the this chamber and warned the government about problems with its local government reorganisation plans, and yet here I am again. It appears the government has finally appears the government has finally listened, but it has done so too late and the damage has already been done.

Thousands of residents been done. Thousands of residents have been denied their right to vote over the course of this process, because of plans that many of us in this chamber warned were on very uncertain legal footing. Councils have poured enormous amounts of time, effort and money into proposals they repeatedly assured were legally sound, only to discover they are now being abandoned. The abortive costs are likely to be substantial and worse still, a number of authorities were relying on reorganisation as part of a strategy to address serious financial concerns.

Those councils are now being left in limbo. In my own area of Surrey, councils were forced down a reorganisation route that now appears to be effectively abandoned by the government and questionable on a legal basis. Will the Secretary of State commit to
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James Naish Portrait James Naish MP (Rushcliffe, Labour)
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Exeter to better play their role in generating jobs, growth, housing generating jobs, growth, housing and better place based services. In our case, devolution does not work without Exeter being on that without Exeter being on that strategic authority. It's one of the two big economic drivers of the region. Can the Secretary of State region. Can the Secretary of State confirm that this remains the case and that this rapid review, should it be, have a positive outcome? We

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it be, have a positive outcome? We can move forward with both LGR and Devolution in Devon in the future. Quick. Secretary of.

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State Well, I want to reassure my hon. Friend that I've said this review should be rapid and we review should be rapid and we should get on with it as quickly as possible with that engagement, but also that devolution should the also that devolution should the timetable for devolution shouldn't be affected, that we need to make sure that we make the right decisions on local government decisions on local government reform, but we want to take forward

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devolution at pace Jerome Mayhew. Local government reform is a shambolic, incompetent mess. Now I just want to put on record how much time, as well as money, has been spent by councillors and by council officials right across Norfolk. It's been a massive, monumental distraction. Not for months but for years. The Independent Local Government Association say this and I quote, there is no excuse for the government's mishandling of this process. Does she agree?

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Yes. No. Madam Deputy Speaker, what I have said is that I have reviewed have said is that I have reviewed the decisions. I have said on record that the work that people record that the work that people across Norfolk, Norfolk, the people, representatives across the whole representatives across the whole conurbation, I've put in a great amount of work. I want to I want to respect that work as the new Secretary of State and make sure that I am listening, that I have reviewed the decisions and that I have made sure that I am making the right and the correct decision.

I don't believe that that's a waste of the time and the resources that have been put into this. I do believe local government reform is an opportunity for Norfolk, and I will work with local leaders to at pace give them that certainty. But I wanted to, out of respect for their work, make sure that I take that into consideration. As the Secretary of State.

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Andy MacNae Mr. Speaker. I do echo comments made by colleagues, particularly as being colleagues, particularly as being an opportunity to review the boundary decisions. But I do also think that all those councillors and officers that work so hard on and officers that work so hard on reorganisation made so much progress in Lancashire do deserve an apology here. But more an apology here. But more fundamentally, more fundamentally, every week that goes past, every day Lancashire falls further behind our neighbours in Manchester and our neighbours in Manchester and Liverpool, simply through a lack of an effective structure, along with the capacity and capability to deliver on our growth potential.

I was pleased to hear the Secretary of State's recommitment to growth in every postcode. So will she meet with me, along with Lancashire colleagues, to agree how we can properly resource Lancashire's growth potential? We can't wait. We need to do it now. We need to properly resource it and we need to deliver on our potential through this period of uncertainty.
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Angela Rayner Portrait Rt Hon Angela Rayner MP, The Secretary of State for Housing, Communities and Local Government (Ashton-under-Lyne, Labour)
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Well, again, I say to my hon. Friend that I recognise the work that has gone in, Madam Deputy Speaker, and that work is not wasted, that this pause will be about working with local areas at pace to get this right. But it doesn't mean that we can't take advantage of unlocking growth in every postcode, and the Ministers here will be happy to work with the hon. Member and other hon. Members from that area to ensure that we

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get the devolution and the package that works right for them. Gagan Mohindra thank you, Madam

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Gagan Mohindra thank you, Madam Deputy Speaker. I'm going to try a different tact rather than the hokey cokey of this process. The more serious point is that local government reorganisation was always a significant risk to the voluntary and community sector. voluntary and community sector. Many charitable funders are reluctant to fund organisations with annual incomes exceeding £1 million, leaving these million, leaving these organisations reliant on commission contracts from local government, NHS bodies and other public sector departments. The proposed transition to unitary authorities was already disrupting the existing funding streams.

Today's announcement leaves this even more so. What reassurance can the Secretary of State give those important community organisations to ensure that they have the funding in place, but also certainty and direction of travel, and to have the confidence to actually start and continue to to do the services they do for my community. Yeah.

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Well, again, I want to reassure the hon. Member that this is about getting the process right, and I getting the process right, and I want him and those local organisations to get in contact with my officials to make sure that we're doing everything possible to support that process. I've said that unitary local government can that unitary local government can help with the smooth functioning of strategic authorities, and I've also recognised that the government is committed to providing

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is committed to providing transition funding. So please come ahead and get in touch with my department. Luke Murphy thank.

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You, Madam Deputy Speaker, and I'm grateful to the Secretary of State for her statement. It will be met with some disappointment and met with some disappointment and frustration locally, not least because many businesses, community groups, charities, councillors and groups, charities, councillors and council officers have put an enormous amount of effort into the proposal for North Hampshire proposal for North Hampshire Authority. I do believe that is still the right course to set up a North Hampshire authority, so can North Hampshire authority, so can she reassure them that their effort hasn't been in vain, and that she will provide the certainty and take

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a decision on the new proposals as soon as possible? Thank you, madam. Absolutely

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Thank you, madam. Absolutely provide that reassurance. I needed that time and on the advice that I that time and on the advice that I received as part of the Jr process and the Prime Minister asking me to look again, I think it was only look again, I think it was only right that I did that in a timely way. But as I've reiterated, I am absolutely clear that I want to absolutely clear that I want to take this forward. Local government reform is a priority, and I want to do that at pace with members across

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the House, including the hon. Member and his local leaders. Nigel Huddleston Madam.

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Nigel Huddleston Madam. Deputy Speaker. There's a video circulating online that claims the three most online that claims the three most difficult things to say in life are I'm sorry, I love you and Worcestershire. It's fascinating to Worcestershire. It's fascinating to see. It's fascinating to see that the right hon. Lady struggles with at least two of those three things, at least two of those three things, but I am. But I am glad that she has now abandoned her decision, or at least paused her decision to destroy the well run, low tax, conservative controlled Wychavon District Council.

But is she aware of the chaos and cost she has caused to councils in Worcestershire and across the country? She is giving very strong vibes that she does not know what she's doing. Is that because she does not know what she's doing?
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Mims Davies Portrait Mims Davies MP (East Grinstead and Uckfield, Conservative)
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Yeah.

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You're better than that. Madam Deputy Speaker, I am sorry.

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Madam Deputy Speaker, I am sorry. I'm not sure I love you, but I love something and I'm Worcestershire. I something and I'm Worcestershire. I do know what I'm doing, I apologise, I do know, I do know what I'm doing and, and I know that this has been and, and I know that this has been a disappointment for some areas. And I don't come to this House and make this statement lightly, but I make this statement lightly, but I do it in all sincerity to get it right.

And I hope hon. Members appreciate that across Worcester and across every other area that we are looking at local government reorganisation. And hopefully, even if I can't say I love you, hopefully you'll be able to say you

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love me at the end of this process. Jacob Collier thank you, Madam

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Deputy Speaker and can I firstly thank the councillors. And council officers from SBC and Staffordshire County.

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and Staffordshire County. Council for the hard work that they've put into this process, and that rapid review is essential to that rapid review is essential to give residents and council workers that certainty that they need. As my hon. Friend for Stoke Central my hon. Friend for Stoke Central said, this should be seen. Aside from the mayoral devolution, which I think is the real prize for our communities to bring power out of this place into Staffordshire. So with that in mind, will she commit to a meeting in Northampton North with Stoke and Staffordshire MPs so that we can talk about getting this

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deal into place here? My hon. Friend is absolutely right to raise that. Devolution can happen at pace and it will unlock potential, and I'm sure the potential, and I'm sure the Minister will be happy to meet with him and my colleagues from number ten North, to make sure that we can

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ten North, to make sure that we can unlock the potential for his area. Sorry, colleagues. Thank you, Madam Deputy Speaker. I absolutely. Share the shock and anger of councillors and council officers at this announcement. And what at the heart of this are councillors who are working so hard to live a frontline services, whether it's education, housing, social care and it is those who are battling this change. And I have been left still uncertain about what's going to happen in May.

So will the Secretary of State please assure the people of Hertfordshire who they will be voting for in May, and also look at the cost and time will they will they be reimbursed that that will be able to go to the services that are desperately needed?

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Well. Again, I gently say to the hon.

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Again, I gently say to the hon. Member that words like shock and anger I, I appreciate the hon. anger I, I appreciate the hon. Member is is using that language. But for me, what was important as Secretary of State is to to make the right decision and therefore to come to this House, to speak to hon. Members to ensure we do that. I still believe that local government reform will unlock potential for her area. I want to make sure that I'm doing it with local people's consent.

I know that you can't get everyone's consent, but I do absolutely believe that we can design services that are going to improve the local services in her area, and we have committed to providing transition funding. And hopefully with local government reform, we can really transform some of these thorny issues that have been around for a long time. Like the Prime Minister said, like

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adult social care and building that resilience at a local level. Noah Law thank you. Madam.

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Madam. Minister. And the Cabinet Office. Last week. Set out their plans to rewire

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Set out their plans to rewire the state and effective local government, of course, remains fundamental to that. So will the fundamental to that. So will the Secretary of State double down on her commitment to listening, as she did so well to us in Cornwall, to did so well to us in Cornwall, to members of this House, to local councils, to members of the public. As part of that process.

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I thank my hon. Friend for that, Madam Speaker, and absolutely, I
17:07
Angela Rayner Portrait Rt Hon Angela Rayner MP, The Secretary of State for Housing, Communities and Local Government (Ashton-under-Lyne, Labour)
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Government reform in Essex has been a farce from the outset, because the people never wanted it. The council taxpayers themselves never council taxpayers themselves never had any desire for this process. So I welcome the fact that Labour's gerrymandered five unitary authorities are clearly now stone dead. But could I honestly give her some advice? Drop it. Walk away. Including the morality we've got by an Essex for a thousand years without a mayor. And the last thing we want in our county is another Sadiq Khan.

Just get rid.

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Well. I won't drop it, Madam Deputy Speaker, because I believe that the Speaker, because I believe that the people of Essex and all over England deserve good local services and anything that I believe is and anything that I believe is worth exploring with local leaders, whether that's Essex or anywhere else, that will improve local services, then I'm up for that challenge. I'm not ready to drop it. I think we can work together to I think we can work together to improve local services, and I'm happy to meet with him or any of his local leaders to progress it.



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Michelle Welsh thank you, Madam Deputy Speaker. I welcome. The review. Which gives a real opportunity. To get local.

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To get local. Government reorganisation right. For my constituents. And I. Do hope that they now will be

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Do hope that they now will be really heard. Infrastructure in my constituency is cracking at the seams due to years of neglect from the previous government. Will the Secretary of State meet with me to discuss the real concerns in my constituency of Sherwood Forest about planning, local infrastructure, local government reorganisation and an exciting opportunity to create a local

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country park. Well, Madam Deputy Speaker Sherwood Forest and a local country Sherwood Forest and a local country park. I'm really up for that. Although I was in the Lake District on Bank holiday weekend and managed on Bank holiday weekend and managed to fall halfway down the mountain, and that's why my legs are a little bit not used to bouncing up and down at the moment because my knees down at the moment because my knees aren't so good. So I'm hoping that it's a bit flatter and the gradient is a little bit more for me.

But is a little bit more for me. But she asked if me and the Minister, I'm sure will be happy to meet with her and how she how we can progress making sure that her area, including Sherwood Forest, benefits from devolution and from local

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government. James MacCleary large numbers. Of. My constituents took part in good faith in the government's consultation on proposed boundaries for the unitary East Sussex. They were appalled by Brighton Hove City were appalled by Brighton Hove City Council's attempted land grab in our area and together we resisted it. So can the Secretary of State it. So can the Secretary of State be crystal clear for my constituents about whether this. As part of this review, she intends to part of this review, she intends to reopen the discussion over East Sussex local government boundaries.
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David Williams Portrait David Williams MP (Stoke-on-Trent North, Labour)
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Well, again, at the moment I give the hon. Member assurances that I am looking at the areas and that I'm going to look to make sure that all all of the consultation and all of the information and the advice is correct and that we're making decisions that are robust. And I want to make sure that I do that. And I'm happy for him to be in contact with the Minister or myself to make sure that we hear what he's saying in terms of that process.

But I have heard him today.

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Jonathan Davies thank you very much, Madam Deputy Speaker. I appreciate that. The Secretary

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I appreciate that. The Secretary of State is new in post, so the issues which she's outlined today are not necessarily of her making, but I must tell her it is extremely but I must tell her it is extremely frustrating for people in Derbyshire. It will undermine service delivery and also business service delivery and also business confidence. Whilst this pause goes ahead and a loss as to how it's proceeded so far without it being proceeded so far without it being totally legally watertight.

So I'd appreciate some assurances that she can give me that it won't be torpedoed in the courts again. And crucially, we're going to be asking people to stand for the existing local authorities in Derbyshire in May next year. People of all parties, civic minded, community spirited people. How long will they serve for? I think we owe it to them to tell them how long their term will be, because they make professional sacrifices and sacrifices of their families as well. So she cannot offer me that information.

I think that would be very helpful. Yeah.

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Well, again, I do recognise the frustration that the hon. Member frustration that the hon. Member has expressed as part of this process, and I want to make sure that we take it forward and it is robust, and that is part of the confidence of why I've come to this House to say that I've wanted to review the decision based upon the review the decision based upon the legal advice provided as part of the process. I want to make sure that those that go forward, that those that go forward, including the 14 other areas, that their rationale for that is, is absolutely watertight.

And I say to the hon. Member, meet with the Ministers as part of this process,

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and we can iron out some of those concerns. Joe Robertson thank you, Madam Deputy Speaker. When the Secretary of.

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When the Secretary of. State embarked on local government review for Hampshire and the Isle of Wight, her department the Isle of Wight, her department accepted the principle that the Isle of Wight Council should remain Isle of Wight Council should remain a standalone unitary authority. Now she is reviewing local government reorganisation. Will she reconfirm reorganisation. Will she reconfirm that the Isle of Wight Council will remain a standalone unitary authority? And it will not be, and is not at risk of merging with a part of the mainland?
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Alison Griffiths Portrait Alison Griffiths MP (Bognor Regis and Littlehampton, Conservative)
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Well, again, Madam Deputy Speaker, we will be making sure Speaker, we will be making sure that we cover that within the review, that people are engaged in that process. And I say to the hon. Member that I do believe that local government reform, it is challenging and complex, but the sort of the searchlight for me in that and the aim is that we do deliver better services for local people, and that is about building the homes that we desperately need. That is about our high street renewal, which this government has taken forward.

We can deliver better services, we can reorganise and we can do better. And I believe that working with local leaders is the way forward to deliver for the people of this country, and that's why I'm committed to local government reform. I want to make sure we get it right, and that's

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why I've made the decision to have the review today. Mims Davies thank. You, Madam.

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You, Madam. Deputy Speaker. I am grateful. As the only. MP in the House who represents

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MP in the House who represents constituents in both East and West Sussex and three district councils, including Lewes, which is going to potentially be split previously. And of course, the potential splitting up of West Sussex. The splitting up of West Sussex. The confusion around devolution LGR in West Sussex is a terrible mess because we have different speeds, different approaches and an unclear timetable, and I say that to the Secretary of State. As the two previous East and West Sussex leaders, she will acknowledge, spent huge amounts of time with positive energy to bring to this process.

So when the hon. Lady, right hon. Lady, rightly talks about outcomes, what does she think she could tell me to tell my constituents when it comes to their services on education, social care,

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roads, infrastructure and how they will be delivered in the future? Well.

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Well. Again, I pay tribute to her local leaders and the work that they're doing in local government. they're doing in local government. I recognise the challenges. I've outlined them in terms of what has happened to local government over over, I would say, the decade and a half that her government was in half that her government was in power. And what I've tried to do is build that resilience up for them. Previous Ministers chose to take a more time to consider the proposals, as she outlines from the two places,

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and we will consider these alongside the wider review of the programme. David Williams thank.

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David Williams thank. You, Madam Deputy Speaker. When I'm out on the doorsteps of Stoke-on-Trent North and Kidsgrove, Stoke-on-Trent North and Kidsgrove, residents tell me that too often they feel distant from decisions taken that affect their lives. What taken that affect their lives. What I want for residents is for them to feel that decision making is brought closer to home, that brought closer to home, that locally we're taking better decisions about improving our buses, our houses and giving young people the skills that match their potential.

Therefore, can the Secretary of State please confirm that the devolved powers are still coming to Stoke on Trent, in Staffordshire, and at speed, because we cannot be left behind?

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Yeah. Absolutely. Madam Deputy Speaker, devolution is at the heart of our devolution is at the heart of our plans to rewire the state and ensure that that happens is exactly

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why I'm making this statement today. Alison Griffiths thank you,

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Madam Deputy Speaker. 26 months. In. And the real cost that the Secretary of State has already Secretary of State has already admitted, the government hasn't assessed the cost of the lost programmes, projects and services which haven't been delivered in West Sussex. And Aaron, because the bandwidth, headspace and resources have been devoted to LGR. So can she instead tell me what has been the financial cost nationally in West Sussex and in Aaron, to our so-far failed experiment with LGR? And secondly, how many months can the district councillors elected in 2027 expect to serve? 2027 expect to serve?
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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with the facts. At around 7:30 a.m. on Saturday morning, around 150 individuals descended on the Port individuals descended on the Port of Dover, many of them wearing face coverings. Kent Police deployed coverings. Kent Police deployed rapidly to the scene of what the force has described as a no notice force has described as a no notice protest. No arrests were made and the crowd eventually dispersed some hours later, at which point full hours later, at which point full access to the port was restored.

Nevertheless, the impact was felt by local residents and workers, for whom the scenes will have been unnerving, as well as ferry passengers and motorists who face delays as a result. Turning to the second incident in Portsmouth in the early afternoon on Sunday, a boat carrying approximately 120 people reached British waters near the Isle of Wight, considerably further west than the majority of small boat crossings. The RNLI, under the direction of Coastguard, met the boat and directed it towards Eastney Marina in the wider Portsmouth area.

At around 8 p.m. a group of more than 200 protesters arrived at the harbour intending to block three coaches, which were due to take the arrivals for processing. Many of these protesters were dressed in all black and wearing face masks. Hampshire and Isle of Wight Constabulary, with the support of other neighbouring forces, used a dispersal notice to ensure public safety and officers were forced to use batons and pepper spray to maintain order in the face of some aggression. Officers worked through the evening and into the early hours of the morning, and at around 4 a.m.

protesters began to disperse and the coaches eventually set off again. No arrests were made on the night, however, investigations are ongoing and where criminality is identified, those responsible should expect to face the consequences. Mr. speaker, these types, Miss Madam Deputy Speaker these types of incidents require

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careful handling by the police, and I place on record my Thanks. To all those. Who were.

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Who were. Part of the. Operational responses. In Dover. And Portsmouth. I am especially. Grateful to those on the front

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Grateful to those on the front line whose efforts were essential. To bringing the demonstrations.

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To bringing the demonstrations. To a. I have today spoken. To key policing partners. As the

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To key policing partners. As the House would expect in the wake of such incidents. Work is ongoing to establish any lessons and ensure that relevant intelligence is shared at pace across our law enforcement system. Peaceful protest is a fundamental part of our democracy and it must be defended. But so too is the right of other citizens to go about their lives without undue interference. And there can be no excuse for threatening behaviour or serious disruption. Yes.

Let me therefore make clear to the House and to the country that disorder of any kind will never be tolerated. And those who cross the line from peaceful protest into illegality will face the full force of the law.

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Yes. This government condemns the intimidating and thuggish behaviour shown by some of the protesters this weekend. We are working closely with the police in Kent and closely with the police in Kent and Hampshire alongside the National Police Coordination Centre, all of whom have our full backing in whom have our full backing in taking any necessary step to uphold public safety and maintain the public safety and maintain the peace. Madam Deputy Speaker, none of this is to in any way minimise the very valid concerns that law abiding people have when they see vile criminal gangs exploiting our nation's generosity, and people making illegal and unnecessary journeys to reach this country.

Let us never forget that the frustration we see in our communities today is a product of chaos and crisis. In the years that preceded the general election of 2024. Since then, this government has taken action to fix the broken system we inherited and bear down on the people smugglers. We have doubled the number of National Crime Agency officers tasked with dismantling organised immigration crime. System wide arrests are up 70%. More than 1100 boats and engines have been seized.

And in partnership with French law enforcement, we have prevented over 48,000 attempted crossings. We are now taking that partnership further with the landmark new deal signed in April, securing a 40% increase in French boots on the ground, taking the total to over 1000, as well as enhanced surveillance technology and new specialist units. At the same time, Madam Deputy Speaker, we are removing the incentives that draw people here illegally in the first place. Since the election, we have made over 6000 small boat returns, a 64% increase in the last two years of the previous government, and we have removed more than 80,000 illegal migrants and foreign criminals from these shores.

As a result of the action this government has taken, this summer saw the lowest number of small boats arrivals since 2020, and so far this year, the number of crossings is down by over 43% on last year. Progress is being made, but we are not complacent. We must and we will be unrelenting, not least in response to any shift in tactics by the gangs. The use of larger boats with over 100 people crammed on board is a clear cause for concern, and we remain alert to the potential for crossings on less frequently targeted stretches of water off our coastline.

The gangs are never going to go quietly, Madam Deputy Speaker. They are responding to the impact our work is having, and we will adapt in turn, both in terms of our enforcement, in partnership with France and in terms of our response here. Madam Deputy Speaker, our priority will always be the safety of the British people. As such, we will continue bearing down on small boat crossings and the criminal gangs behind them as we deliver the strong, secure borders. The people of this country expect and deserve.

At the same time, we will keep working closely with police forces to maintain order on our streets. While we must protect our ancient right to free speech. What we will never tolerate is the disruption of people's daily lives or the intimidation of our communities. House.
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Chris Philp Portrait Rt Hon Chris Philp MP (Croydon South, Conservative)
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The shadow Home Secretary. >> And I thank my constituency. >> Neighbour. >> The Minister for policing, for advance sight of her statement. Now, I am sure we all agree that the right to protest is a fundamental part of our democracy, but the right to protest should never be violently exercised, and it should never cause serious disruption to other people. I am sure all of us would equally condemn any form of protest where those guidelines are abused. I am sure we all equally support the police in making sure protests where it occurs is lawful and peaceful, but this should also be a wake up call for the government, because it is not just those protesters in Dover and Portsmouth who feel so angry about large scale illegal immigration.

It is millions and millions of people up and down this country who feel angry as well. Since the general election, over 80,000 illegal immigrants have crossed the channel all illegally and all unnecessarily because France is a safe country. Nobody is fleeing persecution in France. Almost 20,000 have crossed this year alone, and 625 crossed yesterday, with more coming in the early hours. Every day when the sea is calm. Hundreds of illegal immigrants crossed the channel, and the numbers this year would have been higher were it not for rough seas in the last few months.

The government should not be complacent at all. This problem is not solved and I do not think the plan is working if indeed there even is a plan. I was on the beaches of northern France just a few weeks ago, waist deep in water, as one of these dinghies embarked with about 100 illegal immigrants on it and the French gendarmes. Nacional, who we pay for the Home Secretary, pays for. With £660 million of our money, almost all of it unconditional, stood by.

Ten of them stood by and did nothing while this dinghy embarked in basically knee deep water. They could easily have stopped it. And when I asked one of those gendarmes after it happened why they did nothing, he said they were not to intervene. Almost all of these French officers are prohibited from preventing embarkations in the water. They do not prevent the migrants getting to the waters edge either. And so long as that continues to happen, these crossings will continue as well. She mentions return numbers.

What she didn't mention is those returns of small boat migrants, 6000 in the last two and a bit years amount to only 8% 8% of illegal immigrants crossing the channel. That is to say 92% of illegal immigrants crossing get to stay. There is no deterrent whatsoever in that. And of course, these people who cross illegally are costing billions and billions of pounds to accommodate in hotels and apartments, and even more once they get asylum and start claiming welfare. But people are angry, not just because of the numbers, not just because of the expense, but because of the crime being committed as well.

I met with Siobhan White a few weeks ago. The mother of Rhiannon White, brutally murdered by a Sudanese illegal small boat migrant called Den Magic, stabbed 23 times, including in the neck. There have been numerous rapes committed by small boat illegal immigrants as well, including a girl just 12 years old in Nuneaton, and the government is using a sleight of hand. It's moving illegal immigrants from hotels into apartments, and then it's granting them asylum on an industrial scale.

Just this afternoon, the UNHCR hardly hardly a bastion of right wing extremism, I'm sure she will agree, said that Home Office asylum decision making only meets its own standards in half of cases. And the UNHCR no less said that many illegal immigrants being given asylum do not deserve to be granted that status under the government's own rules. And a whistleblower in The Times today said that only 1% of asylum claims are really genuine, citing amongst many examples. I can't give them all in the interest of time, but there was apparently hundreds of Pakistani men claiming to be gay, based on a letter from the same individual claiming to be the sexual partner of all of them.

Hundreds. That is quite clearly fabricated with the assistance of immigration lawyers. So when the system is being abused on this scale, it is no wonder people get angry. This government repealed the most of the Illegal Immigration Act, which prohibited illegal immigrants from ever getting citizenship. If she wants to create a deterrent, I strongly suggest you reinstitute that measure. They cancelled the Rwanda scheme before it even started. That would have seen illegal immigrants getting deported. If they're serious this and ending public anger, they need to get serious about the measures Lee Pitcher and deport illegal immigrants as soon as they arrive.

Then people won't be so angry.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Can I thank the shadow Home Secretary for the start of his remarks? I think we all would agree that the right to protest should never be violently exercised. And of course, we all agree that it's not just protesters who feel angry about the current system. And of course, we are doing all we can to bear down on it and change what we inherited. I know that the shadow Home Secretary was in France. We all saw the videos over the summer and enjoyed those the weather.

He claims that the weather accounts for the improved situation we find ourselves in. The 43% cut in small boat crossings in people that we've had come across this year compared to last year cannot be accounted for by the weather. That is just a fact, and I would hope that the shadow Home Secretary would accept that. And I know that he spoke to some land officers who weren't maritime officers, who were the officers who can enter the water. And we have footage, and hopefully he's seen the footage of those maritime officers going into the waters and doing exactly what he wants them to be doing.

So I just hope he can learn a bit more about what our deal is and what responsibilities we are paying for. He said that we are not paying. We are just giving the French the money without results. He knows that the new deal that we have done with the French for the first time introduces payment by results. Under his government, there was nothing. We were throwing money with no payment by results. So £110 million of what we give to the French is dependent on them delivering results, which is why we are seeing an improvement.

We are also now funding over a thousand French police. That is historic levels of funding, but also we are working in partnership with them. So to make sure we are doing the things that we need to do to stop the small boats from coming into to to strip the criminal gangs of their armoury. Germany, for example, has just passed a law so that it is an offence in Germany, which is where a lot of these boats were being warehoused to sell boats outside for the use of this kind of smuggling activity in another country.

We are doing every single thing we can, pulling every single lever, and the results speak for themselves. I think. I think, sadly, that the shadow Home Secretary is the only person in this place who thinks that a scheme would have worked. I think the rest of us have come to the conclusion, including including, I suspect, people on his own side, that it was a gimmick and that it will never have worked, and that the numbers that we are seeing in terms of the results that we have seen over the last two years, speak for themselves in partnership with French law enforcement, we have prevented over 48,000 attempted crossings.

That is substantial. Now, have we have we got a lot further to go? Of course we have. And he's he's right to have met the family of Rhiannon White. And it is horrific what happened to her. And nobody would claim anything else. And it is in in in memory of her and in. And it is the right thing to do for every single constituent that we all have across our country, that we take control of our borders and make sure we have a fair migration system.

The government is doing the hard work restoring control at our borders. We are seeing progress. We are not complacent. We will continue to work. But I will end where I began, which is that I agree with the shadow Home Secretary that we must we must allow the police to exercise the powers that they need to, to stop thuggish and violent protest behaviour. And that is what we are looking at and what happened over the weekend. We will learn the lessons if we need to.

From what happened. I am talking closely with the police as he would expect me to, and we will make sure that they have the resources they need to do their job.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Can I thank my hon. Friend, and I was pleased to be able to talk to him earlier today. And of course, him earlier today. And of course, we were in touch over the weekend as well as as the House would expect and as the member of Parliament for that area is absolutely right and proper, that he should lead the way in terms of asking for the right lessons to be learned from what happened. Having spoken to Deputy Chief Constable Peter Ayling and Assistant Chief Constable Nicola Falconbridge today, they took me through the order of what happened and how it happened.

It was a no notice protest in the sense that a lot of protests that we see in this country, the police are told in advance. They're allowed to then think about whether they want to impose conditions and what those conditions should be. This was a no notice protest in terms of the police weren't told about it. Clearly. It was planned, and clearly it was people from outside the area coming in and causing chaos. Of course, we need to learn whatever lessons we need to learn in terms of intelligence.

We have, since the riots of 2024, we set up a new structure or beefed up a the structures that we have around the national coordination of protests and intelligence sharing, looking online, having a stronger capability to look across the internet and see what we can find out there as well. So there is more coordination and, you know, the offer of mutual aid work very well this weekend as it as it always does. But of course, I will listen to to any intelligence he has, and lessons.
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Max Wilkinson Portrait Max Wilkinson MP (Cheltenham, Liberal Democrat)
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Liberal Democrat spokesperson Max Wilkinson. >> Thank you, Madam Deputy Speaker. How is it that far right thugs in balaclavas were able to close Britain's busiest port without the Britain's busiest port without the police receiving any prior intelligence? And how is it that then an apparently separate group then an apparently separate group with some commonalities, were then able to blockade another site the next evening? Will the Minister tell the House whether she will review why the police were caught off guard? More shockingly still, perhaps just as shockingly, no arrests have been reported.

Now, Madam Deputy Speaker, people have drawn comparisons this weekend with the arrests of hundreds of sign holding protesters who have been arrested since July 2025 on other protests. Can the Minister understand why people are confused by the difference in approach? Can she also answer questions from Portsmouth Liberal Democrat Council leader Steve Pitt about the lack of local consultation for identifying appropriate landing sites. This is a key question that needs answering because it clearly caused problems in Portsmouth. Now, Britain's transport infrastructure cannot be left vulnerable to far right mobs.

It is a disgrace, Madam Deputy Speaker, that this weekend reform MPs took to social media to fan the flames alongside people like Musk and Robinson. It is a disgrace that members of this House support such vigilante action. Hear, hear. Now it was the decision to leave the European Union, championed by those reform members and their allies in the Conservative Party, which created the small boats crisis in the first place. We will. We will only get, Madam Deputy Speaker, a safe and controlled asylum system in line with British values.

If we join the EU migration and asylum pacts, it will save taxpayers money to. The government is paying at least £500 million for a three year agreement with France. More money will follow when the agreement with Belgium is struck. The UK's contribution to join that pact, which would bring order and safety to the asylum system, would cost significantly less than we are currently pledging to pay. Joining the pact must be top of the agenda when the Prime Minister meets with EU leaders later this year.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Can I thank him for his comments? >> Can I thank him for his comments? He asked about the lack of intelligence. It wouldn't be appropriate for government to appropriate for government to comment on specific intelligence matters on these cases. But of course we are looking at all decisions that were taken and we will learn any lessons. The two events happened on consecutive days, of course. And of course there was a crossover in terms of the online activity. They were they were they were very different in that one was clearly organised by a group of a group of called the South East Patriots, I think as part of Patriot Platform, which is a kind of far right racist platform.

That was that was clearly organised. Whereas in in Portsmouth, there was a response to a series of events that led to this boat having to dock Eastleigh Marina. And I think there will have been a mix of local people who were very concerned as well as, you know, bad actors who were whipping up activity online and responding in kind. So they were two separate events. But we will, of course, learn any lessons that we need to. Similarly, he asked the question about the landing site and why that site was picked.

And we are, of course, making sure we understand what exactly happened in that circumstance. But also stepping back, you know, members will have seen, you know, a bit of a trend towards people leaving France more to the western end. And what does that mean? And are we making sure we're responding in the right way and that there's enough resource going into that? And we have pushed some of that resource from the French police down the down the coast line. But of course, we will be monitoring those things.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Can I thank my hon. Friend for that question and for the work that that question and for the work that she's doing, and I should also pay tribute to my hon. Friend the tribute to my hon. Friend the Member for Portsmouth South, who is in his place here today but cannot speak as he is a Minister. But I know and I've spoken to him, obviously, I've been in touch with him about the conversations he's been having with local businesses, local individuals and the local police.

And I think my hon. Friend is is absolutely right. There were clearly people there who are who were there because they were concerned about what they were seeing. That is very different from the kind of racist, far right thugs that we we we also see as part of the part of what has happened over the weekend. And it's very important that we distinguish between the two. She asked what more we are doing. I listed the improvements that we're making in terms of the National Crime Agency, the intelligence that we're gathering, and our ability to go after the criminal gangs.

We also need to do more to reduce the incentives for people to come into the country. And the asylum grant rate, which is a statistic that I haven't mentioned yet, has fallen from 77% in 2022 to 38% this year. So that's another that's another mark of protest and of, of progress. And of course, where we are reforming the asylum system more widely. Last November, of course, the Home Secretary set out reforms that we are working through. We've had a consultation on the standard qualifying period for most migrants.

All of these things are all part of trying to create a fair system that doesn't incentivise people to come here from France.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Yeah. hon. Lady for for the question? I know she will have been concerned over the weekend as a local member of Parliament, and I appreciate of Parliament, and I appreciate that. I'm very happy to always be there if she wants to contact me, if she's struggling to get through to anybody. Very happy to give her my number and have a have another chat about about that. Obviously, it was a moving picture as well in terms of what was happening. So it isn't always possible for the police who are dealing with the incident to be able to respond in a way that you might, one might want with that aware of, of what she's saying about is this is this going to be an emerging problem with people trying to land further down? We are aware, and it is in part because we are making it harder for people to launch from their sort of traditional places, that people are starting to launch further west along the French coast.

There's no evidence to suggest that they want to particularly land anywhere other than to get to Manston and to to go where, where they would normally go. But of course, we will keep these things totally under review in terms of the mutual aid that was given, I think I'd say two things. I think the force was, was given the mutual aid that they asked for. There were several forces around. And that actually, in the end, the problem was dispersed. But the mutual aid that's that's not uncommon for forces to offer mutual aid.

When we saw the problems that we had in Cleveland in recent weeks, there were 600 officers who who were who went in in mutual aid. I think it does, just to make a slightly wider point, make the case for reform of policing. If you have a national police service, if you have a national police service, which we are introducing, not that reform. You would have these agencies working much more closely together because they'd be part of the same organisation. So rather than relying on sort of mutual aid from other forces, everyone would be joined up and sharing intelligence.

And I think that would be a better system. Sorry.
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Sarah Jones Portrait Sarah Jones MP, The Minister of State, Home Department (Croydon West, Labour)
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Yeah. >> First I would say to the right hon. Lady that of course people are hon. Lady that of course people are scared and angry and see that the borders, as they see it, are not are not secure. And of course, she will know from her time in the Home Office that we have come some way since she was there and improved the system very significantly. With more than 1000 boats, boats and engines being seized. System wide arrests up 70%, 48,000 prevented crossings, 40% increase in the French boats and the French boots on the ground, increased surveillance technology.

Huge drop, 42% drop in the number of boats coming over, and we have removed more than 80,000 illegal migrants and foreign criminals. So people are right to express a view. And it is disingenuous of of her, I think, to suggest that I was calling those people racist, when I quite clearly was very clear all the way through that there were people in Portsmouth who were concerned, local residents who were coming out because they are angry. And we've heard that. And that is very different from the racist thugs that we see in other places and who were also there, and the whipping up online of that kind of hatred that we saw, we will continue to bear down on illegal boat crossings.

And I would also just finally pay tribute to the Kent and Hampshire police. Kent Police dealt with 1300 999 calls on Saturday, and Hampshire dealt with a thousand. So whilst these incidents were going on, there was also a lot of work being done keeping us safe across the counties.
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Kevin McKenna Portrait Kevin McKenna MP (Sittingbourne and Sheppey, Labour)
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Kevin McKenna. >> Speaker, and I'd like to commend the Minister on the way that she's she's managing to handle two really difficult challenges that are facing the country at the moment. Obviously, there's a small boats crossings. Obviously, these are very, very concerning to people in Sittingbourne and Sheppey, as many people have. Kent, it hasn't escaped my notice that this protest in Dover at the weekend happened at a point that those boat crossings are falling. And the second challenge, this challenge is increasing far right activity, uniform thugs on our streets who've been organising relentlessly behind the scenes and publicly on Facebook, is something that we have to come down hard on.

Now, I'd like to ask the Minister two things, actually. One is in the 1930s. I mean, we've seen this before. We this is this isn't this isn't the first time the country and other countries have faced this. In the 1930s, we banned uniformed political parties and uniform political activists. Obviously, we wear slightly different clothing now than we did in the 1930s. Has the Minister looked at how we can update that law to address these thugs and make sure it's actually fit for purpose in the modern world? And secondly, local news outlet in Kent, independent news outlet Kent Current reports that the night before the incident in Dover, these thugs were mustering in nearby villages.

Local people picked this up and had been reporting it, but that seemed to be missed. So can the Minister look at that further and make sure that this intelligence from the ground, by concerned people in Kent is also factored in? Yeah.
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None Portrait Ministerial statement: Economic Growth
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our shared economic challenges, global instability, conflict and
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Emma Reynolds Portrait Rt Hon Emma Reynolds MP, The Chief Secretary to the Treasury (Wycombe, Labour)
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trade frictions are continuing to drive up inflation and interest rates around the world. While these rates around the world. While these shocks are international in nature, their impact is also being felt here in the UK. From the cost of here in the UK. From the cost of the weekly family shop to the cost of government borrowing, Britain has shown resilience in the face of has shown resilience in the face of these pressures and the economy is now turning a corner. Our growth was the fastest in the G7 in the first half of this year.

Government borrowing fell to its lowest level in six years last year, and interest rates have been cut six times since the general election. We are building on our strengths, our world class universities and our world leading sectors such as life sciences, defence, technology, creative industries and financial services. And because of the choices that this Labour government has already taken, we are in a stronger position today to capitalise on the opportunities for growth across our economy. But in the context of a more uncertain world, we must continue to make responsible choices and fiscal discipline will underwrite every promise this government makes.

Both the Prime Minister and Chancellor have made clear their commitment to meeting the fiscal rules with a buffer against uncertainty, and we will address the long term pressures on our public finances to put debt on a sustainable downward path. And as the Chancellor said earlier today, there is nothing progressive about spending £1 in every £10 on debt interest. In his statement to this House last week, the Prime Minister laid out a clear diagnosis of what has gone wrong in our economy.

Political power was centralised, the economic fundamentals were privatised or outsourced and our country was deindustrialised. The solution is a fundamental shift in the way our country works. Number ten, North and the Treasury are working together to build a stronger, more strategic centre of government and a more active state. Together, we will support the ambitions of local leaders and exert political public influence on and direction over the essentials, including transport and housing. We will devolve power and resources to local leaders.

London is, of course, an economic powerhouse, but if our city regions could emulate the success of second cities in France and Germany, growth in our country could be transformed, the Chancellor has instructed public investment institutions to focus on regional growth, to build on our high growth areas. The Oxford, Oxford Cambridge Corridor and the Northern Growth Corridor. He has today announced a new £150 million northern scale up fund, delivered by the British Business Bank, to back the most innovative and fast growing firms from Liverpool to Newcastle.

A new northern 500 will also bring together 500 of the North's most ambitious mid-sized businesses into a single growth community, focussed on scaling, investment and productivity, the National Wealth Fund will establish new strategic partnerships with South Yorkshire, the Liverpool City Region, the North East and Cardiff, giving these areas support to build their investment pipelines and at the Budget next month, the the government will go further with a roadmap for fiscal devolution, a permanent transfer of power and resources from Whitehall to our regions.

Madam Deputy Speaker, this plan will drive economic growth and productivity in three key areas supporting investment, boosting innovation and getting more people into good jobs. First, investment business investment has increased by nearly 5% since the general election, but in a highly competitive world, we must do more to reduce the barriers that firms face. The government will tackle the thicket of consultation, litigation and administration that is holding up private investment, including by extending our reforms of judicial review from energy to all major infrastructure.

We will bring an end to the consultation culture across government, supported by new guidance from the Attorney General on legal risk, to give Ministers confidence to make decisions. And as the Chancellor has set out, we will make further changes to the Treasury's Green Book, reducing the discount rate from 3.5% to 3% to ensure that the Treasury rule book doesn't go against key regional infrastructure projects, and to make sure places across the country get a fairer hearing in spending decisions.

Work is already underway to progress place based business cases in Plymouth, Birmingham, Liverpool and Port Talbot, and at the Budget we will publish guidance to allow more areas to do the same. Second innovation the UK has a fantastic record on innovation. We are world leaders in frontier technologies, quantum computing, nuclear fusion, space technology and AI. But too often ideas born here have to go elsewhere to find the capital they need to scale. So today we are setting out a new ambition to double the number of unicorns in this country.

The government will identify and back these high potential firms, providing with the necessary capital to scale new cross economy. Sandboxing powers will also enable firms to test frontier technologies safely and building on the important work already taking place in defence and in sovereign AI. The Chancellor will work with government departments to earmark new, dedicated funds to back British innovation. The third vital driver of job of of growth is jobs. Our objective objective is to get more people into good, highly skilled jobs and to make the most of the untapped talent that exists across the country.

That is why, two weeks into office, the Prime Minister set out a bold new plan to transform transform technical education. And this autumn, Alan Milburn will set out his full recommendations to government on how to address the blight of youth unemployment. This is our moral duty, not only our fiscal duty, because it cannot be right that so many young people are stuck on benefits. Madam Speaker, Deputy Speaker, this plan for growth is underpinned by fiscal discipline. It will hand power to local leaders and unlock the potential of our regions.

It will build a strong strategic centre of government and enable greater public direction and influence over the essentials. And it will back British business, British goods and British exports, creating wealth and prosperity in all parts of the country. This is a plan to build hope and optimism across our economy, and to drive good growth in every postcode. Madam Deputy Speaker, I commend this statement to the House.
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Richard Fuller Portrait Richard Fuller MP (North Bedfordshire, Conservative)
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I call the shadow Chief Secretary to the Treasury. Secretary to the Treasury. >> Richard Fuller Madam. Deputy Speaker. Thank you very much, and may I thank the Minister for her may I thank the Minister for her statement and for early sight of it. On a day when the country was On a day when the country was listening for a message of change, it was the same old, same old, a continuity Chancellor with continuity policies and a continuity team of Ministers in the Treasury.

Does the Minister recognise the harsh irony of a government that could find plenty of money to hire 14,000 more civil servants in SW1 that the Chancellor chose to go to the West Midlands, just a few miles away from Jaguar Land Rover, but had nothing at all to say about it. The Minister talked about government borrowing falling to its lowest levels, but I wonder, can she talk also about the cost of government borrowing? Can the Minister confirm that the cost of government borrowing for 30 years is now at its highest rate for 28 years? The Minister talks about there being nothing progressive about spending £1 in every ten on debt interest.

Well, amen to that. But then why Minister did this government choose to increase borrowing by £500 billion over the course of this Parliament? The Minister talked about the Northern Scale Up Fund, an interesting initiative, but can the Minister advise who will be making the investment decisions, and can she assure that they will not be subject to political. The Minister talks about a national wealth fund with new strategic partnerships, a permanent transfer of power from resources from Whitehall to the regions.

Did she listen to the Secretary of State for housing saying that local government reform is on hold? Does she confirm? Can she confirm to the House what proportion of the country will qualify under that measure to be part of Labour's largesse? My fear is that many parts of the country will not qualify. The Minister did talk smartly about removing the thicket of consultation, looking at judicial review and the consultation culture, and we will be supportive of measures that she comes forward with that.

But then, after a brief moment of common sense, Madam Deputy Speaker, the Chancellor then talked about reducing the discount rate from 3.5% to 3%. Now, can the Minister can confirm that the cost at which the government is borrowing is going up and up 5.9% for 30 years, and she has chosen this moment to reduce the rate at which the government expects to get money back from 3.5% to 3%. Can she explain how those numbers add up? And then, of course, the final cherry on the parfait that the government will identify, quote, the government will identify and back unquote, unicorns in this country.

So how will the government identify these unicorns? And can the Minister explain how that is different from the discredited policy of governments picking winners? Then the Minister returned to common sense, and the about the announcement that Mr. Milburn will set out his recommendations to the government. Could the Minister please advise the House because I think many will be concerned about this. On what date will Mr. Milburn make his recommendations? Madam Deputy Speaker, we had an opportunity today from the government, from the Minister and the Chancellor, where they could at least, at least have mentioned the high cost of energy that's crippling British manufacturing.

We could have had the Chancellor or the Minister rule out tax increases and therefore provide some more certainty for business that they can invest. We could have had the government say they will take up the offer from the conservative Leader of the Opposition to work together on meaningful reform and reductions in welfare so that we make work pay. But we didn't hear any of that. Instead, we are heading to a Budget where a Labour government has again run out of money, where a Labour government once again increased taxes to cover their fiscal incompetence.

Same old continuity. Labour.
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Emma Reynolds Portrait Rt Hon Emma Reynolds MP, The Chief Secretary to the Treasury (Wycombe, Labour)
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Yes. >> Thank you, Madam Deputy Speaker. It's a great pleasure to be stood opposite the hon. Gentleman. Again. We've done so earlier on in this We've done so earlier on in this Parliament. I say kindly to him that I would be rather be continuity Labour than continuity. continuity Labour than continuity. Liz Truss. And he mentions I will address the the the the points that he mentions. He mentions Jaguar Land Rover and and he's right to do so. It is a very concerning time for the workforce.

And the Business Secretary is working closely with the chief executive and indeed the trade union leader of unite, and bringing those two together tomorrow to discuss the situation. Jaguar Land Rover has made clear that they face very competitive global headwinds, but we have done a lot to support the automotive industry and Jaguar Land Rover itself. Given the loan guarantee that we provided last year when in the wake of their cyber attack, but also the help that the business Secretary and the government is providing to the automotive sector to bear down on the cost of energy, I think in some cases, he said that he agreed with me, which is always it's always good to hear.

I think we can agree that there is nothing progressive about spending so much money on servicing our debt, and that's why, as a government, we are committed to fiscal discipline. We are committed to the fiscal rules because we want to bring down the cost of government borrowing, but we are not immune to the global instability. That is. That means that the cost of borrowing is also increasing for every other G7 country. But we have got the fastest growth in the G7.

We are cutting our deficit faster than any other G7 country. Business confidence is up. Investment business investment is up, productivity is up. Interest rates have been cut six times since the election and consumer confidence is up. So while he talks down our economy, the Chancellor and I and the whole ministerial team will be talking up the British economy. He asks about the northern scale up fund and he asked a serious question about that, which I will respond. The the British Business Bank will make those decisions independently as in of government, as always, should be the case.

And he's right to ask for reassurance about that. And I provide that reassurance on devolution. We are a government that is very serious about devolving power to every part of the country. We'll have more to say about that at the Budget, and we will set out a risk fiscal devolution roadmap as well. He he accused me nicely of talking smartly about the thicket of consultation and saying that I had some common sense. I thank him for that. I think we can agree.

And he's been in government too, in the Treasury. I remember it fondly when we had meetings together back then, and he. It's good that we have an agreement across the Dispatch Box that we need to make sure that those sorts of things don't gum up the system, that Ministers are able to take decisions, and that we're able to get infrastructure built in this country. I do respectfully disagree with him about the Green Book discount rate. We proudly say that we are reducing the discount rate to 3%, because there have been times in the past when the Treasury has stood in the way of good regional infrastructure projects that have a long term benefit, and I'm proud that we are making sure that those projects get a fairer hearing on unicorns.

He will know that we've already made some changes to tax in last year's Budget to support unicorns, and we're opening up opportunities to public procurement. I think he mentioned pudding at the end. Parfait. I think it was, but I won't respond to that. I'm a big, big fan of pudding myself. On the serious question. Turning to the serious question of the Alan Milburn Review. I cannot give him a timeline, but I will repeat what I said in my statement that it is absolutely our moral duty as a government to ensure that we have more young people back in the labour market.

That's why we've already introduced the Youth Guarantee, so that young people who've been out of work for longer than 18 months will get a pay placement by the government. And we've also introduced a grant for businesses that take on unemployed young people. I think it is a very serious issue and one that we will address.
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Charlie Maynard Portrait Charlie Maynard MP (Witney, Liberal Democrat)
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Liberal Democrat spokesperson Charlie Maynard. >> Thank you, Madam Deputy Speaker, and I thank thank the Chancellor and the Minister for their speech and their statement. We know that and their statement. We know that the Conservatives Brexit deal has hit national GDP by as much as 8%, costing the country up to 90 billion a year in lost tax revenues. Will the government now pull the largest zero cost growth lever available to it by negotiating a growth and defence partnership with the EU, including joining the single market and a new customs union.

Rather than clinging to the same failed red lines that are costing businesses billions every year, being outside the single market and the customs union directly links to the 13% fall in the UK's export of goods. Since 2022. This has hit traditional manufacturing regions the worst. These are the same places that the government's Reindustrialise the North Agenda claims to prioritise. I would like to understand whether she acknowledges the reality of that linkage or not. I welcome the Chancellor's emphasis on the importance of fiscal credibility and link to that meeting the fiscal rules.

However, the reality of these fiscal rules have been easily gamed by successive governments, with our budgetary process being summarised as speculation without scrutiny, short term headroom chasing and gaming the system through a jam i.e. spending today, pain i.e. tax tomorrow. With tomorrow never arriving. The result is that we have. It has been more than 25 years since we had a balanced Budget, and our national debt is now six times larger than 20 years ago. So I want to ask the Chief Secretary.

She will demonstrate that she is serious about tackling tackling our debt, whether she agrees that the key way to do that is to grow our economy, and whether she is interested to consider what we can learn from how other countries such as Switzerland, Sweden and New Zealand, have addressed and solved their Budget process problems. Mr.
18:55
Emma Reynolds Portrait Rt Hon Emma Reynolds MP, The Chief Secretary to the Treasury (Wycombe, Labour)
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I thank the hon. Gentleman for his questions. I will try and do his questions. I will try and do justice to them in the short time available on Brexit. The Chancellor said this morning that Brexit has said this morning that Brexit has hammered British exports. I do agree with him that there is a link between the fall in experts that he between the fall in experts that he talks about and the barriers that the previous conservative government put up with our nearest and biggest trading partner, so I agree with him on that.

And that's exactly why this government is renegotiating a reset with our European partners. We promised in our manifesto we will not join the single market, but we will bring down those barriers at the border, particularly with our SPS agreement that we're currently negotiating with the EU, and there'll be further announcements on that in due course, and that will benefit our agri food industry by making it easier to export to the European Union. He asked about the fiscal rules. I don't agree with his analysis on that.

We have brought forward the fiscal rules to apply to three years to get around some of the gaming that he talks about. We are serious about tackling our debt, and as I said in my statement, we are reducing our deficit at the fastest rate in the G7. I'm always interested to learn from other countries. I think we should always be open to that, and I'd be interested to hear more about what he had in mind.
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Karin Smyth Portrait Karin Smyth MP, Minister of State (Department of Health and Social Care) (Bristol South, Labour)
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a very hot end of June and July. If one can remember back that far. But as part of that process, the as part of that process, the committee scrutinised every clause of the bill and debated over 195 amendments. And we on the government benches are grateful for their diligence. The implementation of the Bill is better for all that hard work, and I also welcome the hard work, and I also welcome the spirit of collaboration that has greeted this bill on the main provisions from all sides of this House, most notably at Second Reading, but also during committee.

And I hope that we can continue in that spirit at this stage. And for our part, we remain committed to working with MPs and peers across the House and other stakeholders to ensure that the end result is a bill that strengthens the NHS. Now, Madam Deputy Speaker, I know we've got a large number of amendments on a variety of topics, so I will keep the remarks on these amendments very short, so I beg to move. New clause 96 and 97 regarding visiting rights. And these amendments strengthen the role of integrated care boards and local authorities in promoting, visiting, supporting people to have someone with them and ensuring the involvement of family, friends and carers and decisions.

They complement the existing legal requirements and the work already underway to drive a change in culture and practice. By embedding visiting at the heart of the responsibilities of commissioners, an amendment new clause 96 explicitly places duties on integrated care boards to promote opportunities for visiting and accompaniment, while 97 Newark 97 builds on local authorities existing wellbeing duties by emphasising the importance of involving other people in decision making, receiving visitors and maintaining opportunities to take trips outside the care home and maintaining meaningful contact and connection with family, friends and carers is critical to the health and wellbeing of so many people in our health and care settings, and they provide invaluable practical help, emotional support and advocacy for their loved ones and accessing care and treatment.

And commissioners should do what they can to support these relationships. So secondly, Madam Deputy Speaker, I would like to move government amendments 60, 61 and 62. I know the question of who is required to sit on ICB boards has raised comments from all across this House, and I'm grateful to all those members who have raised the importance of local government having a voice in ICBs, including my friend, the hon. Member for Birmingham, Erdington and wider, the hon. Members across all sides of the Health and Social Care Select Committee who continually advocated on this issue.

And we agree it was never the intention to weaken the voice of local government in the NHS. We recognise that local authority board members is an important voice for commissioning on the ICB and often providing helpful challenge and very different perspective on those commissioning decisions. This is especially significant in. I will give way.

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Grateful to her for giving way and also to thank her for taking and also to thank her for taking our amendment on this issue. We pressed her over and over and over again and her colleagues, to the again and her colleagues, to the extent where we got a letter back that honestly, at one point we thought was generated by AI because thought was generated by AI because the logic in it had absolutely no follow through at all. So I'm delighted that she's listened.

But delighted that she's listened. But I would also ask her, what else is she intending to listen to us to in particular in these are for tomorrow, but the amendments, the Healthwatch amendments to the Health Inequalities Amendment, and most importantly, the Special Needs Amendment today. What else is she going to listen to us on? Minister.

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Well, I thank the chair of the Health Select Committee, and I can assure her that I'm Karen, not Claude. And those amendments are Claude. And those amendments are absolutely generated in. And, you absolutely generated in. And, you know, I she tempts me to go further on the rest of of this bill, but can I say, I genuinely thank her can I say, I genuinely thank her and the committee, and I hope she would agree that I did spend a lot of time over the past months before of time over the past months before Report stage and Committee stage meeting with her and members of the committee and many hon.

Members across this House. We have some, what we might call some simple provisions in this bill to democratise the NHS accountability and particularly reinforcing single patient record and improve the landscape around patient experience and patient safety. We absolutely recognise that within those simple propositions there's a lot of complexity and we'll continue to listen to hon. Members. We want to make sure that the NHS is strengthened, as I said, from from this. In relation to the ICBs and local authority voice, it was particularly significant over the summer period in light of those comments, but also my right hon.

Friend, the Prime Minister's commitment to rewiring the state and our ongoing reform to social care. And with that in mind, I am pleased to table these amendments which re-establish requirement on ICBs to have at least one board member jointly nominated by local authorities in their area, which sits alongside the existing duty to have a member nominated by the mayor of each mayoral strategic authority, as well as duties and ICBs and local government to work together, including on health and wellbeing boards and in committee.

We had a very useful discussion on health and wellbeing boards along with neighbourhoods and that accountability at local level. I should also note that ICBs are able to appoint other people to their boards if they would benefit from their expertise, and that is a decision to be taken locally. Finally, Madam Deputy Speaker, I want to briefly pre-empt the hon. Member for North Shropshire and make a few comments about new clause one, and I would like to thank the hon. Member for North Shropshire and the way that she has worked with me and the Committee in in committee and through this issue around maternity Commissioner, an issue which I think unites the House on maternity.

And as the hon. Member knows, we have accepted Baroness Amos recommendation from her national investigation into maternity and neonatal care and to deliver on this commitment, I can announce today that we will be bringing forward an amendment to this bill in the other place, to establish a statutory maternity and neonatal Commissioner. We are determined. We are determined to get this right. For too long, too many women, babies and families have not received the care and support they deserve. The establishment of a commissioner represents a significant opportunity to strengthen accountability and champion their interests across the system.

In the light of this, I hope this will give the honourable reassurance she needs to withdraw her amendment this evening. Madam Deputy Speaker, I beg to move these government

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amendments. Integrated care boards duty as to visiting. ET cetera. The to visiting. ET cetera. The question is that New clause 96 be read a second time. And before I call the shadow Minister, Doctor call the shadow Minister, Doctor Caroline Johnson. This debate is heavily oversubscribed. Backbenchers will be on immediate Backbenchers will be on immediate speaking limit and not everybody will get in. I call the shadow Minister, Doctor Caroline Johnson.

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Minister, Doctor Caroline Johnson. Thank you, Madam Deputy Speaker, and I'll try and keep my remarks as short as I can. But first, I'd like
19:33
Caroline Johnson Portrait Dr Caroline Johnson MP (Sleaford and North Hykeham, Conservative)
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to thank my right hon. Friend the Member for Daventry, for all the hard work he's done over the last year, holding the government to year, holding the government to account on health and social care, to thank the whole of the conservative health team for their support. And every member of the support. And every member of the committee who has, the Minister said, scrutinise this bill in detail in such a hot and sticky room before the summer, and I'd room before the summer, and I'd like to thank my parliamentary team for their support with it as well.

And finally, to congratulate the Minister on her reappointment and Minister on her reappointment and thank her for the time that she has taken to engage with opposition on this legislation. Madam Deputy Speaker, I also must declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health. So after that, turning to the bill, it's not a small bill. Madam Deputy Speaker. It runs to over 200 pages, and there are almost as many pages of amendments as there is in the bill, with around 180 different MPs signing or supporting different amendments.

Madam Deputy Speaker, I don't agree with every amendment proposed, but I do welcome thoughts and ideas coming from right across the House. But for most way across the House, we didn't see much from reform. Now, this bill does have scale, but does it have direction? Does it have clarity of purpose? Leadership sets direction a destination. Follow that from that follows a path as smooth as possible from A to B with appropriate milestones. But this bill, like so many of this Labour government's, came as an announcement without enough thought.

Let's go back. The government started with the Darzi report. I won't restate the arguments about why it was done or the weakness of the claims that it is independent, but suffice to say it is. Their report, published by a Labour peer and former Labour Minister for a Labour government, and it says a few things about reorganisation. Lord Darzi wrote that a top down reorganisation of NHS England and integrated care boards is neither necessary nor desirable. Yet the government decided to abolish NHS England and restructure the ICB and half the ICBs budgets all at once, without properly planning what would come next.

So that's the first clause of the Bill abolishing NHS England. One of the main arguments provided was the unnecessary bureaucracy and duplication of staff. And as a conservative, I accept that that is a strong case for efficiency. Government must use taxpayers money wisely. In a letter to the Permanent Secretary sent to the Public Accounts Committee, officials estimated savings of £1 billion a year by abolishing NHS England and redundancy cost payments of approximately 1 to £1.3 billion. But we haven't seen the calculations behind those.

Madam Deputy Speaker, it was announced in March 25th that the restructure would be completed in two years. Yet we're now 18 months in and Ministers don't seem to be on track. From March 25th to July 26th, a year and three quarters of the time they've given themselves a total headcount across NHS England and the minister's department decreased by 12.9%, nowhere near what the government needs to deliver the cost its promised promised savings. So we've tabled amendment 102, requiring the government to publish a full workforce transition plan, a new clause 153, requiring the government to publish precisely how many people it makes redundant.

I'd like to raise a contradiction, Madam Deputy Speaker. The government's talked a lot about devolution and local decision making, but this bill does the opposite. It removes the Council of Governors from foundation trusts. It gives Ministers the power to hire and fire health leaders. It puts an end to local Healthwatch. It gives the Secretary of State the power to to set and adjust annual funding allocations for ICBs and direct them to ring fence funding for service indication integration. It takes away local decision making.

It's also inconsistent with what the Prime Minister said the other day in response to a question about this bill, the Prime Minister said he does not like the idea of a postcode lottery in the National Health Service, but if decisions taken are taken locally, decisions taken will be different and in different areas which will lead to a postcode lottery. So can Ministers shed some light on what they actually believe? Does this government want decisions made locally and accept that there will be different? Or do they want decisions made centrally and back to Lord Darcy? Lord Darcy said something else in his report.

He said, and I quote, constant reorganisations are costly and distracting. They stop NHS NHS structures from focusing on their primary responsibility to raise the quality of, and efficiency of care in providers. Indeed, in fact, it's not too dissimilar to what the Minister of Secondary Care previously concluded herself in opposition when she said the reorganisation of health services always distracts from people's jobs, destroys morale and wastes money. So how is the NHS performing? Let's take a look. Well, the total number waiting for appointment has gone down a bit, as they've said, but in trauma and orthopaedics, ophthalmology, cardiothoracic surgery, elderly medicine and gynaecology, it's gone up in some cases higher than it was before the election.

But for those waiting for an admission who need a procedure or an operation, it's not only going up month on month, year on year, it's higher than it was at the time of the general election. And what about accident and emergency? The number of people waiting for more than 12 hours after a decision to admit was 29% higher in July 26th than July 24th. And that's despite the fact that, Madam Deputy Speaker, there were fewer such admissions in July 26th than July 24th.

And how has the government performed in other health areas? Childhood vaccination rates are in decline. The workforce plan has not been published, despite the Minister saying it was imminent months ago. Fracture liaison clinics haven't been delivered, despite allegedly being one of this government's planned first acts. I could go on, Madam Deputy Speaker, but we don't have much time and I think I've demonstrated the point. NHS reorganisation is distracting from delivery. And one, one of the things I want to talk about that it is not delivering is the response to the Hughes report, and I'd like to thank Doctor Henrietta Hughes, the Patient Safety Commissioner, for her hard work on this report.

When it became apparent the trauma and suffering that some people, particularly women, have experienced from mesh repairs and the harm that children have suffered because of exposure to valproate in the womb. We were all horrified. The previous government changed the way valproate was prescribed and commissioned regional surgical centres of excellence to provide care for women who suffer from the effects of mesh repair. The conservative government also commissioned this huge report, published in February 24th, that investigated compensation schemes for those affected.

But the general election was called just three months later, so delivering compensation, delivering on this report became the Labour government's job. But sadly, Ministers have dithered and delayed for more than two years now. We've had written question after written question, several debates and a lot of warm words, but still no response to the Hughes report. Madam Deputy Speaker, it is simply not good enough. Those suffering should not have to wait any longer, and that is why we have tabled clause one for new clause 145.

This new clause would provide a legal backstop, ensuring the government publishes its response to the Hughes report within 30 days of this bill becoming law at the latest. That's still not soon enough for those affected, but it's the only way of putting in an effective backstop so the government can stop Fobbing off

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justice. Hear, hear. Moving on to other amendments,

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Moving on to other amendments, Madam Deputy Speaker, the government announced out of the blue that ICB running costs will be blue that ICB running costs will be halved by 50%. Why 50%? I have no idea. But ICB scrambled to respond. We know from those inside the health service that it's been a major distraction, with a massive opportunity cost for patient care. When the bill came, Ministers chose When the bill came, Ministers chose to change the composition of ICBs two, removing the choice of hospitals and primary care from boards, as well as the voice of local authorities.

Severing that link with social care, integrated care partnerships will also be abolished. There'll be a focus on mayoral representation, even for mayors, where there is little role, if any, in delivering social care. So in Lincolnshire, Madam Deputy Speaker, for example, instead of a local authority and an ICB on the same geographical footprint, working together over the same area to cover health and social care, we now have a government conspiring to give us an ICB covering three counties and no voice for the local authorities who ensure, after today's announcement whether they're going to be split up or not.

We discussed at some length in committee the importance of health and social care working together. So I welcome the government's U-turn on day one of this term to reinstate local authority representation. But I urge the Minister to consider, as the opposition parties have proposed, to reinstate primary care and secondary care representatives to. There are three amendments on workforce Madam Deputy Speaker, but I'll speak of them briefly because I'm aware of the time. The first new clause 154, would require the Secretary of State to increase the number of medical school training places to 1000 515,000 by 21, 31, 32.

And why? And to put it simply, because they promised they would do and they haven't. And then secondly, merit based applications. New clause 152 the current system for allocating doctors. Their first jobs used to be done on performance. It was when I was a junior doctor. Now it's done by computer algorithm prioritising choice. This is unfair, demoralising and destroys incentive to study hard. We believe in meritocracy and I urge the government to accept new clause 152 and then also new clause 144.

I urge the government to support this too. This addresses the plight of a small but significant group of people, a group of medical students subject to a great injustice. These are students who are British students, British citizens studying at a British university, predominantly Queen Mary University in London, who were told four, four and a half years into the degree that they would not be able to have places on the foundation programme but be at the back of the queue. The Medical Training Prioritisation Act has meant that non prioritised doctors got only 1.8% of the jobs, and they were the last 1.8 that were left.

Now that was the point of the bill. But this particular group of British citizens, the government should, should, should put it into the priority group in terms of our other amendments, Madam Deputy Speaker, which we will talk about no more. No doubt, in the Lords we have an amendment on on self care, new clause 155 to give people more autonomy over their own care. We have new clause 101, which talks about the national commissioning of services, which are the low volume, high complexity services, to make sure that government can't just move them into ICBs without a proper consultation and a proper plan, we have the patient choice, Duty amendment 95, ensuring that patients have the choice over the care they receive in neighbourhood services, as well as hospital services.

We have amendment 88, the single patient record, the single patient record. Madam Speaker has the potential to be truly transformative, bringing the NHS in line with other modern healthcare systems. They can also prevent people having to repeat themselves. But the government has lots of unanswered questions. This is another example of making an announcement without thinking it through. How will existing health records be linked? How will patient carers and clinicians have access? Who will control the data? How will it be kept safe? So we've tabled amendment 88, requiring the Secretary of State to publish a full plan before making changes.

Madam Deputy Speaker there are some parts of this bill that the opposition can support, but the government, in its hurry to make announcements, often doesn't seem to think things through properly. And this is the story of local government reform that we heard in this House earlier today as well. It's the story of the much delayed workforce plan, and it risks becoming the story of this NHS reorganisation in health. Madam Deputy Speaker, there are life and death situations, so we cannot afford for the government to get it wrong.

The opposition have made a series of sensible amendments and

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support. Yes. Backbench speeches are on a five

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Backbench speeches are on a five minute speaking limit. Clive Efford. Thank you, Madam Deputy Speaker.

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I rise. To support the motion number. 90, amendment number 97 in my. Name, which is to.

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Name, which is to. Remove clause ten from the Bill. Clause ten would give powers to the Secretary of State to vary the proportion of public private provision of health services, if they consider that to do so is in the interests of the health service. In evidence to the Health and Social Care Select Committee, the chief executive of the Nuffield Trust said that clause ten of clause ten that it seems to make it more possible for the Secretary of State to explicitly set out to increase private or public provision.

My question is why does she need this power? Introducing an extra level of nuance now, as clause ten will do, has the potential to raise fears within the
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Clive Efford Portrait Clive Efford MP (Eltham and Chislehurst, Labour)
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NHS that it could be abused in future. The clause has the potential to create unintended potential to create unintended consequences. The explanatory notes on the Bill say that this new flexibility is necessary, where flexibility is necessary, where there may be otherwise be a breakdown in provision of health breakdown in provision of health service. Can we imagine a situation where the Secretary of State has concerns about a health service, concerns about a health service, that an approach to assist a local provider would be rebuffed? It's hardly likely to happen.

The explanatory note suggests that in such circumstances, the Secretary of State needs the power to direct local decisions rather than to work with local health service providers to resolve any difficulties. How does the power to influence the proportion between public and private provision help and resolving a breakdown in service? Labour's 2024 plan to make work pay set out a very welcome desire to bring more essential services back into public control, something which is welcomed by health workers across the country.

Because so far the biggest wave of insourcing in a generation, as was promised, has felt more like a triple when it comes to the NHS. The health Bill is something which the new Prime Minister and the new Secretary of State have inherited from their predecessors, so hopefully they will be able to stamp their own mark on it before it becomes law and remove clause ten. And that would be one way of making their mark. The concern here is that those that work for the NHS and those that support it, is that the force has the potential to be exploited in future by those who would seek to move away from the public provision of health care.

There are ample powers to enable the Secretary of State to intervene and resolve breakdowns in provision of health service. We must balance clause ten against what it adds in those situations against its potential misuse by an ideologically driven government that is determined to privatise our NHS, to remove any ambiguity and to protect the NHS from the possibility of this clause being abused by a future Secretary of State. I would urge that it be dropped from the bill.

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Morgan. Thank you very much, Madam Deputy Speaker. I've tabled a number of

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I've tabled a number of amendments to this bill, but I'll hopefully keep my remarks focussed so that there is a good opportunity so that there is a good opportunity for other members to make their speeches. This bill should be about fixing the front door and the back fixing the front door and the back door of the NHS. It offers the opportunity to bring in tangible changes for patients to address pressing problems and introduce desperately needed improvements to desperately needed improvements to patient safety and experience.

The primary care and social care crisis, in particular, are millstones around the neck of the NHS. But instead of these, the Bill has focussed on a top down reorganisation, which risks diverting time and money away from pressing issues and giving sweeping powers to the Secretary of State, which is not in itself without risk. The Liberal Democrats would, instead of put social care and general practice at the heart of this bill, a move which would represent real reform of the health service, in particular nucleus 54 and 56, put down by the hon.

Member for Mid Sussex, would together transform the rights of family carers through guaranteed respite care and reform of the Carer's Allowance. These would put free personal care and an end to catastrophic care costs at the heart of social care reform. The Member for Epsom and Ewell, new clause 53 would ensure everyone can see a GP within seven days or 24 hours if urgent, while amendment 17 would introduce a primary care investment standard. Although general practice is the core of the patient's relationship with the NHS, it is seen its funding decline as a share of NHS spending.

Less than 10% of the NHS Budget is spent on primary care, although this is estimated to constitute 90% of a patient's direct experience with the NHS. A primary care investment standard would help to reverse that trend. Dentistry is another area of primary care which has been neglected, leading to dental deserts and dangerous DIY dentistry. New clause 18 would introduce a scheme to end dental deserts and guarantee appointments for children and those most in need. Now I will give way.
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Helen Morgan Portrait Helen Morgan MP (North Shropshire, Liberal Democrat)
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And does. >> The hon. Lady. Agree with me when it comes to the family mental health pathway and prefers the new clause 82? But the point I'm making is that diagnosis right through treatment and charging for bereavement, mental health support for families cannot can't be an afterthought. It must be a statutory active duty. Does the hon. Lady agree that when it comes to that issue, in particular, perhaps government and the Minister

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should take that on board. Intervention, and I broadly do agree with him. And I'm about to agree with him. And I'm about to come on actually to mental health in a moment. And it's right to modernise the NHS and to end some of the duplication that we see of the duplication that we see between NHS and the Department for Health and Social Care. But the way it has been handled has been chaotic. It's been combined with chaotic. It's been combined with 50% cuts to ICB budgets, unfunded redundancy payments and chaos through the system, and I was through the system, and I was alarmed to read the report in The times of the weekend about advice to the Secretary of State that the changes envisaged in the Bill are impossible to implement, given that the staff of NHS England are on different pay scales to those of the Department.

So given these significant hurdles, I hope the Secretary's. Oh, sorry, the Minister can give us some reassurance in her closing remarks that abolishing NHS and the way that the Bill envisages is actually achievable. We're also particularly concerned that the functions of the Secretary of State, under these reforms, open the door to political capture, a huge risk to take given the unstable political climate we live in. That's why we've tabled amendments 16 to create a firewall between the Secretary of State and operational decisions. These new powers are particularly concerning in the context of the patient safety issues, which we which are created by this bill and which we are going to discuss in more detail tomorrow.

Beyond the Department itself, the Bill is complacent on taking seriously the vulnerability of our NHS from foreign interference and its implications for national security. That's why we put forward amendments, new clauses 2 to 5, which recommend which recognise and address the NHS role as part of our sovereignty and the sensitivity of patient data. My Neil Coyle 17 would require scrutiny in this House of the arrangement between the United States of America and the United Kingdom on pharmaceutical pricing. This deal focuses forced on us by Donald Trump with no safe in the British people will hike prices of medicines in the coming years by billions of pounds and deserves parliamentary scrutiny.

What all of these shortcomings of the Bill attest to is that the NHS already spends far too much time and money responding to failure, rather than improving the safety and quality of services in the first place. Our amendment ten I will give way and that would be the last one.

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I'm very grateful. To my friend for giving way on on the points about safety. Would on the points about safety. Would she agree with me on the gravity of the National Maternity Review and the fact that it found that the fact that it found that Musgrove Park Hospital was the and I quote, most challenging estate in the country. And if it is the most challenging estate in the country, would you agree with me? It needs to be addressed sooner than 2033 so that mums get better treatment sooner than the 2040s.

That is unacceptable. If it's the most challenging estate in the country.

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Well, I thank him for his intervention. Crumbling estates are a big part of the problem across the whole NHS and in maternity, and he's right to highlight the state of his own local hospital and advocate for it. It's quick remedy. Now, our amendment ten, which the Member for Winchester, I'm sure will outline in more detail, will outline in more detail, reintroduces the mental health investment standard. This is a crucial investment to avoid failures further down the line if failures further down the line if interventions aren't made for patients early on.

But nowhere is the cost of failure more obvious than in maternity a devastating scandal which, despite the many recent reviews, still deserves far more attention. Our amendments to finally make our maternity services safe for mothers and babies will therefore be the main focus of my remarks today. But I would first like to thank the Minister for her constructive engagement with me on new clause one and the commitment that she's made at the Dispatch Box today to table relevant amendments. When the bill reaches the other place to put that maternity commissioner in place, and I'm very grateful to her for the discussions that we've had and the constructive approach that she has taken, both with me and the large numbers of campaigners on this issue beyond this place.

So in the light of that, I won't be pushing New clause one to a vote. I will be withdrawing it. But I've seen up close the human costs of the failures in maternity system. Four years ago, the Ockenden review found that over 200 babies and nine mothers in my community had died needlessly in Shrewsbury and Telford due to failures in maternity care. This has been devastating for my community, and since then we've heard that there wasn't isolated. There have been terrible stories from families around the country, most recently following the review into services in Nottingham.

I therefore tabled New clause six, which would introduce a scheme to ensure that every maternity unit in the country is rated good or outstanding by the CQC. This new clause is essential if we are to meaningfully address the crisis in our maternity services and show families that lessons have been learned, not just locally but nationally. The Liberal Democrat maternity rescue package behind this would require an estimated £600 million a year to bring safety in maternity units up to standard investing in safe staffing, staffing and listening to mothers.

But the government already spends £1.3 billion a year, more than double the cost of this package on maternity negligence payments. Introducing this reset is a no brainer, Madam Deputy Speaker, Rather than spending a fortune compensating for failure and heartbreak, the NHS should be getting it right in the first place. Recently, we've seen the consequences of safety failures, with lack of staffing causing North Devon's maternity unit to close, forcing women to take a 50 mile trip if they go into labour. The hon. Member for North Devon, whose constituency has been hit hard by this news, has tabled a new clause 66 to guarantee safe staffing levels and access to maternity unit within 45 minutes.

And while on the subject of women's health, I also want to highlight new clause 11 and new clause 12. Earlier this year, I wrote to the Ehrc to highlight the stark inequality in research and investment in women's health, with a huge gap in investment, governance and reporting mechanisms between the women's and men's health strategies. These new clauses would set up an inquiry into women's health outcomes and ensure that average waiting times for women's health conditions do not exceed the average waiting times for wider elective treatment.

The crisis in maternity care is a national shame and reveals a systemic neglect of the safety of women and their babies over many, many years. However, this is indicative of even wider concerns for patient safety, which I urge the Secretary of State to address in this bill and will discuss in more detail tomorrow. If the government is serious about using this bill to improve our NHS, it must invest, invest time and money in the front and back doors of the NHS rather than structural reorganisations.

The safety and staff of staff and patients must be at the centre of these changes, and I urge the Minister to consider the amendments led by myself and my Lib Dem colleagues, which would improve the Bill to achieve just that. Thank you.

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Yes, Daniel Francis. Thank you, Madam Deputy Speaker. I rise to speak to amendment 32, a I rise to speak to amendment 32, a new clause 39 in my name, which seeks to address the problems facing community equipment and wheelchair services across the wheelchair services across the country. I declare my interest as chair of both the APPG for disability equipment and wheelchair users, and as the parent of a wheelchair user, I know just how important getting these services right is for disabled people and right is for disabled people and their families, and the consequences and long term impacts when it goes wrong.

The evidence gathered by the APPG for Access to Equipment report last year found that 1 in 3 equipment users who responded are waiting significant times for equipment, with 1 in 5 waiting over two months and 55% stating they don't have the equipment they need for their long term needs. At a time when we're rightly focussed on reducing waste and improving patient flow, it makes little sense for somebody to
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Daniel Francis Portrait Daniel Francis MP (Bexleyheath and Crayford, Labour)
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patients experience delayed hospital discharge because essential equipment was not available at home, increasing pressure on hospital beds and pressure on hospital beds and placing further strain on services. And the system is fragmented, currently inconsistent and lacks sufficient accountability and national oversight. My amendments would introduce two things that the system lacks a clear expectation about how long people would wait, with clear set timelines and accountability when things go wrong, and they'd also ensure that patients have a clear pathway for hospital discharge within.

Amendment 32 would require ICB to provide equipment and wheelchair services within 18 weeks of the date that a person's assessed. And I know from my own experience that in my daughter's case, when she was eight, on two occasions, the 18 week deadline was missed and she was without an adequate wheelchair for 21 months. It's the case that these issues simply shunt costs to elsewhere in the NHS. The all party group for wheelchair users has heard evidence from consultants within the NHS about the quality of assessment, interventions and aftercare.

We've heard delays lead to children receiving a wheelchair that is no longer fit for purpose by the time they receive it, and the following are quotes we heard there is the additional care to consider as well. Poor equipment provision leads to pressure sores, increasing sclerosis, all of which have a wider impact on the sector in terms of inequity of care. When asked for information, it's always the same 8 or 10 ICBs who respond. The ones who don't are probably the ones we should worry about.

And there's a level of bureaucracy in the NHS that stops things happening. Disability is not considered as important as other things in health and parameters, and we know the data is available, shows that within ICBs, that wheelchair deadline is being missed by many ICBs 29% of ICBs aren't meeting the deadline for 20/20 5% of wheelchairs within that 18 weeks.

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On that point. Absolutely. Friend.

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For giving way and for the work he's done on the APPG. He's a real champion for this issue. AJ, who are the contracts in my constituency, have similar levels of failure that he is raising today. of failure that he is raising today. People left for months, sometimes six months, without a wheelchair bound, unable to get out of the bound, unable to get out of the house as a result. Does he agree with me that ICBs seem completely at sea with managing this issue? Totally unaccountable? And don't we need much tougher measures, such as

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those who suggest to hold them to account? Yeah. Thank you, and I completely agree with my hon. Friend from agree with my hon. Friend from Uxbridge. There is, as I'll come to in a moment, an inconsistent set of data from across the country, not data from across the country, not just between ICBs, but in the case from my constituency and my good friend over there from Eltham, within those neighbouring London boroughs, for instance, the same ICB. There is a different framework within each borough.

I welcome to support the Children's Commissioner for my amendments, who said across the country, children wait far too long for the right equipment. That's essential for daily life. In recent research on children experiencing delayed discharge from hospital, the office was told that delays in getting equipment and having equipment serviced had led to children being stuck in hospital away from family, friends and school. And as I say, the the postcode lottery doesn't just exist across the country. I know a number of ICB elsewhere in the country where there are significant issues, but that ICB that postcode lottery exists within ICBs.

So in my part of south east London, it can mean that one patient can be discharged while the patient in the same hospital with the same condition living on the opposite side of the road can't because a borough boundary runs through the road and there are different contractual arrangements between different London boroughs within the same ICB. And again, I know firsthand that two children in the same school class can have completely different service standards for their wheelchair, because one lives in one London borough, while the other lives in a neighbouring borough still within the ICB.

I'd also like to briefly speak to the amendment from my hon. Friend from Thurrock Nichols, 85. Like myself, she is the parent of a child disabled child and we have fought these issues for many years, both as parents, but also on behalf of our constituents. I know in my case in London borough of Bexley, when we had that outcome of systemic failings from Ofsted in our central vision, we could hold our local authority to account, but we could not properly hold our ICB to account.

The judgement was issued against the council, not the ICB. And there is more we need to do in

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those areas to give. Right? Absolutely. I thank my hon. Friend for the powerful speeches, giving and powerful speeches, giving and bringing his personal experience. The EHCP, I'm sure you'll agree with me, has the letter H, which

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stands for health, and we need to see the health service doing its part. Does he agree with me? I absolutely do agree, and I've

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I absolutely do agree, and I've had to sit there. Unfortunately, as a Labour councillor back then, as leader of the Labour opposition, leader of the Labour opposition, married to a senco employed by the local authority, employing my own professionals to get through this process, to ensure that that that health aspect was upheld. It's absolutely abhorrent. And for many parents who don't have that opportunity and that insight that my wife and I have, they are left in in a place where they cannot ensure that accountability is there for their child.

As I say, when my borough went through that judgement, systemic failings that really what did come to the fore. So I would be grateful later on if the Minister Secretary could outline on my amendments and on my amendments how it intends to address those with my amendments, how it intends to ensure we deliver those basic objectives, clear expectations for how long disabled people should wait for consistent standards and meaningful Canterbury.

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Accountability for ICBs when services fall short. Thank you, Madam Speaker. Jeremy Hunt thank you, Madam.

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Jeremy Hunt thank you, Madam. Deputy Speaker, and I want to start by thanking the Minister for start by thanking the Minister for the emphasis the bill places on a single patient record, which is something where, you know, despite something where, you know, despite many problems in NHS care, this is actually an area where the NHS is a world leader. But putting a single world leader. But putting a single patient record on the right legal footing, making it possible to share data with proper governance, actually gives the NHS an opportunity to become a world leader in AI, and also the opportunity to transform care for patients.

So that has my full support. I speak in support of New Clause 25 because I. I am worried that the biggest structural reform in this bill is the abolition of NHS England. But there are other structural reforms that are not in the Bill that would have a much bigger impact on patient care. A new clause 25 is about continuity
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Jeremy Hunt Portrait Rt Hon Sir Jeremy Hunt MP (Godalming and Ash, Conservative)
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of care, particularly in general practice and maternity. It is now very clear to many people that the abolition of the old GP list system abolition of the old GP list system in the 2004 contract changes was a huge mistake. In fact, restoring huge mistake. In fact, restoring the system where GPS have their own patients was part of the Labour manifesto. So I think it's manifesto. So I think it's something that the government understands, but it isn't in this bill. A study in Norway, published in the British Journal of General Practice in 2022, over 4 million patients showed that patients who have their own doctor for more than 50 years, 15 years, are 30% less likely to need out-of-hours care, 28% less likely to need hospital care, and 25% less likely to die.

Why is that? Because patients who know their GP, GPS who know their patients are less likely to make mistakes. They're more likely to give an accurate diagnosis, and they are going to better calibrate risk because they will have situational awareness of a patient and their families. And the experience of patients, of course, is infinitely better when they're dealing with a GP who they know, instead of which we have moved to a system in which many GP surgeries effectively operate, like call centres, and you will contact a GP and you may never see that GP again.

It's exactly the same when you call 111. If you get put through to a clinician and contacting a GP in the NHS should never be like calling an Uber driver who you

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never see again because I'm happy to give way to. I'm grateful to my right hon. Friend and for colleagues opposite Friend and for colleagues opposite who did have that in their manifesto, they might want to reflect how much commitment more much more commitment do we have to constituents because they are our constituents, rather than if we were sharing constituents on a day were sharing constituents on a day to day basis? We often go out of our way. We hope to to look after our constituents because of that our constituents because of that sense of ownership, that sense of obligation.

And it's only because we're allocated those people and they are our responsibility that we go to that extra extent. Why would doctors not be the same, and can colleagues not see the sense of

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what my right hon. Friend is saying? My hon. Friend is speaking wise. And of course, this is actually not And of course, this is actually not just about massively improving care for patients. It's also about improving motivation for doctors. And GPS are amongst the most demoralised groups within the NHS. There's a GP surgery in Horfield in There's a GP surgery in Horfield in the Bristol area, which kept the old GP list system as in fact 10% old GP list system as in fact 10% of surgeries have done.

And when I was chairing the Health and Social Care Select Committee, I interviewed this doctor, doctor Lee, and he said that because 60%, around 60% of the patients they see every day are their own patients because they've kept this system, they don't have any problem with GP retention. The GPS who go to work there are happy because they're seeing people that they know. So this would also be transformative for morale inside general practice. Now, people might very reasonably say, well, you were in that job rather a long time.

Why didn't you do it? To which I, I, I want to share with the house a little secret, which is that I did actually try to do this. I changed the GP contract in 2015 so that every NHS patient in England has a named accountable clinician. Unfortunately, I was outfoxed by the system because as a result of that change on every electronic patient record, every one of us here will have a named accountable GP on the record. But absolutely nothing else changed and the NHS continued with the system as it had done before.

Now this is a real opportunity to transform care, transform life for GPS, transform life for patients and the same principle applies to maternity care, where we know with inquiry after inquiry that despite reams of recommendations, things have not been getting better. If every mum, the moment she knew she was pregnant, was told this is the team who are going to be responsible for the safe delivery of your baby. Antenatal, birthing and postnatal. We would restore that personal connection to maternity care, which is one of the biggest issues that comes from so many mothers who say they feel anonymous and not listened to in the system.

The NHS, at its best, delivers absolutely incredible care, and I have three wonderful children who exist because of amazing NHS care. But at its worst it turns patients into numbers. It turns human suffering into box ticking. Now lots of things are necessary to turn that around. But one of the biggest things is restoring continuity of care so that every patient always knows who the doctor is, who's responsible for their care. And that's why I urge the government, if it's not going to be in this bill, to consider how to restore continuity of care in both general practice and maternity.

Yeah, sure. Thank you, Madam.

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Deputy Speaker, can I say there's lots in this bill that is very positive, but a couple of very positive, but a couple of local issues that I want to raise include my local hospital of Stepping Hill. I want to thank the Stepping Hill. I want to thank the Minister for for meeting with me and my neighbour from Hazel Grove constituency to discuss Stepping constituency to discuss Stepping Hill Hospital, and because Stepping Hill is at the heart of healthcare provision in my town of Stockport, it serves around half a million patients a year and is one of the four specialist hub centres for emergency and high risk general surgery in Greater Manchester.

Now, I appreciate that after 14 years of austerity imposed by the coalition government of Liberal Democrats and Conservatives and Conservatives, subsequent conservative governments, it has taken its toll on NHS, and the Labour government is trying to fix things over the last two years. But stepping is a huge issue locally. I have previously raised the condition of hospital a number of times in this chamber, and a number of constituents frequently get in touch with me about the state of of Stepping Hill.

At one point, Stepping Hill was reported to be delivering only 51% of its usual outpatient services, which is simply not good enough. The staff do an amazing job. It has an
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Navendu Mishra Portrait Navendu Mishra MP (Stockport, Labour)
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amazing set of volunteers that support the hospital stepping hill, but so much more needs to be done but so much more needs to be done now. The hospital is. The backlog for repairs at the hospital is estimated at around £138 million. estimated at around £138 million. The government has allocated £2.5 million for targeted essential repairs for fire safety and other repairs for fire safety and other works, and the Foundation Trust has also been allocated £75 million by this government over the next four this government over the next four years.

This is a positive step, but can I urge the Minister to go a bit further in terms of of Stepping Hill Hospital in Stockport, Greater Manchester? The second issue I want to raise is IVF funded treatment. NHS, NHS, IVF funded treatment and I. The reason I raised this. I have also raised this issue previously is we have a situation where we live in this. In a country where we have a postcode lottery in terms of NHS funding for IVF treatment, and it shouldn't be the case now.

I did sign NC 104, tabled by the right hon. Member for Stone, which was about NHS funded IVF in line with the Nice guidelines and once again, sadly, a number of parents in my constituency have been in touch with me about this issue. Sadly, NHS Greater Manchester ICB has taken a step to reduce the provision and they did conduct a consultation a few months ago and 74% of respondents either disagreed or completely disagreed with the proposed one plus cycle offer.

I have tabled a Freedom of Information request to Greater Manchester ICB in terms of the cost and resources that went into this consultation, because they did the consultation and then they just proceeded to reduce the provision, and this disproportionately impacts low income women, people who live in poorer backgrounds, and it's simply not good enough. Greater Manchester has a population of almost 3 million people and this is is a regressive step. So I think the government needs to do a lot better in terms of, of, of mandating legal access to NHS funded IVF.

Now, current data from fertility unit in the northeast shows us that only only two areas where ICB funds three full rounds of IVF treatment show that the chance of having a baby for a woman under the age of 40 after three cycles of treatment is 70%, whereas without people who get access to one cycle is just 4 to 6%. The. In England we need standardisation of IVF treatment. Can I also add my support to NC 108, which has been tabled by my good friend from Liverpool West Derby? I won't say much on this because I have spoken on three separate occasions in Westminster Hall and this chamber about about about data hygiene and safety.

And I have had a very large volume of correspondence from constituents on this issue. Many people in Stockport are worried about foreign tech firms having access to their sensitive personal medical records, and I think people need to have access. People need to have confidence that NHS, the data, the personal details, the data they provide, the NHS won't be misused. So I'm supporting that. NC 108 from from from from the hon. Member from West Derby. Now, can I just finish on on the point that, as I said earlier, in the last two years, this government has achieved a lot.

But we need we need to recognise that there's so much more to be done. I mean, Labour governments, of course, always fix fix things in the long run. But can I just can I just ask the Minister specifically

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in terms of stepping in hospital you. Layla Moran.

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Layla Moran. Thank you, Madam Deputy Speaker. I'd like to start by talking taking up that theme of maternity, which up that theme of maternity, which has already been mentioned by a number of members, and to welcome number of members, and to welcome the government's commitment to Instating, a maternity commissioner. Instating, a maternity commissioner. I sit on the expert reference group is what we're called that feeds into the maternity and neonatal taskforce. And so I'm seeing how the government is trying to pull all of these different issues together.

The committee has repeatedly heard across a number of inquiries how important this issue is. And we do need someone who is independent of government, who is going to be able to knit it all together. Our Black Maternal health report heard how workforce shortages are undermining efforts to improve maternity care. Data is lacking, and there's a culture
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Layla Moran Portrait Layla Moran MP (Oxford West and Abingdon, Liberal Democrat)
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where women, particularly black women, are not listened to. Investment and training are needed Investment and training are needed to tackle this. The First Thousand Days report found that the UK has some of the worst early years health outcomes in Europe, including in infant mortality, and we've called for proper targets for we've called for proper targets for early years. Professionals in the long lost workforce plan. As an aside, where is the workforce plan? aside, where is the workforce plan? I'd love to see it locally.

However, Oxford University Hospitals that provides maternity care for my residents and indeed my own family baby took first steps this weekend. It was a momentous occasion, finally. But I also reflect. I also reflect and very genuinely. There are people in my NCT class who did not have as good experience as we did, and have been proactively contacted by the hospital to have an apology given and an explanation for that awful traumatic birth. They didn't even complain. And this is as a result of, in part, the CQC inspections.

But I think more importantly, the Amos inspection or inclusion in of OU and the John Radcliffe in her report. So I toured it this summer again and heard specifically from trust leaders and also the midwives. They are doing everything that they can to respond to all the criticisms that are being levelled at them by families, but they did tell me that there is only so much that they can do without a new building. Amos's own report said the maternity and neonatal unit sit across multiple floors.

We saw delivery suites that don't have windows that were cold, small and cramped, and had pillars in the middle of them, affecting where equipment could be placed. A large number of them don't have en suites. Can you imagine what that must be like to be giving birth in those rooms? So as the government knits together as action plan, can I please beg them to not forget investment and in particular capital investment when they are empowering the commissioner to do their good work? Now, I want to move to a few of the other amendments.

I support the work to tackle health inequalities and amendments. New clause 90 and 91. Over and over again we hear as a committee how if we want to unlock productivity in the NHS, that is where we need to focus. And I also support the campaign. From my hon. Friend, the Member for Newton Abbot and his cross-party amendment, New clause 34, which echoes the finding of my committee that the government really needs to think again when it comes to Palantir and instead

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supercharge the capability of UK course. I thank. My hon.

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My hon. Friend for giving way. On that very point. Does she agree with me that the recent NHS agree with me that the recent NHS cost benefit analysis showing the Palantir project will cost £1.1 Palantir project will cost £1.1 billion and deliver benefits of £800 million, a net loss of £300

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million for the NHS underlines the now. I thank him for his intervention. He's been a doughty campaigner on this and, as has other members on the committee, including the Member for Chelsea and Fulham. We also know the data is based on much of the data being taken from Chelsea and Westminster Hospital, and not much else across the country. We have a lot of questions about that particular contract and hence why we came to that very same conclusion. But I would primarily urge the government to please consider the new clause 85, in the name of the hon.

Member for Thurrock name, which is about imposing duties on ICBs in delivering the EHCPs. We did a round table in my constituency to give evidence for our own hearing on this. This was based, by the way, on a recommendation that came out of the Education Select Committee's work on EHCP, and so we decided to take up the H bit in that round table. I heard movingly from families who kept saying things like, everything is a battle. One child, Stefan, suffers from multiple epiphyseal dysplasia, which affects his hips.

He needs support to get around. He's very, very bright. He desperately wants to learn. His mother was there and told me how against school policy, he is allowed, exceptionally to keep a phone on him. Why? Because there is no one that the school can employ to make sure that he can be wheeled from class to class. So instead, what happens? And, you know, mother and school have done everything they possibly can is he keeps a phone in his pocket and he rings up mum so that she can come from home and deliver to him to his next class.

This is the kind of thing that ridiculously goes to tribunal. And then those tribunals cannot hold the ICBs to the same level of accountability as local authorities. The whole thing is nonsensical. So the title, I will

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of course give way. The giving way. I just wanted. To agree with the point that she

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To agree with the point that she is making around this, and just add the voice of a member of the Education Select Committee and the findings of the Education Select findings of the Education Select Committee's report, which equally found that we have to have a system where ICBs can be held to account for delivering on EHCP plans.

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Yeah. Grateful to him and the work of that committee. We're doing work together right now on children's mental health. And so this theme, I'm sure we will continue to pursue. But the point around this was also the impact wasn't just on that child, it was on the mother who couldn't work. It was on the distress that they had to battle the system. The mental health of both parents was being affected. This doesn't need to be this way, and I genuinely believe that accountability is part of the answer.

So my plea to the government in ending is simply to say it is past time that the H part of EHCPs came in to a statutory footing, and I urge the House to support new clause 85.

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Danny Beales speaker, there's much to support. As part of this bill, and I

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As part of this bill, and I support its ambition to enable many of the provisions of the welcome of the provisions of the welcome ten year plan for the NHS. The plan is the right one. The three shifts are correct and we do have to fundamentally reform the health system. If we're to meet the modern health and care challenges we all health and care challenges we all see in our constituencies. To some extent, these challenges are not new. These ambitions are not new.

We've seen similar initiatives before, but the systems, the structures, the bureaucracy, the siloed budgets push against change in the health sector. They've hindered and reinforced these silos and made the same investment choices. They prevent digitisation. They've kept care and acute, and they've stopped, joined up working. So this bill could and should be a key lever to overcome them if we are to achieve those ambitions. I
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Danny Beales Portrait Danny Beales MP (Uxbridge and South Ruislip, Labour)
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very much support the digital single patient record, a key ambition as part of the shift from analogue to digital health. We've analogue to digital health. We've all heard from patients who have to tell their same story over and over and over again, at every single health appointment, between care and health, between community and secondary care. So the potential secondary care. So the potential for a genuine single patient record could be transformational. We have, could be transformational. We have, however, heard from pharmacy, from community mental health services that for this to work, they have to have a seat at the table when designing that single patient record.

So I do hope whilst this bill enables the architecture, the delivery will fundamentally ensure that all of the health and care system are crucially part of the decision making process about the design of the single patient record. Regarding the abolition of NHS England. Again, I think the idea of streamlining bureaucracy at the centre is a good one, delivering power and budgets and resources and decision making power locally again, is admirable. The success, however, of that will be that the right decisions are taken at the right happy.



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My hon. Friend, for giving way. One of the concerns I have about the changes and the abolition NHS the changes and the abolition NHS England is at the moment highly specialised services which are there in 79 of them in the country there in 79 of them in the country for treating the rarest and most complex conditions, currently sit directly with NHS England, and it directly with NHS England, and it isn't clear exactly whether or not these will continue to be commissioned centrally.

And does he

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commissioned centrally. And does he think it would be helpful if we had clarification from the Minister on that? I thank you for that contribution and having worked in neonatal care services and the NHS for ten years in areas of specialised services, one of the benefits of NHS England was bringing together highly specialised services and ensuring consistent service specifications and up up lifting the quality and availability of care across the country. So I do hope that when we make decisions about which specialised services will be devolved to ICBs, consideration will be very much given to that point.

Equally, we've heard from national population health programs like the Diabetes Prevention program. It's been a huge success. We can't lose the benefits of of scale of public health initiatives like vaccinations and prevention programmes as we make those final decisions about the levels of decision. And I would welcome the minister's thoughts and reflections on on that the importance as well, of integrated working. We do have to, as I say, blend budgets, bring together decision makers across current silos, divides. And in that spirit, I very much welcome the change through Government Amendment 60 to give local authorities a seat back at the table.

We need a bigger voice for public health and for social care in health decision

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making, not less. So I very much thank the Minister and the listening. To the.

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To the. Health committee. The NHS Alliance's view is that this is not enough. They would like to see a reciprocal duty to collaborate, reciprocal duty to collaborate, which I think is an interesting one, but I do think this is an important

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but I do think this is an important start up. Very much happy to do so. Thank my friend. For giving way and congratulate

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For giving way and congratulate him and others in the Select Committee who did the work around strengthening local authority representation on the Integrated Care Board. But would you agree with me in the sentiments of my new clause amendment, which are really saying that we need to do a stronger duty to cooperate both within the NHS and between the NHS and local authorities?

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Thank you for. The contribution. She might have actually read my speech. I was about to turn to her, speech. I was about to turn to her, to my friend. These amendments and the the the suggestion around reporting on on integrating health reporting on on integrating health and social care. I think they're interesting ideas. I think they have a great deal of merit. I hope that the Minister will outline her response. The government's approach, particularly with the ongoing case particularly with the ongoing case review, to enabling more progress on integration of health and social care.

Turning specifically to inequalities, we've had it mentioned already in the debate, and one of the government's key ambitions, obviously, is growth in every postcode, also good health in every postcode. And time and time again we see disproportionality, inequalities, unfortunately seemingly hardwired into our health system. Well, to change that we are going to have to do something different. And I do welcome my hon. Friend from Stoke on Trent's amendments and 90 and 91, which haven't been unfortunately selected, but I think they do definitely reinforce the government's ten year plan commitments to halve the gap in healthy life expectancy between the richest and poorest regions, and to raise the healthiest generation of children ever.

Unfortunately, we have moved against those in the last ten years and we will have to do something differently to bridge that gap. In my own constituency, from north to south, there's a huge divide in the quality of health and of outcomes based on postcode, and that must change. And whilst the government is not minded to to accept these amendments, I would very much know that the Minister is passionate about inequalities and the Bill does require neighbourhood health plans to be developed, which I think is an important new measure when responding to neighbourhood health needs and preparing those plans.

The responsible local authority and partner ICB must have regard for guidance issued by the Secretary of State, so I hope the Minister may explore using this guidance to ensure that neighbourhood health plans, when they are developed specifically, must address inequalities between neighbourhoods. And finally, turning to another major challenge. The government is rightly grappling with the Sen system. I'd just like to thank my hon. Friend and fellow member of the Health and Social Care Select Committee, the Member for Thurrock and her amendment, NC 85, which does seek to address this chasm between the education and the health system.

And while this is fundamentally a health bill, I think it's right to ask the question what more the health system could and should be doing. We do know, as the chair of the committees rightly said already when we looked at EHCPs, the H is far, far from present. The decision makers are not required to come round the table. The specialists are not provided. In my own constituency, I've been to specialist schools where nursing provision isn't there, so people miss school days.

The specialist transport isn't there, so people can't even get school transport because it doesn't have the proper health knowledge of of, of the bus drivers. Quite clearly, we do have to have an education and health response. So I hope the Minister will, in her closing remarks, address, address. How if this bill isn't the right mechanism, how the future Sen reforms may pick this up and how the Department of Health will contribute to that. Madam Deputy Speaker, to conclude, there is a great deal to support in this health bill.

It is a major step forward, particularly around digital healthcare, giving people control of their records and joined up care. And I hope the government will continue to drive forward reform of our health system.
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Gavin Williamson Portrait Rt Hon Sir Gavin Williamson MP (Stone, Great Wyrley and Penkridge, Conservative)
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Hey. >> Thank you, Madam Deputy Speaker. If we all think about a memory, we often have quite a common memory. This is so incredibly important. And that is holding our child for the very first time. And how important and how special that is. But sadly, there are so many people up and down this country that aren't able to have that memory because they're having difficulty in having children. In 2004, the National Institute of Clinical Excellence recommended a way forward on IVF, and that was to give all a minimum three cycles of IVF treatment.

This was something that they set out 22 years ago. It's something that you would hope there's actually, over time, all ICBs would have moved towards delivering. Sadly, it's something that people have actually moved away from, and it's not because it's an issue that has got easier or better or is impacting less people. The reality is it's an issue that has got more difficult, impacting more people, meaning that more people are not going to have that amazing joy of holding their own child.

I would ask the Minister to look at new clause 104.

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This has been tabled in my name, along with the support of 16 others along with the support of 16 others from across this House. The issue of people not being able to have children is growing. Male fertility has been collapsing over the last few decades, as people deal with greater pressures in order to buy their own home. They're having children later in life as against earlier in life. But we have a postcode lottery.

There are only two ICBs across the country that offer the nice recommendation of three cycles. And in fact, as we've already heard in Manchester, that has actually been what was offered has been decreased. That has also been the case in in Cheshire and Merseyside as well in Staffordshire. You're not even where I represent. You're not even entitled to one full cycle of IVF, meaning that unless you're incredibly rich, you are condemned to probably never been able to have children.

This, Madam Deputy Speaker, is just not right, and I urge the Minister to be proactive in looking at how this can be addressed. We face a demographic issue in this country with a falling birth rate, with less than 600,000 babies born in this country last year, and that is only going to get worse. It is sad that the NHS isn't prioritising this, and I understand the pressures that ICBs operate under, and it may be always seen that actually it's an easy, no cost option to to deprive people of the ability to have a child.

But for those people who desperately spend their whole life doing everything they can, remortgaging their homes, begging for money from family and friends in order to have a cycle of IVF, it is destroying them. There is no humanity in this system, and I urge the Minister to look at clause 104, to give the opportunity to have families have the opportunity, the most greatest blessing that they can have to hold their own child. And I would urge the Minister to take action as against just ignoring something

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that is so important to so many. Jen Craft Madam Deputy Speaker,

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Jen Craft Madam Deputy Speaker, I strongly welcome this landmark bill, which will protect and strengthen our health service for decades to come. But for children decades to come. But for children with special educational needs and disabilities who are disproportionately impacted by not getting the healthcare they need, I believe that this bill should go further. That is why I have tabled further. That is why I have tabled a new clause 85, which seeks to address the fundamental imbalance in the provision of health services for disabled children and young people.

Currently, the statutory duty to deliver education, health and care plans the legal mechanism by which children with special educational needs and disabilities can receive support, sits entirely with local authorities.

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Jim Shannon can I commend the hon. Lady for all our endeavours in this particular subject matter? And this particular subject matter? And does she share my concern that when a child is diagnosed with cancer, parents are instantly overwhelmed by medical jargon, by appointments by medical jargon, by appointments and by sheer panic? And does the hon. Lady agree that government and the Minister should accept the the Minister should accept the common sense duty to ensure no family faces those critical first

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two weeks completely alone? Thank you, the hon. Gentleman for his intervention. He raises a
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Jen Craft Portrait Jen Craft MP (Thurrock, Labour)
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very good point about the impact of a childhood illness, not only on the child but on the family himself. And I very much do agree that And I very much do agree that support for families is absolutely crucial. They are part of the care team, in fact, for children when they are unwell. And that they are unwell. And that acknowledgement is something that very much needs to be strengthened and taken forward. As I as I was saying, the statutory duty to deliver EHCP sits solely in with deliver EHCP sits solely in with local authorities and in practice, this means that councils are the only body that can be held legally responsible for providing the service a disabled child needs to access education and this includes, for example, health services like occupational or speech and language therapy.

Health bodies are not subject to that same requirement, and through my work as a member of the Health and Social Care Committee, as a constituency MP and as a parent of a disabled child, I know that this too often means that health are just not at the table when it comes to delivering services for children with special educational needs and disability. There is a fundamental lack of accountability in this system and in practice, this can lead local authorities or families to have to procure privately, which can drive shortages in the NHS workforce, or it means that provision is substandard or non-existent.

My constituent son Haider, for example, has an EHCP which outlines his need for speech and language therapy to fully access education. And despite his mother's mother Kyla's relentless efforts, the support was not delivered for months. Kyla tells me she has been forced to watch while Haider has become withdrawn, anxious and isolated. And my constituent Elisabeth has a similar story. She's been fighting to get occupational and physical therapy for her son William, but significant delays securing

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assessments from healthcare professionals have resulted in arrangements. My hon. Friend. Give way.

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Give way. Absolutely. I thank my hon. Friend for a powerful speech and for all the work that she does on for all the work that she does on this. It is particularly difficult with children when there's these long waiting times, because a long waiting times, because a child's life is so is so attenuated. So if you're waiting 18 months, that's one and a half, two school that's one and a half, two school years. And I'm sorry if if the parent is waiting.

Does my hon. Friend agree with me that actually it's key to prevention? Is getting these things dealt with as quickly

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as possible? I completely agree with my hon. Friend and I thank him for his intervention and the example I was intervention and the example I was just giving about my constituent Elizabeth and her son, William, and his lack of early intervention has his lack of early intervention has meant that he has missed countless hours and days and weeks of schooling and a really, really critical point in his development. critical point in his development. And I met another woman last week at a drop in that I hosted called Annika.

And her daughter Winnie has Annika. And her daughter Winnie has cerebral palsy and an EHCP that clearly states she requires a physiotherapist, but the family have been forced to arrange this for themselves. But there are countless other families in this situation. I think every single member in this House has cases from their own constituency, and it's just not good enough. And evidence

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suggests a. She is giving a most powerful speech, and we will all have speech, and we will all have experienced the frustration of parents with a child with an EHCP not at the health element. Does she not at the health element. Does she share my concern that the abolition of Healthwatch might further remove one of the few elements that one of the few elements that actually, externally and independently marks the work of the NHS, and that we're moving to a NHS, and that we're moving to a situation where it'll be the NHS itself and Ministers who collect the data and mark their own homework and will lose yet another of the very few tools that a parent has, is frustrated to hold the

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system to account. I thank the hon. Gentleman for his intervention, and I do agree his intervention, and I do agree that there needs to be better accountability in the health service. It currently doesn't work, and the mechanisms by which we can and the mechanisms by which we can hold healthcare bodies to account a few and far between. And it is most acutely felt, I believe, in acutely felt, I believe, in paediatric care and in the special educational needs and disability system, where a mechanism for system, where a mechanism for holding public bodies already exists.

By EHCP. I believe that it falls entirely. That it falls entirely on local authorities is misguided, because roughly about 50% of what a child needs in order to access education, if they have an EHCP is rightly healthcare, and that should be provided by a healthcare service. And there must be better accountability and transparency when that doesn't happen for parents and for their children. And I know that parents themselves often have to go out of their way to spend, on average, 8500 pounds a year on their child's healthcare so that they can access education.

I will not because I am going to run out of time, but I do thank him. Roughly 40% of people have paid privately for therapies, and that many are forced to fundraise for vital medical equipment their child is legally entitled to. And it's worth noting that beyond the direct costs, many parents are also forced to miss work because the right support is not available for their child to attend school. Around 40% report cutting back their hours, and 35% have left the job market completely.

And before I became a member of Parliament, I stopped work to become a full time carer for my daughter, and I don't regret that choice for a second. But it was a difficult and sometimes lonely period. And like many parents, I hadn't anticipated just how hard it would be to secure basic support for my child and to continues to this day to secure the basic healthcare support that she needs to support her education and her place at school. And I'm wearing this dragon today for her and she will know why that is.

And I won't share it with the house. But if she watches this, she'll see the dragon. It will make her smile. But I knew clause 85 is intended to fix this inequality. It will place a statutory duty on ICBs to deliver the health part of EHCPs. It matches the existing duty on local authorities. The fundamental concept that there must be a meaningful legal requirement on health services to deliver the support set out in EHCPs is critical if we do not act, if we do not rightly demand that health services pull their weight, the status quo of young people missing out on education will continue.

Plans and reforms, I'm afraid, will be doomed to failure. Disabled children are no less worthy of a decent education than their peers, and no less capable of thriving in school. But we are denying them access to the tools they need to succeed. I'm grateful to the health, education and health and social care and the Education Select Committees for their support, as well as the nearly 100 members across this House who put their name to this clause. I want to express my thanks to the charities involved in the centre for their continued campaigning efforts and for the parents, the many, many parents who have contacted me.

I sincerely hope the government will give this clause the attention it deserves, and if they can't bring it forward in total, we'll will give a commitment for proper

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accountability. From after the next speaker. There will be a four minute time There will be a four minute time limit, but I will not reduce it further than that.

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Tom Gordon speaker, I'd like to start by welcoming the commitment from the Minister for Dispatch Box about a maternity about a maternity Commissioner, and thank my hon. Friend the Member for her tireless campaigning on this issue. It's campaigning on this issue. It's something that, when I worked for her many years ago, the scandal at South was something that I was all too aware of from sitting in on surgeries with her and indeed in my own constituency of Harrogate and Knaresborough.

Today, I've ended up with tireless campaigners bringing those same issues to me when they face maternity issues at Leeds Hospital. Two turning to the amendments tabled in my name. First one is New Clause 36, which would require the government to bring forward a formal transition strategy and report back to Parliament on what happens when NHS England is abolished. This is a reason. The reason for this amendment is one of concern from families who've lost loved ones at the hands of the mental health trust.

They've said time and again that they're concerned that the delayed appointment of a chair to that inquiry is something they're really worried about, as we see the largest changes to the health service in a generation, they don't want that to be lost. So press the Minister, whether that is something that she might be able to push forward or get her colleagues to do so. Turning to new clause 43. This would reduce inequalities when it comes to access to clinical research, funding and trials. I've been working closely with Yorkshire Cancer Research, based in my constituency in Harrogate and Hornbeam Park, and we know that across Yorkshire, clinical research, trials and funding gets about a quarter of that received in London.

The logic follows that if those areas outside of London and the South East are getting less research funding, then inequalities will be struggled to be closed in those areas too. We know that cancer. I will give way.
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Tom Gordon Portrait Tom Gordon MP (Harrogate and Knaresborough, Liberal Democrat)
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For the hon. Member for giving way, and he's touching on a point way, and he's touching on a point of health inequalities that I think is really, really important. Cancer cases are expected to rise by about cases are expected to rise by about 30% by 2040, and England already has fewer radiotherapy machines per head than comparable European head than comparable European countries. Weston-super-Mare doesn't even have one, despite being the size of the city of Bath. Would he agree with me that that needs to come in conjunction with with the rest of the investment in

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that he's talking about? Gentleman for his point, and I completely agree with him and as completely agree with him and as well, my colleague the hon. Member for Westmorland and Lonsdale, who's not here but tirelessly is campaigning on radiotherapy and campaigning on radiotherapy and radio as well. The point I was making around those health inequalities is that if we look at inequalities is that if we look at regions like Yorkshire, we have a high incidence of cancer and also poorer outcomes. So we need to poorer outcomes.

So we need to close that funding gap to close those inequalities. New clause 61 and new clause 93, both in my name, pertain to NHS dentistry, and there were many other clauses that I also added my name to and support Newark 61 would make sure that there was adequate provision of dental appointments in Harrogate and Knaresborough in my constituency. We know over the last two years and across North Yorkshire as a whole, that the number of people who are having access to an NHS dentist appointment is down from 50% to just 37.

The issue, when it arises at casework and surgeries, is often precipitated through people who work in A&E telling me about their traumatic stories of people reaching A&E as a result of emergency dental care or lack of, and in particular, some harrowing stories that we've heard from local children about their inability to focus in school. New clause 93 would require the Secretary of State to publish before Parliament a regular report on the state of NHS dentistry, including that unmet need, that unmet need, and also pay

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particular attention to workforce capacity and distribution. I will give way. I'm really.

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I'm really. Grateful for giving way. In Dorset, we have lost 44 dentists in Dorset, we have lost 44 dentists in the last five years, and there hasn't been a single new contract hasn't been a single new contract given for ten years. Would he suggest that his new plan would reverse that, to allow us to be

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reverse that, to allow us to be able to see exactly where the gaps are in the system? I thank my friend for her intervention, and I agree that that is something that we do need to see and we do need to do, which is why I tabled this amendment to get the answer to some of those questions that not just constituents in my patch, but those in hers as well, are asking us as members of Parliament. It's particularly frustrating that we're now into the second year of this Labour government, and at the outset, the talk of dental contract reform was one that kept cropping up, and we've seen little progress on that.

So I pressed the Minister on what more can be done to make sure that we get those gaps filled. Turning to New Clause 121, I sit in Parliament as chair of the all party parliamentary Group for diabetes, as was mentioned earlier by the hon. Member for Uxbridge, there have been some fantastic care when it comes to diabetes and really world leading practice. This new clause would maintain existing national diabetes prevention, treatment and audit programmes, and we would want to see an explanation being brought forth from government about how we can see those continued with regular reports in Parliament.

Overall have been a fantastic number of amendments tabled by colleagues from across the House. I hope the Minister will pay attention to them and can provide us with some answers on them this evening and going forward.

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Anna Dixon. Speaker, I. Worked as a civil servant for the coalition government and saw first hand some of the duplication and confusion that was caused when NHS England was set up. So I NHS England was set up. So I welcome this bill. The decision to abolish NHS England, but reversing the fragmentation caused by the Tories failed reforms of the NHS will not, on its own, create a more will not, on its own, create a more integrated and joined up service for patients and carers.

And that's why, Madam Deputy Speaker, I've tabled a new clause 106. This would place a requirement on the Secretary of State to report to Parliament within six months of the act, passing on how well NHS bodies and local authorities are working together to integrate health and social care in England. Having worked in the health and care sector, I know how vital it is to have integrated services and I know as an MP, and I'm sure others do, and from personal experience how devastating uncoordinated care can be for patients, for their families and for our NHS.

One of my constituents, Ellery Carroll, was diagnosed with diffuse intrinsic pontine glioma, an inoperable brain tumour, in September 2024. Very sadly, she died in May this year, just aged nine. Ellery and her parents friend Christian, suffered in ways that are unimaginable, but it was a lack of cooperation between services that added to their suffering. Just one example. And after going for an MRI scan at Great Ormond Street, Ellery had to endure repeated scan at Lgi in Leeds due to an inability to share results between hospitals and I hope the single patient record that this bill also creates will help
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Anna Dixon Portrait Anna Dixon MP (Shipley, Labour)
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join up systems and reduce such problems. We see this disjointed problems. We see this disjointed care, both within the NHS, between hospital and community services, but also between health and social but also between health and social care. Another constituent, Roger, in his 90s, had a fall and serious in his 90s, had a fall and serious head injury last year, again after the acute hospital treatment in Leeds, there was a failure of the Leeds, there was a failure of the NHS to join up his care with Bradford social Services, resulting in delays to his discharge.

He developed infections in hospital and delirium, and after nine months of being moved from one hospital to another, despite his wife fighting to get him home with support, he died in hospital. These Madam Deputy Speaker are the consequences when our health and care systems aren't integrated. It's also expensive. Around 1 in 10 hospital beds in England are occupied by someone who doesn't need to be there often. Again, because community or social care are not available, we know that any reform of the NHS will ultimately fail unless we also reform adult social care.

And that's why I welcome the priority given to this by the Prime Minister and the commitment he's made to bring forward the conclusion of the Casey Commission. But even if we build a National care service, which we must, there is a risk that if it doesn't work in sync with our National Health Service. So it's essential we place very clear obligations on all parts of the NHS to cooperate and integrate with social care. So I would ask the Minister, in her closing remarks to set out how she and the Secretary of State will monitor the impact of the health Bill on integration and how they will ensure cooperation remains a critical priority for the NHS, not just on paper, not just in law, but in the way that we all experience health and care in a joined up way.



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Thank you, Madam Deputy Speaker. Steve Barclay thank you, Madam

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Steve Barclay thank you, Madam Deputy Speaker and I rise to speak to clause one on the abolition of NHS England and Clause six on NHS England and Clause six on promoting innovation, and what has characterised the first of those has been an announcement without any clear plan, and that is what has driven the cost and confusion that a number of members across the that a number of members across the House have spoken of, and for those in any doubt of that, they can just look at NHS England's own accounts.

The 2526 annual accounts show the costs have already gone up by more than £100 million, above what was forecast, and now sits at above half £1 billion. I don't recall seeing that on election leaflets and indeed just six directors. NHS England have been paid over £800,000, so that points to the cost. And sometimes these big figures are hard for constituents to get their heads around. So just to localise it for my own constituency, in terms of the Cambridge and Peterborough, ICB alone has paid out £14 million in redundancy last year and has merged with a number of other ICBs to form the eastern central ICB.

And yet we now hear from government that they should align with metro mayors, which means going back to exactly what they were before the Cambridgeshire and Peterborough ICB. And that's just one of many confusions around this announcement. The Member for North Shropshire spoke about confusion over the timetable, what was described to the media as now an impossible timetable. We have also reports this weekend in the media in terms of the destination of staff in NHS England, can they actually go in to the department or will another body be set up because of some of the pay disparity between the two? And this is more than well, around 18 months on from the actual
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Steve Barclay Portrait Rt Hon Steve Barclay MP (North East Cambridgeshire, Conservative)
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announcement. And indeed this confusion seems to extend to government itself because they seem government itself because they seem unable to answer pretty straightforward written parliamentary questions indeed. Just to give, given the time limit. Just to give a few examples, I asked how many people have been asked how many people have been hired to NHS England since the announcement of its abolition, not least given the huge cost over half £1 billion in voluntary redundancy. Despite the deadline being passed, the Minister hasn't answered the question yet.

We know from another written parliamentary question more than a thousand jobs have been advertised, so it's relevant to know in an organisation that's paying people to leave how many people they are then having. I also asked how many people have accepted voluntary redundancy. Again, a written parliamentary question that's past its deadline on not being answered. So this process is

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characterised by a lack of transparency. Of course. Everyone grateful to my right hon. Friend who's giving a typically punchy speech. Does he agree with me that every signal is agree with me that every signal is that this has not been thought through? The very fact they've conceded on the fact, oh, we're going to have local government going to have local government coming back on board. How could you conceive of health and social care without local government being engaged? But on every front it looks as if they haven't thought it through, and they are abolishing everything from the Safety Inspectorate to Healthwatch.

And we have a government which is out of control, spending tens of billions, if not hundreds of millions on redundancies, with no clear end

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destination in view and wasting a huge opportunity. My friend is absolutely right. They are spending millions of They are spending millions of pounds. There isn't a plan, it was announced. Without working that out. It came as a surprise to many within the system. It's had a chilling effect on many decisions, and you can just see that this is and you can just see that this is an isolated. Just today we had the complete shambles of local government reorganisation, where on the last day before summer recess, the last day before summer recess, the Secretary of State rushed to the House to push through an announcement that the new Secretary of State today is then reversing on.

Whilst the Chief Secretary is then contradicting her by saying actually they want to have a higher legal appetite in terms of risk and they want to have fewer consultations. So there's just this confusion across departments and actually the issues around clause one, which a number of members have spoken to give an illustration of that. But given the time limit, let me also just turn to to clause six. And, you know, I don't doubt for a minute that the Health Minister, the Secretary of State, anyone in the department doesn't want to promote innovation.

I know the right. My friend, my right hon. Friend the Member for Godalming and Ash spoke a lot about this in his book about capital to revenue switches and the pressure that takes away from innovation. And I used to have a wry smile when I was health secretary at the battles I had with him when I was being pushed by the Treasury to do exactly the same thing. The issue is not the lack of will. The issue is the alignment between procurement regulation and also the clinical leadership, particularly in the colleges, and the ability to scale innovation.

It's not about having more ministerial pilots. And finally, just because I'm almost out of time, can I just pick up on the chair? The House Select Committee's very good points around data. My frustration when I was in the department was often I had to go on dashboards that were open source to get information that should have been available to me as a Minister. And I suspect the same is still the case in the department. We should make data dashboards a common theme.

If you look at the CSV files that the department publish, they're extremely difficult to access. Make data more transparent. It will help the debate in this Parliament. I dare say it'll help Ministers get more support.

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David. Thank you, Madam Deputy Speaker. I thank the. Minister for this bill, and I want to put on record that I'm the chair of the sickle cell and Thalassaemia APPG, and I'm speaking to new clause 162. and I'm speaking to new clause 162. It is well known that the NHS commissioned specialised services unevenly across England, and I'm unevenly across England, and I'm confident that this government's ambition is to end the postcode lottery of specialised services. lottery of specialised services.

And I would like to hear more about this new clause 162 is designed to do something very simple. It is designed to ensure that Parliament can identify, identify where inequalities exist, measure where they are improving, and hold the Secretary of State to account when they are not. Let me make the case for the experience of people who live with sickle cell. Sickle cell disorder is the fastest growing serious genetic condition in England. It causes episodes of serious chronic pain, spasms and a crisis that will continue if left untreated.

It can damage organs and frequently requires hospital care. When a crisis strikes, patients have to attend A and E wait for
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Janet Daby Portrait Janet Daby MP (Lewisham East, Labour)
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hours, often only to be seen by medical staff who may have little or no familiarity with their or no familiarity with their condition. Due to past experiences, many sufferers do not trust the NHS to meet their needs and stories of to meet their needs and stories of sufferers who have died in hospital due to complications such as Evan due to complications such as Evan Nathan Smith, are well known. In 2021, the no one listening report demonstrated that people with sickle cell need to be listened to.

That report prompted NHS England to act. It initiated the Sickle Cell Thalassaemia quality Improvement programme, and from that program came seven pilot emergency department bypass units. They are dedicated facilities that allow sickle cell patients to avoid A and E and receive immediate care to bring that crisis under control. This service works, but here is the problem that brings me to this new clause. When the APPG met last week, we heard from stakeholders that this progress is indeed fragile. There are only seven bypass units across the country and with the transfer of commissioning responsibilities under this bill, there is a real and legitimate fear that what is being built in just begun will not be protected to continue.



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Great friend for giving way. I was. Also a member of the APPG and it. Was also at that meeting and in

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Was also at that meeting and in the Health Select Committee, we raised this very point that you had these short term pilots and we these short term pilots and we managed to get an extra year's funding. I have to say, and I will say this as a person, I am I feel say this as a person, I am I feel that if this was a problem which affected white people, predominantly not black people, it would be taken a lot more seriously. And I think that the government needs to reflect on that when it comes to deciding whether or not it wishes to accept this amendment and whether or not it wishes to give sickle cell sufferers the full support that they need and are not sufficiently getting John Glen.



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Absolutely. Thank my hon. Friend. He couldn't have said that more clearer. It is absolutely about inequalities within the health service, and he has explained that and expressed that extremely well. And I know, like myself, he will And I know, like myself, he will continue to advocate on behalf of ethnic, ethnic, minority and diverse people. This new clause diverse people. This new clause causes the Secretary of State to do two things. First, to produce an annual report laid before annual report laid before Parliament on the performance of specialised services against national standards, and second, to ensure the regular publication of data on quality and outcomes.

The kind of information currently captured in a specialised services quality dashboard, which NHS England has maintained on a non-statutory basis. Without legislation, those dashboards could quietly disappear when NHS England does, and this indeed must not happen. The new clause would make the continuation, or something equivalent, a legal requirement. I want to be clear about the modesty of this ask. We're not asking the government to build new services. We're not asking the government to ring fenced budgets. We're not asking the government to second guess local commissioning decisions.

We're asking them to measure, to publish and to report. We're asking for the basic accountability for patients with rare conditions. We're asking for geographical dispersed people, predominantly from black and minority ethnic backgrounds, to have services that work. Madam Deputy Speaker the patients who rely on specialised services are often marginalised twice over once by their condition, and again by a system that does not always see them clearly. The new clause would require the Secretary of State to identify and to report back to this House what they find.

I urge the government to take seriously the new clause and to respond appropriately.

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Steff Aquarone thank you. 19. Closes a dangerous gap. In this bill.

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In this bill. And commands the support of members on both sides of the House. It is right that clause four calls for the Health Secretary to reduce inequality of access to health services, but the bill must explicitly cover rural and coastal explicitly cover rural and coastal health inequalities, or else less densely populated communities will always lose. At face value, it always lose. At face value, it makes sense to measure success by the greatest number helped in the long run. It's a false economy.

Delayed diagnosis and treatment ultimately costs the NHS more. It's a little bit like access to high speed broadband Madam Deputy Speaker. We rolled out the first phase to places where most people could be connected, and that rewarded the government and providers with some impressive sounding numbers, while disguising failure in the margins. Rural and coastal communities are literally and politically at the end of the line, and are therefore reached.

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Last. Of course. I thank my hon. Friend for. Giving way. As you all know, the

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Giving way. As you all know, the Chief Medical Officer. The Rural Health report is due later this year. Rural health can't be seen as year. Rural health can't be seen as an afterthought. This is why I tabled a new clause 120, which would create a farmer friendly would create a farmer friendly general practice scheme similar to that to the Veteran Friendly Accreditation Scheme. It would
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Steff Aquarone Portrait Steff Aquarone MP (North Norfolk, Liberal Democrat)
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Accreditation Scheme. It would recognise GPS who proactively reach isolated farming communities. So does my hon. Friend agree that the government must treat Rural Health Report's recommendations as a

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genuine test of action, not just warm words. I thank you for the intervention and I absolutely agree. And to that and I absolutely agree. And to that end, in order to achieve genuine equality of access, the government must go outside in Madam Deputy must go outside in Madam Deputy Speaker. That is, to design provision around the hardest places to serve. She gives a great example, then work inwards from there. If Australia can effectively serve communities living in remote outback, we can meet the needs of outback, we can meet the needs of people living in rural and coastal England.

These are the words of the right hon. Member for Ilford North when he was the Health Secretary. Not only do I agree with him, but I challenge the current Health Secretary to turn his government her government's own words, into law. We got it wrong with broadband. We cannot afford to get it wrong with people's health. In my North Norfolk constituency, I see the struggles for health, access and outcomes first hand. When you're on the coast, you're starting with literally half the access to inland areas.

Have conventional service models assume you can approach access from any direction, but on the edge where our coastal communities sit, half our access is in the sea. The sea may be beautiful, but it does not run a bus service or staff a clinic or provide a patient catchment combined with sparse populations and poor transport. That means coastal communities need more local points of care, not fewer. On top of that, the services we do have are burdened by exceptionally long waits. We're not unique in this, as some of the poorest healthcare access and outcomes can be found in communities like mine.

We know the challenges of health and wellbeing in these areas, from the excellent work of Professor Chris Whitty, he spelled out how we suffer shorter life expectancy and higher rates of major chronic illness, higher rates of alcohol and drug related harm, and more cardiovascular and chronic lung conditions. These are very serious problems. They can't remain an afterthought in national health policy. National systems must not mistake population density for severity of need. Besides, problems caught earlier and treated faster lead to better outcomes.

It's one of the reasons I was so frustrated to be told by the government before recess that they have no plans to provide an urgent treatment centre at Cromer Hospital in my constituency, which would transform access to urgent care across north Norfolk. Now I'm putting the department on notice today. My constituents and I will continue pressing the case until Ministers reconsider. Let me tell the House what these inequalities mean. In human terms. It means constituents like Kelly, who's been waiting more than 70 weeks for a hip replacement, living every day in pain.

Another constituent, Samantha, told me she waited 30 weeks to see a gynaecologist. The NHS standard is 18 weeks. Appallingly, our wait times made a young woman so unwell that she was forced to sacrifice her education. During the wait, her symptoms worsened to the point that she had to step back from the degree she was studying for. I heard from Ian, who has metastatic prostate cancer and requires treatment at the Norfolk and Norwich Hospital. It's a half day trip for him by car to get the essential treatment he needs.

He also told me that he considered using a local bus service, but that would be an hour just to get there. Living with a damaged bladder condition, he told me it makes life very unpleasant. I'd go further and

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dehumanising. But the hon. Gentleman. Give way, I will.

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I'm grateful to the hon. Gentleman for giving way. And he's giving a powerful speech on behalf of rural and coastal areas. One of rural and coastal areas. One word he hasn't used yet is the word age, because age is the clearest proxy for health need that there is. It's not deprivation, it's not It's not deprivation, it's not other things. It's age. And yet the distribution of health funding in this country has, under successive administrations, failed to recognise that and has failed to allocate the funding.

And that is why his constituents and mine find themselves with chronically less spent on them per cancer patient than compared to those in areas intervention.

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I couldn't agree more. It's one of the many aspects in which rural and coastal communities, particularly coastal communities, have so much more in common around have so much more in common around the country than they do, even with their inland neighbours. Just a few miles away. Again, theoretically miles away. Again, theoretically available treatment becomes practically inaccessible if it requires a journey to be made without, in this case, reliable without, in this case, reliable toilet access. But in the cases he raises where access to private transport is all that more limited, transport is all that more limited, Kelly, Samantha, Ian and so many more are entitled to the same access to good treatment and the same chance of good health as people living in urban and inland communities.

It's absolutely right for the government to pursue this bill, and I support the aim wholeheartedly, but I challenge them to assess it based on who's left behind, not just who can be helped, accept this amendment, or explain why rural and coastal inequalities do not merit explicit protection.

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Thank you, Madam Deputy Speaker. My remarks will focus mainly on new clause 69, which is in my name. I would say getting rid of NHS England is one of the best things I think this government has done, and as a working clinician, at least, as a working clinician, at least, we now get away from so much admin we now get away from so much admin and management. So this. My, my. My amendment though, is quite a simple amendment though, is quite a simple one about self-care and health literacy.

Now, demand for healthcare has increased enormously well since 2019. For example, GP consultations in my area have gone up 30%. When I started work as a GP, patients saw me three times a year. On average. It's now about eight times a year and indeed, A&E attendance has gone up about 20% over the last decade. And yet the health of the nation remains the same. So this is the demand side of the NHS that we very rarely discuss. And this is what I'm asking from the from the Secretary of State.

So what are the causes of this? So there's a concept in medicine of something called the symptom iceberg. Now most of us get symptoms every day, but we don't go to the doctor. We only go to the doctor with a very small amount of them. But that's increased over the last 20 years. And all the roles of something called we call lay referrals, which is like your mum who used to live next door, is often much further away. We're socially isolated and atomised society, and we also have a much higher expectation of our health, which you can't fault.

But that means that you go to the doctor with very minor things, for example. So there's also factors like AI, I don't know, in my surgery we use AI, but that also creates its own demand, I believe. And also there's good old doctor Google. Now doctor Google is consulted over 50 million times in this country and every year. So if you try and do that go to Doctor Google. You usually end up with cancer or needing an emergency ambulance. So that is clearly driving demand.

There are also doctor factors. If we carry on treating sore throats with antibiotics, people will carry on coming back in Earaches generally get better headaches, don't usually need to see a doctor and so we're overdiagnosing and overmedicalising everything. And in terms of NHS factors, there are things like the algorithms for one, one, one and litigation. So what I'd also like to talk about is health literacy. What does that mean? That means about knowing about your health. But it also means understanding that we're not always in totally good health.

And just because we're feeling a little bit low or a little bit tired, we don't have to consult the health service. One of the my colleagues in Stroud, Doctor Hugh Van Hoff, has started something called facts for life, which is a school based education service going into schools. In the last ten years, he's worked with over 200 primary schools. And if you teach young children about health and about how it's normal to sometimes feel tired, have a sore throat and stuff, you can actually reduce the consultations in the NHS, and you can also teach children how to understand the, the, the, the, the internet.

So when they look at something with statistics, they know actually what it means. Instead of saying, oh, my risk of cancer has been doubled. By doing this, they actually understand what that might mean. So that's really important. Very briefly, we are also overmedicalising patients. 9 million patients in this country are on antidepressants. All right. That is a scandal. That's 1 in 20. That is a scandal. That's 1 in 20. That's in England alone. One 1 in 5. Certainly. I'll give way.
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Simon Opher Portrait Dr Simon Opher MP (Stroud, Labour)
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Thank the honourable.

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interpreting. Statistics. Does the hon. Gentleman agree with me that the idea of GP confidentiality in terms of dealing with data such as from the Palantir FTP, is absolutely critical. Certainly when we come to the Certainly when we come to the single patient record and that this bill should not be reducing bill should not be reducing confidentiality or data privacy to achieve the single patient record. Yeah.

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Yeah. Can I thank my hon. Friend for that comment? And I think he's absolutely right. What I would also say, though, is that NHS data and GP data is a massive resource for our scientists in this country, and I agree with him. It should be owned by the UK and it should be a sovereign wealth issue. And I'd like to make sure that that happens over time. So I'd just like to talk a little bit about Overmedicalization, if I may.

Madam Deputy Speaker. So what often happens, I'd like to try and actually divert patients with mild to moderate mental health symptoms into social prescribing, such as access to nature, arts and culture, exercise or indeed comedy. And let's try and reduce those 9 million antidepressants so people don't have to come back for review. They less harms like suicide in the first couple of weeks of taking them. And that's also look again at Neurodivergence and try and look at a way of not medicalizing so many children with this condition.

So to conclude, Madam Deputy Speaker, if we are serious about reducing waiting lists and making NHS sustainable for the future, we cannot focus only on supply. We must address rising demand too. So giving people the knowledge and confidence to look after their own health will empower them. Free up clinicians to care for those who need them most, and ultimately build a healthier population. That is what New clause 69 seeks to

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achieve, and I urge the government to accept it. Edward Morello thank you very

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Edward Morello thank you very much, Madam. Deputy Speaker. Any half. Of children in my constituency of. West Dorset have seen a dentist

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West Dorset have seen a dentist in two years. There has been a 20% decrease in NHS dental practices, decrease in NHS dental practices, and some of my constituents have written to me recently to say that they have been quoted in excess of they have been quoted in excess of £7,000 for the most basic of treatments. Amendment 47 would require the government to establish training hubs in Dorset. It ensures dental hubs will train dentists for the future and mandate final year trainees to provide supervised treatment to NHS patients straight away.

Trainees are already providing treatment for free, paid for by the taxpayer as part of their training. Those appointments should be for the NHS and not for private patients. Amendment 48 would ensure that the dental funding underspend is redirected towards additional NHS appointments, shorter waiting times, outreach, home and school based services. Amendment 49 would require the dental funding formula to account for a reality in an ageing population, an ageing population, disability transport costs and recruitment difficulties. We should also do more to support GPS.

Amendment 51 on rural and coastal GP funding would recognise the additional recruitment and travel costs faced by practices serving dispersed populations with worse economies of scale. Amendment 52 on primary care estate investment would establish a dedicated capital investment programme for practices whose premises are outdated, unsafe or restricting the delivery of care. Amendment 54 would expand the electronic prescribing and mandate greater interoperable records, which would reduce paperwork, avoid delays and give clinicians the information they need when they need it.

The collapse of Daire Hughes Pharmacy showed us the limits of the current regulatory framework, which was largely designed around independent pharmacies, not large companies controlling extensive pharmacy networks. During my Urgent Question
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Edward Morello Portrait Edward Morello MP (West Dorset, Liberal Democrat)
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on Daire Hughes, there was a cross-party support for legislative action, which has not come from the government. Amendment 55 would give government. Amendment 55 would give the Secretary of State powers to require an ICB to intervene where there is a serious risk to patient there is a serious risk to patient safety or medicine supply, something we did not have to tackle. Daire Hughes crisis amendment 56 Daire Hughes crisis amendment 56 would give the ICBs their own stronger powers to require remedial action, suspend arrangements or action, suspend arrangements or secure an alternative provider acting immediately where patient safety is at risk.

These are exactly the powers that the Minister told me they needed a year ago to act, and the government has not accepted these amendments. New clause four, new clause 74 would ensure that employees are not forgotten. When a provider fails, it would protect wages and essential employment rights and help staff transfer to a replacement provider where possible. Amendment 58 would require government and ICBs to support new independent pharmacies to open after a large scale closure and help them secure medicines and supplies quickly, and then that 59 would mean funding allocations reflect Rurality population, age, travel costs, recruitment difficulties, economy skills and unmet needs.

All of these clauses would be designed to improve this bill. They will all be rejected and that is a shame. In West Dorset, we need a joined up, NHS accessible NHS dentistry, sustainable GP practices, resilient pharmacies, modern infrastructure and funding systems that recognise the realities of rural rural Britain and coastal healthcare and I hope

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the government will listen. Ian Byrne thank you, Madam Deputy Speaker.

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Deputy Speaker. To speak to my amendment. A new clause 108, because the public rightly expect any company entrusted to operate within our National Health Service to be basic standards of ethical conduct, both standards of ethical conduct, both inside and outside the NHS. Madam Deputy Speaker. In my experience as parliamentary lead in Hillsborough Law, I regularly. Members of the public who was shocked that a duty of candour which would compel public officials to tell the truth to the people they serve does not already exist.

I believe many of my constituents will be equally shocked that the basic principles of ethical accountability are not already enshrined in government procurement policy, but they are not new. Clause 108 is not radical. It's a straightforward safeguarding, requiring the Secretary of State to review the NHS procurement framework and ensure the companies with proven involvement in violations of international law or breaches of internationally accepted standards of business conduct, cannot be offered public contracts. Those standards include the UN Guiding Principles on Business and Human Rights, and the OECD guidelines on multinational enterprises.

What exactly is there to disagree with? That's the bare minimum of businesses that do not contribute to harm, that they carry out human rights, proper human rights, due diligence, and the transparency of how they handle the data of the people they serve. Yet, Madam Deputy Speaker, we currently have a company operating at the heart of our NHS infrastructure to the Federated Data platform. It fails to meet that basic standard. I'm talking about the US secretary. Palantir has consistently refused to publish a formal human rights impact assessment for the software used in Israel's assault on Gaza, violence and detentions in America, and its use of NHS staff and patient data.

Such lack of transparency is not a technicality, but a serious failure to meet the standards under the UN and OECD guidelines. I first raised concerns about Palantir's NHS contract in a letter to the then health secretary in August 2023. These concerns have been echoed by many, many others. I am pleased that Parliament have started to push back because of being dropped by numerous committees. I also fully support new clause 34, tabled by the hon. Member for Newton Abbot. Madam Deputy Speaker, patients trust the

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NHS with the most sensitive. I call. Hon. Member for giving way. Does the hon. Member agree with me that it is a fundamental principle of anything like the SPR, that it must have privacy by design at the have privacy by design at the centre of it, and as such a firm like Palantir that has a US slightly cavalier, somewhat casual slightly cavalier, somewhat casual attitude to how data privacy should be controlled should not be allowed

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anywhere near it. Thanks to my intervention, I fully agree I signed his amendments and we've been in many committee speaking on this new clause 108 provides a proportionate and evidence based mechanism to address this. The new clause does not name or target any individual company. It establishes a clear and principled test rooted in international law and internationally accepted standards, which every contractor must meet. If a company such as Palantir cannot meet that test, it should never hold contracts within our NHS and other government departments.

I've repeatedly urged the government to trigger the 2027 break clause in contract to operate the federated data platform. I make that call again tonight, but there's only two like new clause 108 that we can ensure companies like Palantir cannot operate within our public services. Again, it should be adopted through this bill. But the principle behind this should not end with the NHS. It should be applied across every every government department led by the Cabinet Office, the Cabinet Office report on Social Value and Procurement, published last month, was very welcome, but contained a glaring omission, a clear ethical foundation.

My clause would provide that crucial and much needed safeguard, ensuring a legislative framework, preventing companies like Palantir from securing public contracts in the future. Madam Deputy Speaker, last week I visited the Vatican and spoke with
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Ian Byrne Portrait Ian Byrne MP (Liverpool West Derby, Labour)
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officials about how the United Kingdom could lead the world in ethical use of artificial intelligence and advanced technologies. Tonight, my government has a real opportunity to put a marker down and demonstrate that Britain intends to be at the forefront of that global movement. I look forward to helping movement. I look forward to helping them achieve that if they adopt my amendments. Let's make it clear that scrutiny, transparency and respect for human rights are not optional. Extras and public procurement, but conditions of entry for any company seeking to save NHS workers and patients.

That's what clause 108 calls for, and that is the change that will be welcomed in Liverpool, West Derby across our country and indeed in the halls of the Vatican. I look forward to the government response tonight.

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Hear, hear. David Chadwick thank you. Mr. Speaker. Today I'm speaking

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Mr. Speaker. Today I'm speaking in favour of new clauses 133 and 134, which stand in my name. These new clauses would require the UK Secretary of State for health to work with Welsh Ministers to update the England and Wales Cross Border Healthcare Statement of Values and principles, and to bring forward proposals to place those principles on a formal legal footing for many people living along the border, cross border healthcare is simply a fact of life. In Powis, at least 40% of people depend on hospitals across the border in England.

Yet the framework governing how our two healthcare systems work together remains based on a voluntary statement of values and principles dating back to 2018. And, Madam Deputy Speaker, we do not need to look far to see why the current arrangements need reform. Since last July, Paris Teaching Health Board has asked English hospitals treating Paris residents to treat them more slowly than patients from England as part of cost cutting measures. This is despite the fact that they had always previously been treated as equals.

The impact of that decision has been devastating. Many patients have now had their waiting times increased to up to two years, forced to wait longer in pain, all the while deteriorating in their conditions. And it's not just myself and the Liberal Democrats who have been sounding the alarms. English providers on the English side of the border have themselves resisted these arrangements because of concerns about the impact on patients. Yet there seems to be little will from either the Welsh Government or the health boards responsible to resolve this issue.

Meanwhile, patients are falling through the cracks. My constituents should not have to navigate the administrative boundaries between the NHS England and NHS Wales simply to get the arrangements, the treatment that they need. Eight years after the statement of Values and principles was introduced, the limitations of relying on a voluntary statement with no formal legal footing are clear. New clause 134 would require the Secretary of State to work with Welsh Ministers to update the. That statement, reflecting the problems cross border patients face today.

Crucially, it would also require the government within two years to
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David Chadwick Portrait David Chadwick MP (Brecon, Radnor and Cwm Tawe, Liberal Democrat)
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bring forward proposals to place those principles on a statutory footing. The border should never be a barrier to receiving health care. a barrier to receiving health care. It is time to update these principles, strengthen them and give cross border patients the give cross border patients the statutory protections they deserve. Because, Madam Deputy Speaker, I fear that cross border healthcare fear that cross border healthcare is going to continue deteriorating over the next couple of years. Over the summer recess, I held a series the summer recess, I held a series of public meetings in response to plans by Paris Teaching Health Board to cut the number of community beds, which will just mean that more people will end up stuck in community beds on the

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English side of the border. Thank you. Doctor Allison Gardner. Thank you, Madam. Deputy Speaker.

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Thank you, Madam. Deputy Speaker. This government aims to shift focus from treatment to prevention, and it is in the spirit of this. I have it is in the spirit of this. I have tabled new clauses 1991 in my name. These strengthen the frameworks and These strengthen the frameworks and around the health inequalities and address the wider determinants of health. New data from health health. New data from health reveals a shocking reality. There is an up to an 18 year gap in life expectancy between different parts of the UK and indeed between nearby neighbourhoods.

Health shows that within my constituency of Stoke on Trent South, just a golf course separates two areas, with an average life expectancy gap of eight years and 11 months. Reaching old age is somewhat of an aspiration in my in more of my deprived areas. Indeed, in most deprived communities, people spend an average just 52 years in good health. These stark inequalities are driven not only by health care but by the wider determinants of health, including poverty, housing,
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Allison Gardner Portrait Dr Allison Gardner MP (Stoke-on-Trent South, Labour)
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education, employment and the environment. Within Stoke on Trent, healthy life expectancy at birth healthy life expectancy at birth has fallen by 6.6% for men, and in the last decade and for women, the picture is even worse, falling by picture is even worse, falling by 9.6% in healthy life expectancy in the last ten years to just 53.5 the last ten years to just 53.5 years. The health bill represents a real opportunity to enshrine in law real opportunity to enshrine in law a statutory duty for the Secretary of State to go beyond reducing inequalities in NHS access and

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outcomes to reflect wider cross-government Goals for health improvement. Our health is shaped by the world Our health is shaped by the world around us, the food we eat, the money in our pockets, the air we breathe, and the home we live in. In other words, every part of government has an opportunity to influence people's health. The purpose of New Clause 90 is to purpose of New Clause 90 is to ensure that government takes greater responsibility for improving the nation's health. This includes mitigating any increase in health inequalities, just such as seen in my constituency.

This clause would make improving health a duty to place placing prevention on the same footing as treatment. But a stronger duty alone is not enough. That is why New clause 91 would require the government to publish a new health improvement and inequality strategy within six months. The strategy would include long term targets for adults and children. Public reporting on progress, a duty on Ministers across government to have regard to the strategy and independent accountability arrangements. Now, the Minister, who has worked very hard on this bill with her engagement and I commend her for that, has alluded to the fact that pre-existing guidance and processes in place are are in place, and these are designed to tackle health inequalities.

And she is right. However, I argue that they are clearly not working as health inequality has increased. So I ask again, what is the harm of embedding this duty in this bill to tackle the most fundamental issue in health across England health inequalities. These amendments have cross-party support, and I note that there are also supported by the Health and Social Care Select Committee, and I thank health for their work on these amendments. And again, I thank the Minister for her engagement and I get.

I urge the government to consider accepting these clauses. I will briefly just mention, oh, gosh, I've lost it. I've just muddled everything up. A new clause and 019 also placed in my in My name. This clause was written by myself and Harry Schwab, with whom I work on the standard BS 30440 and a validation framework for the use of AI within healthcare and I previously worked with the AI and digital Regulation service for the NHS for NHS England, working with nice, MHRA, CQC and HRA.

And in the interest of time, I will say that in that duty I was. I identified a number of accountability and regulatory gaps that certainly I would need further addressing, and I would ask that the Minister for Health Tech would meet with me so we could discuss these further, and they do partner quite well with a new clause 108 as well, which I didn't spot. And I

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apologise for not signing your amendment. Thank you. Charlotte Cane thank. You, Madam.

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You, Madam. Deputy Speaker. In the constituency of Ely and

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In the constituency of Ely and East Cambridgeshire, only 40% of adults have seen a dentist in the adults have seen a dentist in the past two years, and for children, it's only 54% seen in the last year. And the impact on that is that 12.5% of children in East Cambridgeshire have tooth decay by the age of five. We are in a dental desert and it's incredibly difficult to get an NHS dentist appointment. But the most frustrating thing when I talk to the dentists is that it is the contract that is preventing them from doing this, not their own intentions.

The contract, because it's based on units of treatment. They tell me, for example, if they do one filling, they just about cover their costs from the unit they get paid for. But that unit
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Charlotte Cane Portrait Charlotte Cane MP (Ely and East Cambridgeshire, Liberal Democrat)
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covers up to three fillings. And at three fillings they're making a loss. But even more frustrating, loss. But even more frustrating, they get allocated their units at the beginning of the year, and once they've used them all, they can get they've used them all, they can get no more. And yet they're aware that there are other dentists locally who have not used all their units who have not used all their units by the end of the year, and they hand them back. Why isn't there a hand them back.

Why isn't there a mechanism whereby those units can be given to the dentist, who have the capacity to do more work, so that at least more people get treated? It is really frustrating to me to know that my constituents are struggling without a dentist, and I have dentists in my constituency willing to treat them, but they can't get the funding from the NHS to do that. Utterly shocking. So that's why I support New clause 18 and the other clauses that seek to make dentistry more available to people.

I'd also like to pick up on what people have said about NHS in rural areas. It's really important to understand the size of rural areas, the lack of public transport. My constituents, nearly in one village, nearly lost their GP surgery a few years ago. The ICB wasn't particularly worried because there were other GPS within the general area that they could apparently get to. Well, they couldn't because there wasn't public transport. They kicked up enough of a stink that.

Fortunately, the ICB changed its its view and has made sure that they do indeed have a local surgery. Because you've got to understand that it is a much, much bigger area. It's not like in a town or a city where you probably can get a bus to another GP. You. If you can't get your GP, you've got a real problem because your GP can't get to you either. And I would also like to pick up on what's been said about Palantir.

I've had a lot of people contact me about that. Constituents, as it were, patients and GPS who are very, very worried about how that contract works and how Palantir operates. Medical data is hugely, hugely sensitive. People have to be confident that that is being managed by a company that they can trust. And Palantir doesn't meet those criteria. It's an incredibly expensive contract. As we've heard, it doesn't deliver the the value for money that we need.

But more importantly, people don't trust it and it's their medical records. So

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it has to be with a company they. Trust and. Give way. I will. I thank my hon. Friend for giving way. May I. Does she agree with me that this element of trust is even more important when we get the single patient record, and absolutely critical to enabling GPS absolutely critical to enabling GPS to use it. Medical, medical professionals everywhere and patients to trust it.

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I absolutely agree the single patient record is so important to making the NHS work efficiently, effectively to help it treat patients better. To achieve that, we as patients have to trust that that data is being well protected. And I'm afraid a lot of the people I talk to, including GPS, who are obviously critical in convincing the patients that Palantir is safe, do not trust it. We have to pull out of the contract with Palantir. So will the Minister please consider that? Please make sure you consider the aspects of rural areas.

And also please, please, please get

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us some NHS dentists in Ely and East Cambridgeshire. Hear, hear. Apsana Begum.

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Apsana Begum. Thank you, Madam Deputy Speaker. I rise to speak firstly to New clause 108, tabled by my hon. clause 108, tabled by my hon. Friend the Member for Liverpool West Derby, along with new clause 34, tabled by the hon. Member for 34, tabled by the hon. Member for Newton Abbot. Madam Deputy Speaker, countless constituents, countless numbers of constituents have contacted me about Palantir Technologies telling me their concerns about the company's involvement with Israel's military and Trump's ICB, and over 35 members on a cross-party basis, have signed my Early Day motion calling on the government to activate the break clause in the NHS Federated Data Platform contract.

The objection is not just about Palantir's ethics, but also about its operations under that contract, and I share the concerns of many, including the National Data Guardian, about whether data are identifiable to individual patients may be accessible to Palantir. The potential success of the proposals on the single patient record, and whether it manages to gain the confidence of the British public, depends on the government listening to these concerns and making sure that issues around data access and limits, patient opt outs and the data controller are resolved.

I know that the hon. Member for Newton Abbot has tabled a number of other amendments related to data safety, which I support. I also wish to speak in support of amendment ten. In the name of the hon. Member for North Shropshire on ICB financing, I am deeply concerned by the introduction of a duty under clause 48 for each of the constituent colleges of the ICB to achieve financial balance. Madam Deputy Speaker, in East London, we are currently fighting against a massive eight figure cuts in the East London NHS Foundation Trust, where workers have been on strike amid cuts to jobs in much needed mental health services, all of which are being justified by reference to new requirements for financial balance across the trust.

Under the provisions of the clause of clause 48 in this Bill, matters
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Apsana Begum Portrait Apsana Begum MP (Poplar and Limehouse, Labour)
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will be made much worse and the ability to shift and adapt capacity across the system will be rendered across the system will be rendered impossible. One of the reasons why this is so regrettable, particularly in an area like east London, where the need for mental London, where the need for mental health services is acute and rising, is that the cuts to these services will simply lead to greater costs will simply lead to greater costs to arise elsewhere. For that reason, I also support amendment ten, I also support amendment ten, tabled by the hon.

Member for North Shropshire, to place ICB spending on mental health services on a statutory footing. I also support amendment 45, tabled by my hon. Friend the Member for York Central. As I am concerned, as others are, about provisions in the Bill for the reorganisation of ICBs. These are among many aspects of this Bill which regrettably point towards a revival of prior decades marketisation policies policies which have by now been largely discredited. To tackle the biggest health challenges that we face, we require partnership working joined up decision making between the NHS, local authorities and expert voices, a dialogue between providers and commissioners.

Removing the potential for this type of dialogue appears to be a significant misstep, particularly for integrated care, and turning ICBs into purchasers alone appears to be being done for the benefit of reinforcing a purchaser provider split a split which experts have said time and time again does not work, does not deliver improved performance and outcomes or even value for money. So while I am relieved that the government is tabled its own amendment 60 to reverse the scrapping of local authority ICB membership, I remain in support of amendment 45 in order to ensure that NHS Trusts and foundations trust to retain their voice in commissioning and public health decisions.

To conclude, Madam Deputy Speaker, the fundamental problem in this bill lies in its adherence to a logic of marketisation. It is deeply regrettable that the government is returning to the harmful public private partnership model for capital investment and rehashing of

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the PFI disaster, the negative effects of which are still being felt across my East London constituency. Shockat Adam.

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Shockat Adam. Thank you, Madam Deputy Speaker. I refer members to my register of interest. As a practising interest. As a practising optometrist and also as an officer for the APPG for eye health and visual impairment. Sight is precious Madam Deputy Speaker and precious Madam Deputy Speaker and none of us would like to lose it. But sadly, 2 million people in this country are living with some form country are living with some form of sight loss today, which, on the department's own projection will rise to 2.7 million by 2030.

Every day, 250 people in the UK start to lose their sight. That's one person every six minutes and left unaddressed. That number is set to more than double to over 4 million by 2050. We are witnessing a growing problem and this bill sadly does not treat it with. I feel the urgency it deserves. So tonight, I urge the government to strengthen this legislation in these specific ways. On governance, clause 21 rightly ensures ICB boards reflect local political accountability, but it says absolutely nothing about clinical accountability.

Optometrists have no guaranteed voice in the rooms where commissioning decisions affecting their patients are made. I think it would be unthinkable to build a localised health care without GPS at the table. It would be equally unthinkable to do so without pharmacists. So I ask the government plainly optometrists have an expertise, the infrastructure and the systems already in place to relieve pressures on our hospital. Yet this bill says nothing about it. Concerning commissioning, I want to see eye care, glaucoma monitoring in particular, along with the management of minor eye conditions commissioned consistently by every ICB in England and not left to a postcode lottery.

Optometry already has what I call the tack effect. It is trusted, it is accessible and it is capable. Commissioning it properly would reduce unnecessary demand on emergency departments, freeing them to focus on the genuinely specialist cases while improving patients access to specialist eye care where they need
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Shockat Adam Portrait Shockat Adam MP (Leicester South, Independent)
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it. Because right now, according to a recent report by the Association of Optometrists, they have found of Optometrists, they have found that 780 000 people, the equivalent of the entire population of Greater Nottingham, attend A and E with eye Nottingham, attend A and E with eye problems annually at an average cost of £145 to the NHS, per A&E presentation. That is £113 million a year. But at least seven out of a year. But at least seven out of ten of these people with an eye problem would be successfully managed in a community optometry setting, with the right service commissioning.

These stats reflect a lived reality for many across our country, and if the new government wants to make smarter decisions with public money, they must consider this. And finally, on the single patient record schedule, one, clause 47 should be amended so that subsection explicitly includes optometry within a single patient record framework, ensuring optometrists have appropriate access to relevant patient information. Madam Deputy Speaker, this bill takes real and welcoming steps in many areas, but then more than 2 million people have already lost their sight, a number none of us want to see doubled to over 4 million by 2050.

Fundamentally, to see should be a right and not a privilege. So I ask the government

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to look again. Hear, hear. Thank you, Madam Deputy Speaker. I rise as.

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Deputy Speaker. I rise as. Chair of. The all party. Parliamentary group on Spinal. Cord injury to speak to

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Cord injury to speak to amendments 103 104, New clause 160 and amendment 105 on my name. And I and amendment 105 on my name. And I thank the Minister for meeting me during the passage of the Bill and for her subsequent letter, and I for her subsequent letter, and I also thank the Spinal Injuries Association for its support to the APPG and, crucially, to people living with spinal cord injury. These amendments are not about preventing reform. They are about ensuring that when responsibility for how highly specialised services changes, patients continue to read safe, equitable and nationally consistent care.

Spinal cord injury
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Andy McDonald Portrait Andy McDonald MP (Middlesbrough and Thornaby East, Labour)
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is a relatively low volume but complex lifelong condition complex lifelong condition requiring specialist expertise, rehabilitation and long term follow up. National commissioning exists to prevent fragmented services and postcode variation. If commissioning moves to integrated care boards, we need confidence care boards, we need confidence that specialist workforce capacity, national standards and the sustainability of specialist centres will be protected. I therefore ask the Minister to clarify how those safeguards will work in practice, particularly around workforce rehabilitation and geographical variation.

I also seek clarity on whether spinal cord injury services will transfer to ICBs, and what criteria will determine that decision. Amendment 104 and new clause 160 would provide national assurance and parliamentary accountability for outcome access, workforce and geographical variation. Amendment 105 addresses the single patient record. Specialist charities provide vital, practical and peer support after life changing injury, even where they are not part of the clinical care. And that's why this appeal is so resonant.

If we can engage with those providers at that early stage, the outcomes are undoubtedly going to be improved. So this amendment would allow referral with patient consent to approved condition specific organisations sharing only necessary information. Madam Deputy Speaker, I will not press these amendments to a vote today, of course. I hope the Minister will consider further safeguards and clarification during the Lords stage. For patients dependent on specialist services, their care and access to support should not depend on where they live.

Thank you.
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Karin Smyth Portrait Karin Smyth MP, Minister of State (Department of Health and Social Care) (Bristol South, Labour)
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Which brings us to the Minister Karin Smyth. and I do want to thank members across the House for these contributions. It has been, as we expect, on a bill of this size, a wide range, and I. I won't be able to address every single amendment, but I do commit to to trying to cover them all in the time that I've got and if necessary, get back to people afterwards, because as a government, we do know what we've set out to do through this bill is ambitious.

We're not we don't resign from that. We want to be ambitious. We want we are determined to make a real and positive change for people who use the NHS up and down the country, and throughout the Bill we have remained focussed on the key objectives which are to strengthen democratic accountability, stripped back bureaucracy and empower patients. So on integration, this bill and our wider programme of reform does support the further integration of health and care and beyond. I know this is a matter of considerable interest to members across the House, including who I've met with my hon.

Friend the Member for Shipley and as highlighted by my friend the Member for Uxbridge and South Ruislip, and I can assure them and all members of this House that we are committed to supporting joint working between local authorities and the NHS, and this bill upholds the existing duties to cooperate on NHS bodies and local authorities. Making it happen is the task on the ground, not additional legislative requirements. But as I told the hon. Member for Shipley when I met her, we're very happy to continue working and using her expertise to help make that happen.

With regard to on SEND and new clause 85, let me pay tribute to the work of my hon. Friend, the Member for Thurrock and New Clause 85. I agree with her that we need a much more joined up approach across education and health. It's one of the reasons the new Secretary of State for Health and Social Care has made clear to the department and the NHS that we must give greater priority to maternity and child health. If children have to wait a long time for the treatment or support they need, the problems can last a lifetime, as we've heard.

So I can tell my hon. Friend, that we will strengthen the SND expectations on ICBs in the new NHS planning framework, including joint commissioning, implementing local SEND reform plans and the new experts at hand offer. We are also determined to strengthen. Accountability has been raised here today. The Department of Health and Social Care will join NHS England and the Department of Education in reviewing this summer's local SEND reform plans to ensure proper ICB engagement and the Bill gives the Secretary of State the power to intervene to ensure these ICBs are meeting their duties.

The framework of requirements on the NHS to provide care across local populations works very differently to the duties on local authorities to support individuals, and therefore this kind of amendment would not be workable for the NHS. But we share its sentiment and we want to work with the hon. Member to ensure that Icbs are accountable for their responsibilities on SEND. Can I also add I'm going to move on. I'm going to move on because there's a lot to get through. I would also add to my friend, the Member for Bexleyheath and Crayford, a powerful on his own experience and the terrible experience of his constituents, I will commit to write to him about what we want to do with ICBs to make that situation better.

Can I also refer to. As referred to to New Clause 56 and the member from Mid Sussex. And can I also thank my hon. Friend the Member for Blaydon. Concept for the ongoing work and interest on carers throughout this Bill. I can assure the House that the government fully recognises the importance of supporting carers health and well-being. This includes ensuring that they can take breaks from their caring responsibilities where needed, and the Care Act already includes duties to assess and address carers current and future needs.

And of course, we want to ensure carers get the full benefit of the single patient record and we intend to use our regulation powers already in the Bill to achieve this. On inequalities, which has highlighted a lot today, we are committed to ensuring that local areas are empowered to make decisions to tackle the specific health challenges they face and make real progress on health inequalities. And I want to reassure the House that reducing health inequalities remains a priority for this government. And I know that the chair of the Health and Care Select Committee and the committee indeed takes great interest in this, and we are committed to working with them.

Can I thank my hon. Friend the Member for Stoke-on-Trent South and the Member for Uxbridge and South Ruislip for their championing of this important issue and our meeting last week. I am not, however, convinced about New clause 91. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health rather than creating additional statutory red tape. We already have a wide range of duties from the 2006 act. We've got a new duty on combined authorities.

The purpose in the 2022 act of ICBs was indeed in this space as a duty on foundation trust with the equality and the public sector equality duty, as well as our commitment in the ten year health plan. Again, the issue is making it work and empowering local leaders to do just that. To my friend the member from Lewisham East, I commend her work on the APPG and I will write to her specifically on the issues she raises. Additionally, on including. She talked about specialised commissioning.

Also raised by my friend the Member for Middlesbrough. We know that this is an ongoing area of concern across many areas and I commit to keeping in touch with them and others on maternity and women's mental health and maternity services. Again, I can assure the House this is a priority for the Secretary of State. That's why we published the action focussed Renewed Women's Health strategy. It's why we're undertaking a single national action plan on maternal health, overseen by the National Maternity and Neonatal Taskforce, to drive improvements where it matters to families, clinicians and other experts.

Now, I know many members of this House are committed to improving mental health, but I do want to take the opportunity to thank my friend, the Member for Sherwood Forest, for all of her work on this as the National Maternity Adviser. The party opposite raised the Hughes report. I can assure the House that the government. We recognise the importance of providing a response to the Hughes report. Work is ongoing in this area. I don't have time to go into all of that work at the moment, and we will do so and commit to it at the earliest opportunity.

They had a long time. The hon. Member opposite said that it was about to do it before the election. Well, that's not what we found when we came into power. There's a lot of work to do on this and many other areas they left us to do, but we are committed to it. On fertility services reducing inequalities maternity services, I know, has been raised by the my friend from Stockport and the Member for Stone, Great Wyrley and Penkridge, and he's been a tireless advocate on this area, as have many others.

I have recently written to him. Nice guidelines inform how ICB should commission this, but I know it's not uniformly implemented and we will continue to work with ICBs to evaluate the next steps on primary care. A lot of discussion on primary care, particularly including dental access across the country. We are committed to rebuilding dentistry in England, but actions speak louder than words and we are making great strides to improve access, ensuring an urgent care safety net across the country, reforming the dental contract and developing a ten year workforce plan.

More broadly, we think it's right that under this bill, primary medical services become the responsibility of ICBs. They have the right knowledge of their areas to make commissioning decisions. This includes on eye care. That is their responsibility for all primary medical services. But rightly, they will be accountable to the Secretary of State for their performance and response to issues raised by the right hon. Member for Godalming and Ash. He he is right that we always say that he could have done it while he was in power.

But, you know, we we don't always say that, but he's right, absolutely right about continuity care. I've also visited the practice he talks about in Horfield in Bristol. That's not just because I was on the PCC board when the 2004 changes happened. But broadly, Bristol does have different standards on some of these issues, but I think it highlights our point. We don't need to make some of these provisions in legislation through the neighbourhood care plans and neighbourhood work and work in primary care networks.

This is exactly the sort of good practice that can be shared in local systems. On the single patient record. Madam Deputy Speaker, this is fundamental to the government's mission to create a modern, joined up NHS, which puts patients at the centre of their care and on amendments 26, 42 and 43. I want to assure members that the overarching purpose of making regulations to create and operate the single patient record is limited to the direct care of patients, and the clauses already explicit about this.

Crucially, the clause does not create any new data sharing gateways for secondary purposes such as planning and commissioning, and these amendments are therefore are not necessary on data safeguards. The security and privacy of people's health and social care data are paramount. As you expect, we will. We will build in the strongest safeguards into the record. On new clause 32, I can assure members of the SPR will be designed to protect personal data by default, with the highest standards of cyber security and information governance, ensuring that only the right people can access the right information at the right time and only for the right reasons.

Finally, I have heard how important is the single patient record is accessible and inclusive. I would like to thank my friend the Member for Battersea, and in her clause, amendment 4 to 87, for the important work she is doing to publicise this hugely important area, and I do want to ensure her an hon. Members, we are confident that the Bill is drafted to enable information related to support needs and reasonable accommodations to be included in the SPR, and the Department will have regard to the Accessible Information standard.

As SBR has developed, we are also committed to tackling digital exclusion. We've considered this as part of the single patient record equality impact assessment, and work is already underway to help address barriers around connectivity skills and confidence. And again, I've heard my friend the Honourable Mid Ulster and Thornby about the need to engage him and others in the single patient record as we go forward on the Federated Data platform. Decision about public contracts must be made through fair, open and non-discriminatory processes.

This is governed by UK procurement law, which recognises certain international treaty obligations. NHS England is reviewing the Federated Data Platform contract to determine if it should continue with standard contract management processes. This will look at the evidence of delivery and impact of the platform, and that should be the basis on which a contracts continuation is decided. I won't, I won't give. We've heard a lot from the hon. Gentleman. I do want to make some clear points for the House this evening.

We've heard a lot of discussion about commercial processes in the House, and hon. Members, including the hon. Gentleman, have raised important points around data security, governance and ethical standards of contracts, support for domestic suppliers and for voluntary community and social enterprise organisations. Contracts involving NHS data and digital services must be subject to proper scrutiny. The government's approach is to assess risk based on the nature of the data, service and supplier access, and, crucially, we already have the tools we need to carry out appropriate due diligence through legal powers and robust contractual provisions.

All new clause 108. In the name of my friend the hon. Member for Liverpool West Derby, and I agree with the spirit of this amendment and fully recognise the importance of ensuring that the NHS does not inadvertently support exploitation or rights abuses. UK legislation already incorporates some international laws. For example, the Human Rights Act of 1998 incorporates the European Convention on Human Rights into UK law. Similarly, we can use existing legislation and guidance to exclude suppliers from NHS procurements, both the Procurement Act and the provider selection regime allows us to exclude providers where there has been serious misconduct or illegality.

For example, we could exclude a supplier under the Procurement Act for breaches of modern slavery and or human trafficking laws. We have very high standards and expect all suppliers to meet them, including whichever companies go on to provide the single patient record. On a related note, the Chancellor has already written to the Secretary of State to ask that the NHS procurement better supports British industry. In light of this, the Secretary of State has commissioned within the health family a review of strategic procurement pipelines to find opportunities for the new social value model to support more British jobs, skills and innovation.

The First Secretary of State, who is leading work on procurement across government, would be happy to meet with my hon. Friend the Member for Liverpool West Derby, as part of this important work as it progresses, and I can assure him that the actions we take will be fully in line with the principle of international law, as he has set out in the amendment. In closing, Madam Deputy Speaker, I thank my hon. Friend the Member for Stroud for his help in driving down access to to healthcare with that sore throat.

But I would like to end this debate by thanking all sides of the House for their contributions to an interesting and helpful discussion, the expertise that we've heard and the scrutiny of members has and will continue to strengthen this, this bill. And as a consequence, and actually, I will give way to hon. Member for who spoke earlier. Yes, that's fine, spoke earlier. Yes, that's fine, that's fine, that's fine. Good work.

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I'm really grateful to the Minister for giving way. I've listened carefully to the debate listened carefully to the debate and referred to my new clause 57. The challenge of the NHS is there is so much significant, is so much significant, unaccountable power being held that we, as MPs can't even deliver for our constituents. Will she look at our constituents. Will she look at her my amendment and work with me to ensure that we get the bill in the right place with regard to

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the right place with regard to accountability before the bill goes to the Lords? Well, I thank my friend for York Central for that, because and as she knows, over many years, I have spoken from the opposition benches about the lack of accountability of our local systems to local members of the Parliament. I think it was a great loss in the Lansley bill. It's one of the things that drove me to becoming a member of Parliament, and I think in my role as the Minister of State, I have endeavoured to make sure that local members of Parliament have.

I want the the right hon. Member as Secretary of State for health twice. So he had his chance to put all the right things on the bill, but I. I'm not helping my sore throat, but the point the point being exactly as she mentions in this bill, is about putting back that Democratic accountability direct to the Secretary of State. We've had a lot of pushback in different places around the provisions to do that. That is what this bill does. It puts accountability back to the Secretary of State.

It devolves that responsibility for delivering to the ground, to NHS organisations, and, crucially, it empowers patients. It strengthens this bill

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and I commend it to the House. Here. The question is that new clause

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The question is that new clause

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The question is that new clause 96 be read a second time. As many as are of that opinion say aye. Of the contrary, no. I think the ayes the contrary, no. I think the ayes have it. The ayes have it. The question is that new clause 96 be question is that new clause 96 be added to the bill. As many as of that opinion say aye. I Of the contrary, no. I think the ayes have it. The ayes have it. We come to government.

New clause 97. I call the Minister to move new clause 97

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formerly. Report involvement of others and visitors.

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The question is that new clause 97 be read a second time. As many 97 be read a second time. As many as of that opinion say aye. I Of the contrary, no. I think the ayes the contrary, no. I think the ayes have it. The ayes have it. The question is that new clause 97 be question is that new clause 97 be added to the Bill. As many as are of that opinion say aye. Of the contrary, no. I think the ayes have contrary, no.

I think the ayes have it. The ayes have it. New clause. Order, order! Under the order of the House today, I must now put the questions necessary to bring proceedings to a conclusion. New clause six has been selected for separate decision. I call the Liberal Democrat spokesperson to move new clause six formally. Formally. The question is that new clause six be added to the Bill. As many as of that opinion say aye. Of the contrary. No, no. Division.
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None Portrait Legislation: Health Bill: Report:New Clause 145: Division
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Is Is that Is that new Is that new clause Is that new clause 145 be added to the bill? As many as of that opinion say aye. Of the contrary. No, no. The Tellers for the ayes are Sir Ashley Fox and Jerome Mayhew. The Tellers for the

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Order. Order. Order! Order. Order! Is Order. Order! Is the

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Order. Order! Is the Order. Order! Is the right Order. Order! Is the right 170.

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The noes to the left 316. Nose. The ayes to the right were 170.

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The ayes to the right were 170. The noes to the left 316. So the noes have it. The noes have it unlock. I call the Minister to move government amendment 60 to 64 and 70 and 71 formerly. The question is that government amendment 60 to 64, 70 and 71 be made. As many as of that opinion, say I, I of the contrary. No, I think the ayes have it. The ayes have it. Bill. To be further considered, what day? Tomorrow? Tomorrow?

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Yes.

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Motion number three on Environmental Protection. Minister. To move. To move. The question is, To move. To move. The question is, as on the Order Paper, As many as of that opinion say aye. I of the of that opinion say aye. I of the contrary. No, I think the ayes have it. The ayes have it. Motion number four on plant health Minister to four on plant health Minister to move. I beg to move. The question is, as on the Order Paper, As many as of that opinion say aye.

I of the contrary no, I. The division is deferred until Wednesday. Motion number five on trade unions. Minister to move. I next move. The question is, as on the Order Paper, as many as are of that opinion, say I, I of the contrary. No, I think the ayes have it. The ayes have it.

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Motion number six on business of the House Minister to move. To move.

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The question is, as on the Order Paper, as many as are of that Paper, as many as are of that opinion say aye. Of the contrary, no. I think the ayes have it. The no. I think the ayes have it. The ayes have it. We now come to motion number seven relating to the environment, Food and Rural Affairs environment, Food and Rural Affairs Committee. Jessica Morden to move. The question is, as on the Order Paper, As many as of that opinion say aye.

I of the contrary. No, I think the ayes have it. The ayes have it. We now come to motion number eight on the Joint Committee on the National Security Strategy. Jessica Morden I beg to move. The question is, as on the Order Paper, As many as of that opinion say aye.
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22:29
None Portrait
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expand the councils of Exeter, Plymouth and Torbay while leaving an unworkable rural Devon council. Spanning a 100 mile drive from Spanning a 100 mile drive from Lynton to Salcombe, 1783 people signed an online petition about signed an online petition about this issue and I have been contacted by hundreds of constituents who are deeply concerned about the risk posed to vital local services. Devolution should be built from the ground up, not imposed by Whitehall. This plan made a mockery of that and it's not what rural Devon wants.

I appreciate a review is now underway and I welcome it. The petitioners, therefore request that the House of Commons urge the government to reverse its decision on local government reorganisation in Devon, and to reconsider alternative

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etc. Local government reorganisation in Devon.

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in Devon. I beg to move that this House do now adjourn. The question is that this House

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do now adjourn. Danny Beales thank you, Madam Deputy Speaker. I'd like to begin by welcoming the government's by welcoming the government's decision at the start of the summer to pause the application of VAT on medicines donated for free to patients through compassionate access, early access and related schemes, the health, charities, patience and industry bodies I've worked with are grateful to Ministers for recognising this issue needs to be addressed, in particular for the ministerial statement previously setting out the government's intention to introduce a new approach to VAT on free of charge donations of medicines.

I know my right hon. Friend the Financial Secretary and previously the Member for Chipping Barnet have both worked a great deal on this issue, and I thank them both for their commitment to find a resolution without a permanent solution. However, pharmaceutical companies do not have the legal certainty to fully regauge re-engage with early access programmes. And whilst to date only Bayer has withdrawn from these schemes outright, I've heard from a number of other companies who tell me that the uncertainty is causing them to reconsider drug by drug, whether they can afford to continue offering free access for fear of creating open ended VAT liabilities.

And tragically, the people who are paying the price for this delay are patients. I know the government recognises the the consequences for patient outcomes, which is why it has committed to bringing forward a new approach, either through changes to VAT rules or through a reimbursement scheme. I also welcome the fact that the new approach will apply once introduced to donations made on or after the 23rd of June 2026. However, a pause is simply not good enough to resolve this issue fully, and I have called for this debate today to ask the government to reconfirm its commitment to find a permanent solution and to ask the government to move forward as quickly as possible in determining that comprehensive solution.

I would

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gladly give way and then I'll come. Thank you, Madam Deputy Speaker. My constituent Joseph was diagnosed My constituent Joseph was diagnosed with a brain tumour at just 28 years old. He was fortunate to receive early access to Vorasidenib through compassionate access schemes, but Royston is only the second new NHS approved brain cancer drug in 20 years. So does my hon. Friend agree that given the hon. Friend agree that given the painfully slow progress we've seen in developing treatment for brain tumours, we should be removing every possible avoidable barrier to patients receiving these promising new medicines?
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Danny Beales Portrait Danny Beales MP (Uxbridge and South Ruislip, Labour)
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Thank my hon. Friend for that. >> Thank my hon. Friend for that. And as the chair of the APPG for access to medicines. Those are stories I've heard far too often

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and I completely agree we should be removing every single barrier. I'm very happy to give way. Jim Shannon Derek Twigg. First of all, can I commend the hon. Member for Uxbridge and South Ruislip for bringing this forward? He has hit the nail on the head on an issue that's, quite frankly, a matter of life and death for families right across the United Kingdom. Her Majesty's Revenue and Customs are sweeping and penalise that relief is disgrace. So does the hon. Member not agree that a temporary pause, while welcome from the Treasury is simply not a solution? When the clock is ticking for cancer patients and those with rare diseases, and that government should commit to working with the Treasury and devolved health executives, including my own constituency of Strangford, to secure a permanent VAT exemption and ensure that tax bureaucracy never stands in the way of human empathy.

Thank you.

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Danny Beales. Thank you for that contribution. And I agree we do need to find a permanent and comprehensive solution. I think hopefully there are issues that we can er fully today. And you know, fundamentally, I think the principle underlying I think the principle underlying this issue, which is very straightforward, that is, if a pharmaceutical company is willing to provide a life saving medicine to provide a life saving medicine to a patient free of charge because the patient has a serious or life threatening condition and is threatening condition and is exhausted, the available standard treatment options.

We shouldn't have a tax system that makes access to life saving drugs more difficult, which reflects those member's points. So far, pharmaceutical companies already operate these schemes at a loss. For example, over the last four years, AstraZeneca alone has given more than 2500 patients access to innovative, life saving medicines free of charge, costing millions of pounds. This is clearly not a commercial transaction. It is a moral, compassionate, motivated decision and program and in my view, this means it should be supported, championed and facilitated by government, not blocked or disincentivized or made administratively more burdensome.

But this is exactly, unfortunately, what had happened since the HMRC started charging VAT on those donations. This isn't just a line on a tax return or impacting the bottom line. The impact is also having real world consequences on patient groups. The consequences of this delay are gut wrenching and deeply frustrating for clinicians, patients and their families. Every day, every week, every month that we wait for a permanent solution to move forward, more severely ill patients are denied access to drugs that could save their lives and extend them at no cost to the NHS.

It is also important to note that patients with rarer cancers are disproportionately affected by this issue, as they generally already have fewer treatment options. In August, I was contacted by Emma and her husband Ian. Ian and Emma are currently watching this debate online from Ian's hospital room at UCL and couldn't be here in person. Ian has an advanced, rare and aggressive bile duct cancer following his latest chemotherapy, his consultant, Professor Bridgwater, recommended Regorafenib as Ian's next treatment. This was previously supplied free of charge by Bayer through the Compassionate Use Program.

However, since Bayer's liability for VAT on the medicines it was donating, it withdrew from the programme, meaning Ian lost free access to the potentially life extending treatment. Ian and Emma are now urgently trying to find the money to pay privately for Ian's treatment, and the costs of thousands of pounds per month. It goes without saying that many families cannot afford to pay thousands of pounds a month each and every month for treatment. Working with sarcoma UK, I've also heard from Doctor Robin Young, a consultant medical oncologist at Weston Park Cancer Centre, who reported that a 62 year old patient with metastatic leiomyosarcoma whose disease had progressed through all standard chemotherapy options, was also denied this drug in January 2026 because of buyer's withdrawal.

The patient subsequently self-funded an alternative treatment at a cost of £3,500 for one month, before deciding he could not afford to continue with that treatment. These are heartbreaking decisions for patients and their families. I've also heard from Doctor Alice Lee act, Alex Lee, a consultant medical oncologist at the Christie NHS Foundation Trust, who has reported that two patients with advanced osteosarcoma were refused access to this drug earlier this year, with bio citing the VAT position. Tragically, one of those patients has since died.

She was just 20 years old. I hope these stories make clear, Madam Deputy Speaker, the urgency of resolving this issue as soon as possible, which will enable not only Bayer to re-engage, but ensure those existing participants continue to be able to access drugs through the programme. And potentially new drugs can also enter early and compassionate access schemes in future. On paper, it may be a niche and complex part of tax policy, but in real life it is a desperately ill patient.

It is a family and it is a clinician having to explain why a medicine which had previously been made available can no longer be provided. Turning to the position of the pharmaceutical industry, patients, clinicians and the Minister will be pleased to hear that the pharma companies are keen and willing to re-engage with the compassionate early access and other schemes. Once a suitable solution can be finalised with government. But I have heard some concerns from the industry about the pace and scope of current negotiations since the government announced a pause.

The first issue is about the breadth of the definition. The product will be exempted from liabilities. The definition definition used to determine any VAT exemption going forward should include the full range of schemes that pharma companies engage in to provide these medicines free of charge. This includes compassionate use where a clinician requests a specific medicine as a last resort. Once other options have been exhausted, usually off licence early use for new patients immediately after a trial. Post-Trial provision for patients who responded well in the trial and need to continue, and also bridging prescriptions for patients where a drug has been approved but is not yet funded in the NHS.

However, I've been told that the definition initially suggested by the HMRC during negotiations has been too narrow, narrow and does not cover all of these uses. I would encourage the Minister to look again at this. Given the compassionate use of off licence drugs accounts for a substantial proportion of patients who currently benefit from donations to the programme. I understand that the government may now be willing to move to a better position this point. I would welcome confirmation from that from the Minister. The second issue is that I've heard is that the HMRC is considering attaching two conditions to any VAT exemption.

First, the patient must be treated on the NHS rather than by a private clinician, and second, medicines must be supplied directly by the company to the NHS. I'm sceptical of the merits of both these points. First, I do not think that patients should potentially lose access to a life saving free treatment at the cost, which is at the cost of industry. Just because the clinician recommending the treatment is a private doctor. On the second, I would be grateful for the Minister to explain the practical level how such an arrangement would actually work.

We all know that the NHS themselves can refer to private clinics that clinicians can, particularly for specialist issues, work regularly between practices in NHS and private clinics. The fundamental fundamental question must surely be is it clinically needed? Is it free at the point of use of the patient as a medicine that is being provided? The third issue related raised by pharma, pertains to the question of historic liabilities. My understanding is that many pharma companies have already paid VAT for historic liabilities, and it is important to say that we do not expect that they will be able to recover that in full.

However, given the upcoming changes, it would be helpful for the government to provide some clarity on the legal position with regards to historic liabilities before the pause, and I would encourage settlements to be negotiated constructively with the understanding, based on the nature of these liabilities, closely related to this issue of historical liabilities is that of coordination between government departments. On this issue. AstraZeneca has told me that despite ongoing negotiations with HMRC and the pause announced in July, they are currently being pursued by HMT for accounts by the end of September, which has been indicated should include VAT liability on compassionate access, a position AstraZeneca are not confident is consistent with what they are hearing from HMRC.

Business needs certainty to prepare their accounts and I would encourage the Minister to ensure HMRC and the Treasury are working from the same hymn sheet. I would like also to raise the point of the the method and pace of resolution. My understanding is that the government is currently looking at creating an exemption for compassionate donation of medicines through a legislative change to the VAT act. However, I'd like to ask whether the government has considered issuing a business brief from HMRC to clarify the new position, given that this could be a faster and more effective route.

So I'd be grateful for the Minister's perspective on that as well as the patient benefits. There are also clearly more broadly, a key strategic opportunity here for us as a country to be a global industry leader for life sciences research. Many other countries do have complex schemes in place, and sometimes charging a VAT or equivalent on such issues. However, I understand the Netherlands, whilst liabilities exist, technically they're not enforced in practice. If the UK were to fully resolve this issue clearly and put it beyond doubt, it would be a genuine point of competitive advantage advantage for attracting life sciences, investment research and clinical trials to this country.

At a time where our overall competitiveness in the sector is under pressure from other directions and policies. I would also encourage more. It would also encourage more participation of innovative new drugs and potential wider patient applications of them, driving forward future potential research opportunities and improving healthcare practice. To sum up, my questions to the Minister are as follows. First, can the Minister confirm that a permanent solution will define eligibility products broadly and as widely as possible, to include the full range of such schemes that are presently used? And will the Minister reconsider the proposed restrictions on eligibility to NHS treated patients only? Secondly, on timescales, the government has said it will act as soon as possible, but for a patient with a life threatening disease, the phrase can feel like a very long time.

Can Ministers set out a clearer timetable today about actions and next steps, and when the consultation with industry is likely to conclude, and will the government decide to bring forward a change or a reimbursement mechanism? Can the Minister explain why a business brief route has not been preferred to date, or if so, if it can be explored and when detailed guidance is likely to be published and operational. Finally, what is being done to repair the relationships with industry that have been damaged as a result of this policy? Where a company such as Bayer has withdrawn? I hope that they will be encouraged strongly to re-engage as soon as possible.

So the patients we've heard about today can gain access quickly. And can the Treasury work with the Department of Health and Social Care to both engage industry and also be in direct communication soon with clinicians to help identify which patient groups that have been most affected could be notified as soon as possible that these treatments may become available again. To conclude, Madam Deputy Speaker, this is, on paper a narrow technical issue of tax policy. Not always the thing that might, might, might, might make front pages of newspapers or the most engaging social media video.

But in practice, a clear and quick resolution to this issue is a life and death issue for many thousands of people. It is the difference between a patient like Ian fighting to save thousands of pounds a month or not, and just to be able to focus on his health and his loved ones. It is the difference between a clinician having to explain why a medicine that was available last year is now not available, or instead being able to provide this innovative and life saving drug to them and many more patients besides.

It is the difference between a pharmaceutical company that wants to do the right thing. Providing drugs to patients for free at a low cost, or withdrawing their drugs completely because the costs become significant. Once again, I strongly welcome the ministerial statement that and the pause from June. I thank the Minister and his predecessor significantly for their work to date, which has made a difference, and I know that he is committed to engagement on this issue and finding a way forward.

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Thank you very much. Minister. James Murray. Thank you, Madam Deputy Speaker

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Thank you, Madam Deputy Speaker and it's a pleasure to respond in this debate, and I'd like to begin by thanking my hon. Friend, the by thanking my hon. Friend, the Member for Uxbridge and South Ruislip, for securing this debate and for all his engagement and and for all his engagement and campaigning on this very important issue. I know from my conversations with my hon. Friend that he cares very deeply, as do I, about ensuring patients can access innovative medicines, particularly when there is unmet clinical need.

Free of charge. Arrangements play an important role in giving patients early access to medicines. As my hon. Friend so powerfully illustrated when he spoke about the patients and families who have shared their stories with him, I was moved to hear the experiences of those patients, and I am grateful to my hon. Friend for sharing them this evening. My thoughts are, as I'm sure every member's thoughts will be, with those patients and families, including the family of the young woman who my hon.

Friend told us had tragically passed away. I am sure that everyone in this House agrees that we must find a solution, which means those patients and others like them can continue to access life saving medicines. Madam Deputy Speaker, before responding to the points made, I will first set out some of the context to the existing VAT treatment of donated medicines. This evening's debate concerns the application of long standing VAT rules to some medicines supplied free of charge under UK VAT law.

Some transactions where no money changes hands are treated as though a supply had been made and these are known as deemed supplies. These rules help to keep the VAT system fair when a business has reclaimed VAT on its costs. These are not new rules introduced by this government. These are long standing features of VAT system dating back to the early days of VAT before the VAT act 1994, HMRC wrote to the sector in 2020 323, as part of the process of ensuring that businesses pay the correct tax.

However, the government recognises concerns raised by pharmaceutical companies and patient groups about the potential impact of this treatment on free of charge access and ultimately on patients. And that is why, as my hon. Friend mentioned, on June the 23rd, my predecessor announced that the government would bring forward a new approach as soon as possible, as set out in the written ministerial statement on the 2nd of July. The government is considering either changes to the VAT rules or a reimbursement scheme.

The new approach will be effective for donations made on or after the 23rd of June 2026. Officials in the Treasury, HMRC and the Department for Health and Social Care have been working closely together and engaging constructively with the pharmaceutical sector to develop the details of both options. That work must ensure that any approach supports patients whilst also being legally robust, operationally workable and sustainable. We recognise that free of charge medicines are supplied through a variety of arrangements. These include both early and expanded access, including post-trial access and arrangements which operate after MHRA authorisation.

Now my hon. Friend raised the question of which medicines would be in scope of the new approach, and the government is considering this question carefully. In collaboration with the sector, the solution must capture genuine patient access arrangements without creating unintended consequences elsewhere in the VAT or supply systems. It is important that we complete that work quickly so that patients across the UK can benefit from innovative medicines as quickly and as safely as possible. It is equally important that we get this right to avoid inadvertently omitting important avenues by which medicines are donated or open the door to abuse, and that is why we are working closely with the industry to craft the scope appropriately.

My hon. Friend also asked about which forms of donations would be in scope, and whether it would apply only to donations to the NHS. He would appreciate that I am not in a position to announce any final decisions today. Whilst work remains ongoing with the firms, however, I can reassure him that I have no desire to artificially circumscribe the scope of the new approach, unduly leaving out genuine donation practices. My hon. Friend asks about timelines. I regret that as it is a potential tax change.

I cannot give further detail beyond reassuring him that I have reiterated the urgency that we both feel of the need to reach a swift resolution, and I have imparted this urgency to my officials on the question of historic liabilities. The new approach will apply to donations made on or after the 23rd of June 2026. I am happy to hear input from firms on that point as we go through the process. On the question of coordination, in the case of AstraZeneca, it would not be appropriate for me to comment on the tax affairs of an individual taxpayer, but I would certainly encourage firms in the round to share the detail of any specific concerns they have with my officials.

On the question of whether HMRC could publish a business brief to fix this issue as a matter of existing, law, firms must account for VAT on donated medicines. An HMRC brief can only communicate a change in policy when the law itself has changed, or following a judicial decision requiring a change in law. The Revenue and customs brief cannot make the change in law itself. And lastly, I share my hon. Friend's desire to see Bayer return to the Early access scheme so that patients can regain access to innovative medicines.

We have committed to apply the new approach retrospectively to donations made on or after the 23rd of June 2026,

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and I hope that Bayer takes confidence from that and rejoins the early access scheme as soon as possible. The Minister.

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The Minister. Give way, give way. Danny Beales has been very generous as ever. I appreciate his generous as ever. I appreciate his response about the limitations of the business brief process on amending the VAT act, specifically, amending the VAT act, specifically, if that is the right route. Does the Minister know how roughly long that would take to find a resolution? If that is the route for resolution, how generally long that would take? And I fully support his point about re-engaging.

And, you know, in good faith the government has moved. I hope Bayer

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will also Minister. I thank my hon. Friend for his

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I thank my hon. Friend for his question. As the changes we are discussing today concern a discussing today concern a potential tax change, I'm afraid I can't give him further detail about any timelines, but I would again reiterate the fact that I've imparted to my officials in Treasury and HMRC the urgency that I feel about this and that I know he and others will share. And I'm glad that he joins me in calling on Bayer to take confidence from what we've announced and rejoin the early access scheme as soon as possible.

Madam Deputy Speaker, I'd like to again thank my hon. Friend for securing this debate and for the constructive way in which he has raised this issue this evening and at times in the past. In concluding this debate, I would like to pause to reflect on the impact of continued access to medicines for patients. Individual members have raised with me the importance that early access medicines can have, especially for those in the most tragic of circumstances, who sadly have few other options. I have been moved and hearing these cases, and it is vital that we keep those medicines accessible.

I am grateful to members across the House for bringing this issue the attention it deserves. I am also grateful for the constructive engagement that my officials have had with the pharmaceutical sector, and I know that we have a common goal in resolving this issue swiftly. I look forward to setting out further detail once the work has concluded, and when final decisions have been

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taken. The question is that this House do now adjourn. As many as of that opinion, say I. The ayes have it.
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