Health Bill (Fourteenth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Edward Argar]

The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.

I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.

I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.

The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.

[Helen Morgan]

New clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.

[Edward Argar]

The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.

The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.

The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.

I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.

I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.

While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.

Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.

I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.

I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.

Health Bill (Thirteenth sitting)

Debate between Edward Argar and Helen Morgan

Tuesday 7th July 2026 Public Bill Committees

[Helen Morgan]

The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.

[Edward Argar]

Clause 65 and schedule 10 focus on local healthwatch arrangements. As I said when speaking to the previous group of amendments, Healthwatch is respected and trusted at a national level, and that is even more the case at a local level. I fear that the Government seek to remove something that works, that is effective and that ensures a strong patient voice in the system.

It simply does not work to have integrated care boards take on those responsibilities, as they will be marking their own homework rather than being the independent patient voice. It is a little like the discussion the Committee had during the previous grouping on HSSIB, in which it turned out that the CQC will be able to investigate itself, but the chief executive of the CQC would decide whether any protected disclosures could be published during that investigation. That measure brings things entirely within the system and removes the independent voice, which is exactly what this clause also does.

The ICB is the voice of the NHS system, not the voice of the patient. We need the grit in the oyster that is provided by an independent voice talking to the ICB. Being in the room with an ICB will not mean that the patient voice is heard more loudly or clearly, or that it will be acted on—it is probably more likely to mean that it is not. As an example from my constituency, the ICB did conduct a consultation exercise on the proposed closure of St Mary’s birth centre in Melton Mowbray, the response to which was overwhelming: the patient voice said that they did not want that to happen. That response was fed into the ICB, but the ICB did what I fear it planned to do all along and closed the centre. Given that that voice in the room came from a consultation exercise led by the ICB, it seemingly did not make a jot of difference to the outcome or decision, or to whether the patient was heard.

On the impact of local authority scrutiny panels, the NHS ICB in Melton previously recognised the need for increased GP provision in the town due to the increasing size of the town and the long waiting times, but just recently decided to reverse that position and say that it did not see the need for that. Members of the scrutiny committee, across all parties, were absolutely clear that they disagreed with that decision, but did that get listened to or make a jot of difference to the ICB? No—the ICB did what it was going to do anyway and changed its mind.

My concern is that we will see less grit in the oyster and patient voice, and more managerialism in the NHS ICB system. We heard from the hon. Member for North Shropshire and the shadow Minister about the challenges there would be, even were that patient voice to happen. Given the Government’s 50% cuts to ICB budgets, which are already impacting frontline services, ICBs will not be able to take on additional responsibilities without the funding that they need. That is quite apart from the principle that they should not be marking their own homework. I fear that “system knows best” will become the default.

We have also heard about the geographical challenges. Given that mergers and acquisitions are getting even bigger, ICBs are moving further and further away from what was conceived: for them to have the same geographical footprint as the upper-tier local authority providing social care, to ensure that the two organisations spoke to each other and were better integrated. Removing the representative from the local authority that provides that healthcare from the board, even if they are replaced with a mayor, does not bring about the reconnection with social care provision that is so central. Removing the voice of general practice or primary care from the ICBs again moves that independent challenge away from the system.

I fear that this is a fragmentation of those links at a local level and the weakening, if not silencing, of a patient voice that can challenge publicly and ensure that what patients need to have said is genuinely said. Being in the room does not mean that that voice is heard or acted on, as shown from the examples I have spoken about: there is a consultation exercise, the view is reflected on, and the ICB does what it was going to do anyway and does not change its position. I have genuine concerns about the loss of an independent patient voice in a local context.

The Minister will correct me if I am wrong, but I think she made the point in her opening remarks that we have lacked not recommendations and suggestions for changes but action to fix the issue. But it is not for Healthwatch to take action to fix the issue; it is for the ICBs and the NHS to act on those recommendations. We are proposing to give the bits of the system that have failed to take action and fix the issue not just the responsibility that they already have but the responsibility for reflecting patient voice. The one bit that is working—where patients’ voices are heard—is the bit that we are getting rid of. We are not seeking to fix the bits that have real pressure and genuine levers to compel an ICB to act on those recommendations when they are made independently, rather than simply marking its own homework.

As with my reflections on clause 64, I genuinely fear that in this weakening of patient voice, particularly at a local level, the patient will be the loser because the system will continue to do what it wishes to do. It will do its consultations, and it may have a director of patient experience at an ICB level, but they will be working for the ICB; they will not be there as an independent voice to challenge the ICB—including publicly—on what it is doing.

I hope that the Minister reflects further on the real diminution, if not the neutering, of patient voice that comes with some of these arrangements. As always, I look forward to her reflections when she winds up.

Health Bill (Twelfth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Edward Argar]

I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its

“scope of work beyond the original remit.”

It goes on to say:

“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”

I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.

Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:

“Most investigations into safety incidents should continue to be managed within provider organisations”.

That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.

[Helen Morgan]

I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?

[Edward Argar]

The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.

Health Bill (Seventh sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.

[Edward Argar]

The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.

I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.

Health Bill (Sixth sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.

[Edward Argar (Melton and Syston) (Con)]

I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.

[Helen Morgan]

The right hon. Gentleman asks an extremely important question, and I am happy to clarify. It would be an appropriate clinician within the GP practice, and it could obviously be a telephone appointment, because that might be more convenient for the patient. Lots of patients are really happy with telephone appointments and we should be using them wherever that is the patient’s choice, because we want—I think we all do—to see an NHS that is patient-led and not politician-led.

--- Later in debate ---

[Edward Argar]

It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised.

The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned.

I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical triage as to what is the most appropriate access point to primary care services for the individual, based on their symptoms and needs.

For me, despite the work being done in Melton Mowbray at the moment to improve waiting times, it remains a very significant concern that despite the integrated care board having a few years ago acknowledged publicly the need for additional GP provision in the town, whether a second GP practice or a new satellite service, it said a few months ago—despite the fact that in the intervening period there has been considerable housing development in the town—that it considers that there is no need at the present time for additional GP provision, and so it does not appear to have a plan to expand that provision. That is obviously concerning. All of us in this House will from time to time have these issues in our constituencies and, I suspect, sometimes get frustrated by the fact that ultimately we can press our ICBs and ask questions of the Minister—who, I have to say, always responds in a courteous and measured fashion—but ultimately the decision maker is the integrated care board’s board and it will do what it wishes to do when it comes to commissioning those services. There is a disconnect there.

My challenge with regard to new clause 2, despite my being in agreement with the need to improve access to services, is that there is a lack of clarity about how that will be done and there is the fear that it may raise expectations that are not necessarily deliverable on in the current context. The Liberal Democrat five-year plan for GPs is in their 2024 manifesto, and the hon. Member for North Shropshire alluded to the commitment to 8,000 additional GPs. It is not my usual habit, but I have read the Liberal Democrat website, which sets out the background. I appreciate that this is from 2024 and the hon. Lady may have moved things forward a little bit since then, but it states that the five-year plan

“gives patients the legal right to see a GP within a week or 24 hours if needed urgently”.

The hon. Lady may wish to respond on that.

[Helen Morgan]

I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.

[Edward Argar]

I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation.

My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.

--- Later in debate ---

[Helen Morgan]

I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.

[Edward Argar]

I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.

We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.

Health Bill (Second sitting)

Debate between Edward Argar and Helen Morgan

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Helen Morgan]

Q Do you think that the health and wellbeing boards, as envisaged by the Bill, will be the right structure to deliver those relationships, and how do you ensure that they have the right skills?

Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy.

I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS.

It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health.

The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.

[Edward Argar]

Q Having been both a local councillor and a Health Minister, I am very conscious that the real test of any joint working arrangements between different bodies comes when budgets start getting a little tighter. We see that tension growing a little bit with the cuts made to ICBs’ budgets.

I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.

Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.

My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?

Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?

Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.

Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.

Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.