Health Bill

Andy McDonald Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[Andy McDonald (Middlesbrough and Thornaby East) (Lab)]

May I begin by welcoming the Secretary of State to his place and wishing him well in the responsibilities that he carries on behalf of patients, NHS staff and communities across the country? I welcome the Bill and its intention to improve patient care through investment, modernisation and better integration across the health service.

It is right to acknowledge the progress made on waiting times and waiting lists since Labour returned to government, with the overall waiting list falling significantly and long waits continuing to come down, but may I add my voice to those of others about the appointment of a chair for the Tees, Esk and Wear Valley inquiry? My right hon. Friend the Member for Ilford North (Wes Streeting) gave that commitment, which we were pleased to hear, but we have yet to see that chair appointed. If that could be given attention, we would be most grateful.

I remain concerned about the continuing impact of historic private finance initiative costs on NHS trust budgets, including the pressures facing South Tees hospitals NHS foundation trust in my patch. Too much money is still being diverted from frontline care. I regret that this issue remains unresolved.

The principal reason I rise today is as chair of the all-party parliamentary group on spinal cord injury. Last summer, the APPG’s inquiry into spinal cord injury services reached a clear conclusion: the evidence points to the need for more national co-ordination, not less. Spinal cord injury is a low-volume but highly complex condition requiring specialist pathways, lifelong rehabilitation and co-ordinated support, yet the inquiry heard repeated evidence of fragmented services, postcode variation, delayed rehabilitation and patients being lost within the system. The APPG therefore called for a national strategy and a modern service framework for spinal cord injury care. As we intend to hold a lived experience roundtable shortly, I invite the Health Secretary to come and meet people with spinal cord injury to hear their concerns about the proposed changes to commissioning.

We welcome the excellent constructive engagement from the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), and NHS England officials, but we remain deeply concerned about proposals to transfer spinal cord injury commissioning from national oversight to integrated care boards. Indeed, NHS England’s own evidence to the inquiry emphasised national standards, national quality metrics and nationally co-ordinated pathways, quality measures and oversight. If national consistency has not yet been achieved under national commissioning, what evidence demonstrates that transferring responsibility to multiple ICBs will improve outcomes or equity?

What is at stake is not abstract. When somebody sustains a spinal cord injury, their life changes overnight. They may require specialist rehabilitation, housing support, benefits advice, mental health support and long-term clinical care. Patients and families should not be left to navigate a fragmented system alone. That is why I welcome the ambition behind the single patient record and Diagnosis Connect.

Connecting newly diagnosed patients directly to specialist support reflects one of the APPG’s recommendations. Organisations such as the Spinal Injuries Association help people rebuild their lives after life-changing injury. I hope that Ministers will consider including spinal cord injury within the early phases of Diagnosis Connect.

The question is not whether structures change on paper; it is whether people living with spinal cord injury will experience safer, more equitable, more co-ordinated care. I hope that the Secretary of State will answer some straightforward questions. If NHS England accepts that national consistency has not yet been achieved, what evidence shows that localised commissioning will improve it? How will national standards, benchmarking and quality oversight remain coherent under a fragmented arrangement? Do the Government accept that spinal cord injury differs fundamentally from standard population health commissioning because of its low volume, high complexity and cross-boundary nature? What safeguards will prevent widening regional inequity, if accountability is dispersed across multiple ICBs?

The APPG’s inquiry concluded that spinal cord injury services require stronger national co-ordination and oversight, not greater fragmentation, and I hope the Government will reflect carefully on that evidence. This country led the world in spinal cord injury provision under the leadership of Professor Ludwig Guttmann after the second world war, with the remarkable work that he achieved. We need to return to those days of being pioneering and world-class. As a lawyer who previously practised in this area, I am afraid that over the past several decades services have deteriorated and gone backwards. We must restore those services and bring trust to people who so desperately want reassurance that there is a national system for them to rely on that will address their needs. We are currently not in that place at all. The Bill is an opportunity to address that, and I trust the Minister will take that on board.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

Health Bill

Andy McDonald Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[Shockat Adam (Leicester South) (Ind)]

I refer the House to my entry in the Register of Members’ Financial Interests. I am a practicing optometrist and an officer for the APPG for eye health and visual impairment.

Sight is precious and none of us would like to lose it—but, sadly, 2 million people in this country are living with some form of sight loss today. On the Department’s own projection, that figure will rise to 2.7 million by 2030. Every day, 250 people in the UK start to lose their sight—one person every six minutes. Left unaddressed, that number is set to more than double to over 4 million by 2050. We are witnessing a growing problem, which, sadly, the Bill does not treat with the urgency it deserves.

Tonight, I urge the Government to strengthen this legislation in some specific ways. On governance, clause 21 rightly ensures that ICBs 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. It would be unthinkable to build localised healthcare without GPs at the table. It would be equally unthinkable to do so without pharmacists. I say to the Government plainly: optometrists have the expertise, the infrastructure and the systems already in place to relieve pressure on our hospitals, yet this Bill says nothing about it.

I want to see eyecare—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 TAC effect: it is trusted, accessible and capable. Commissioning it properly would reduce unnecessary demand on emergency departments, freeing them to focus on genuinely specialist cases while improving patients’ access to specialist eyecare where they need it.

A recent report by the Association of Optometrists has found that right now, 780,000 people—the equivalent of the entire population of Greater Nottingham—attend A&E with eye problems annually, at an average cost of £145 to the NHS per A&E presentation. That is £113 million a year. At least seven out of 10 of those people with eye problems could be successfully managed in a community optometry setting with the right service commissioning. Those stats reflect a lived reality for many across our country. If the new Government want to make smarter decisions with public money, they must consider that.

Finally, I turn to the single patient record. Proposed new subsection (7) to clause 51 should be amended so that it explicitly includes optometry in the single patient record framework, ensuring that optometrists have appropriate access to relevant patient information.

This Bill takes real and welcome steps in many areas, but more than 2 million people have already lost their sight—a number that none of us wants to see double to more than 4 million by 2050. Fundamentally, seeing should be a right, not a privilege, so I ask the Government to look again.

[Andy McDonald (Middlesbrough and Thornaby East) (Lab)]

I rise as the chair of the all-party parliamentary group on spinal cord injury to speak to amendments 103 and 104, new clause 160 and amendment 105 in my name. I thank the Minister for meeting me during the passage of the Bill and for her subsequent letter. I also thank the Spinal Injuries Association for its support for the APPG and, crucially, for people living with spinal cord injury. These amendments are not about preventing reform; they are about ensuring that when responsibility for highly specialised services changes, patients continue to receive safe, equitable and nationally consistent care.

Spinal cord injury is a relatively low volume but 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 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 outcomes, 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. That is why this appeal is so resonant. If we can engage with those providers at that early stage, the outcomes will undoubtedly be improved. The amendment would allow referral, with patient consent, to approved condition-specific organisations sharing only necessary information.

I will not press these amendments to a vote today. I hope that the Minister will consider further safeguards and clarification during the Lords stages of the Bill. The care and access to support for patients dependent on specialist services should not depend on where those patients live.

[Karin Smyth]

I thank Members across the House for their contributions. As we would expect for a Bill of this size, it has been a wide-ranging debate, and I will not be able to address every single amendment, but I will try to cover them all in the time I have. If necessary, I will get back to people afterwards. As a Government, we know that what we have set out to do through this Bill is ambitious. We do not resile from that; we want to be ambitious. We are determined to make a real and positive change for people up and down the country who use the NHS, and throughout the Bill, we have remained focused on the key objectives. Those are to strengthen democratic accountability, strip back bureaucracy and empower patients.