Health Bill (First sitting)

Caroline Johnson Excerpts

Tuesday 16th June 2026 Public Bill Committees

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

I am a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and an NHS consultant paediatrician.

[Sojan Joseph (Ashford) (Lab)]

I used to work in a mental health trust for many years, and I am still its employee—I am on an extended career break from the trust.

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[The Chair]

You are, absolutely. Normally, as a courtesy, I allow a very brief comment if you want to say anything.

Dr Dash: No, thank you.

[Dr Johnson]

Q Good morning, Dr Dash. What effect is the abolition of NHS England having on its current day-to-day functioning? What sort of number of people are working solely or mostly on the transfer, and is that affecting your ability to deliver on your core business?

Dr Dash: I do not believe it is affecting our ability to deliver. Much of the work to date has been led by a joint team of people from across NHS England and the Department of Health and Social Care, who are working together, have put together a process and have been going through all the things you would expect of any integration process. That has been a fairly confined team.

As they are starting to look at what needs to happen in each of the different functional areas—the different directorates—that we have set out, they are working with the directors general or the executive directors leading each of those to understand what different functions we need to enact within each of those directorates, and what their teams could look like. They are putting time into that, which is good—that is what we want them to do, not least because they are also looking at ways of working, not just at numbers of people—but I would not say that it is a distraction. In fact, in some ways, I would say it is really helpful, because it is helping to define the core priorities and the key things that we need to focus on, and how we can continue on the journey of seeking to improve health and healthcare services. That is across those executive directors and directors general.

The team who are putting a lot of time into this, not surprisingly, are the people working in the HR functions. That team are spending a lot of time going through the mechanics, and they have been managing things like the voluntary redundancy programme. I would hope, and I believe, that there is no negative impact on our focusing on what we need to focus on.

[Dr Johnson]

Q You wrote a report about the CQC that was not hugely flattering, and you have also written a report about the patient safety landscape. First, why did you choose to roll HSSIB into the CQC, given what you said about the CQC and the clear and obvious conflicts of interest that it creates? Secondly, you identified in your findings that a large number of clinical nursing staff were being moved into more managerial roles, with an effect on clinical capacity. Which of your recommendations would have dealt with that, or what would you recommend now?

Dr Dash: On the first question, as you say, my first review looked at the CQC, and that there are a number of considerable challenges there. I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled. It has already gone from the previous chief exec to a new chief exec, and it is now out looking for another chief exec, and the chair has changed too. That has definitely impeded progress. As I said, it has made considerable progress in some key areas, in particular the use of technology, but it still has a way to go, and we all need to acknowledge that. I note that the ministerial team in the Department of Health and Social care has suggested that the integration of HSSIB into the CQC should happen only when the CQC is in a more stable position, which sounds sensible and pragmatic to me.

On the second review that I did, I was asked to look at the regulatory and quasi-regulatory landscape. I was referred to a report that had been done by Professor Carl Macrae and others that talked about 126 organisations. When I looked, I found more than 150, and I listed all of those in my report. I spoke to many people—well over 200 people who joined various roundtables and so on—and the very consistent theme was that this is so busy and confusing, and keeps leading to all sorts of different recommendations from different organisations, but also to people having continually to respond to all these different bodies asking for people to fill out a form, asking questions and doing reviews. As a result, our clinical staff—not just our nurses, but all our clinical staff—are having to spend considerable time filling out those forms and going through tick-box exercises. You will hear people talk about that a lot.

The concern is that this very busy landscape is distracting from what it is there to do, which is to improve quality of care. I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations, which are listed in my report, of which HSSIB was one. Across the six—of course, six is a small number out of that 150—I was asked to look at where there were opportunities for rationalisation and simplification. The observation was that colleagues in HSSIB have some great skills and capabilities in carrying out investigations into healthcare, highly complementary to the work of the CQC, which is equally there to understand how well different organisations are performing, to give the public confidence, to give ratings and to identify problems, and therefore putting those two organisations together would create significant synergies and opportunities for them both to work well.

[Dr Johnson]

Q What about the risks of that—the conflict?

Dr Dash: I do not see a conflict. I think they are complementary and this is all about improving the regulatory landscape in the healthcare system.

[Karin Smyth]

Q As you outlined in your review, there are 150 organisations in this area. How do you see the new patient experience directorate in the Department working to give confidence in this area and to try to make sense of some of that and improve it?

Dr Dash: One of the things that I observed when I was doing the review, and that I have observed even more so now that I am in post, is that we do not have effective mechanisms of really learning from patients and patient experience. If I compare how the NHS works with how other large organisations in our country work, we are not systematically collecting patient information, we are not looking at that in detail, we are not segmenting it into different groups of people, and we are not systematically bringing it into board meetings, which is where it should be in order to drive improvement. We are hoping, or expecting, that the new director of patient experience will take a real leadership role in this and will improve the way in which the centre works but, more importantly, will be working with organisations right across the NHS to build those skills and capabilities, and to put patient experience feedback and improvement in patient experience right at the centre of every discussion on improvement.

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[The Chair]

We will now hear evidence from the King’s Fund and National Voices. Again, I fear that we will have to stick to the timings, as we have very limited time. We have until 10.25 am for this session. Could you please identify yourselves for the record?

Sarah Woolnough: I am Sarah Woolnough, chief executive at the King’s Fund.

Jacob Lant: I am Jacob Lant, chief exec of National Voices.

[Dr Johnson]

Q Sarah, the King’s Fund report said that the potential cost savings of abolishing NHS England

“would be minimal in the context of the entire NHS budget”.

Many MPs across the House have struggled to get numbers and costings in questions both oral and written, particularly in relation to staff redundancies. We have not received information on the full arrangements of where NHS England’s functions are going to go yet. How can we be sure that its abolition will save any money at all?

Sarah Woolnough: I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model. Our ongoing concern has been, “Is the benefit worth the cost?”

[Dr Johnson]

Q Yes, although yesterday we received an answer to a written parliamentary question saying that the abolition of NHS England is causing no disruption to the development of new services. That is the Government’s view.

Sarah Woolnough: It is inevitable that, in any large-scale change in an organisation, there will be opportunity cost. These arguments were very well rehearsed by the previous Secretary of State. He undertook personally that he would not follow this course of action, exactly because these things take longer and cost more, and because the benefit realisation case is not always clear.

It is also quite hard to tell—we have grappled with this as a think-tank—whether there is good evidence of what you are delivering at the end, and whether the benefits will be realised as you stated they would be up front. It is harder to get the granular evidence and costings to prove the case, but our ongoing concern has been whether you need to wholescale reorganise to drive the sorts of benefits that the Government have said they want to deliver.

We absolutely understand and agree with those who say, “Let’s reduce duplication. Let’s streamline. Let’s make sure that we’re getting value for money and spending taxpayers’ money wisely.” Do you need to launch a large reorganisation—a mass rearranging of the deck chairs of this nature? Our view has been, “You shouldn’t and you don’t.”

[Dr Johnson]

Q Thank you, Sarah. That was also the view of the Darzi report. He said that it was “neither desirable nor necessary”.

Jacob, what effect will the abolition of Healthwatch have on people’s confidence in the independence and reliability of views of patient experiences?

Jacob Lant: First, it is important to note that we know that there are people who are reluctant to come forward and share their poor experiences of care with the NHS directly. They fear retribution if they complain or speak up. Research by Healthwatch has shown that about one in five people experience poor care, so a significant proportion of people are unwilling to come forward and speak to statutory agencies. That will be concentrated in communities who are particularly marginalised—those who already lack trust in institutions. There is a clear case already that there will be a group for whom the lack of independence will be a real concern.

The second point is about the unsolicited feedback that is gathered by the Healthwatch network. Dr Dash and others have talked about how the system does lots of engagement itself, and how it could therefore surely take over those functions. But the system engages on its terms: it is about service reconfiguration that it wants to do, or about trying to gather experiences on a particular topic in which it is interested. Healthwatch allows an opportunity for continual listening and engagement with communities, where they can speak up about anything that is affecting them, from dentistry to patient transport and administration of care. Those issues are not necessarily on the system’s agenda. As I see it, under the changes that will disappear.

[Dr Johnson]

Q The Bill requires that Healthwatch be abolished, to an extent, and that local authorities do their own inpatient engagement instead, but they do not seem to be mandated to do so in quite the same way. Local authorities are under financial pressure. Do you believe that such engagement will happen at all, or to the same extent that it does now?

Jacob Lant: There are a few points on that. The narrative around the Bill is that Healthwatch is being abolished and its functions lifted and shifted across to local authorities and ICBs. That is not the case. We lose a number of important functions.

For example, the signposting support that Healthwatch provides will disappear so patients and care users will not have that to help them to understand how to navigate local services. I mentioned the unsolicited feedback that is gathered; that function will disappear. The outreach into communities, particularly marginalised communities, will disappear. The voice for patients and communities on health and wellbeing boards disappears, so there is no feed into those local decision-making bodies. There are several places where there is not a direct lift and shift across. That is a concern, and the Committee should probe it further.

On the resourcing point, at least local authorities will get part of the existing funding for Healthwatch to support their functions in that space. Under the Department’s impact assessment, ICBs will not get any funding from the current pot. That represents a 50% cut in the resourcing for listening to patients and communities, which is a concern.

[Karin Smyth]

Q Accepting what you have said about delays with staff—we absolutely recognise that—do you think that the abolition of NHS England is the right thing to do?

Sarah Woolnough: As an organisation, we have taken the view that we would not necessarily relitigate the decision. I think you can argue it both ways. I understand the desire to reduce duplication and to have clearer lines of accountability. Our concern has been the opportunity cost and everything that you are not doing at the time that you are spending so much energy and resource driving the abolition through.

Jacob Lant: I would echo everything Sarah says. From the work that we do, we see that decision making is taking longer, programmes are taking longer and it is taking longer to secure an impact on things. That is very frustrating, and underpinned by the massive change that is ongoing. Let us take as an example a programme exploring the experience of waiting for hospital care—of being stuck on waiting lists. Jim Mackey spoke about that at the NHS ConfedExpo last week. It is a major focus for the NHS and new guidance is expected by the end of the month. We have been waiting for that since 2021. The most recent effort towards it has been about 18 months. I can only think that drags on because we have so much other change going on in the system. I wish we focused more on doing things directly for patient care.

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[The Chair]

We shall now hear evidence from the Academy of Medical Royal Colleges and the Institute of General Practice Management. Once again, I am afraid we have to stick to the timings. This session will end at 10.55 am. Will the witnesses briefly introduce themselves for the record?

Kay Keane: I am Kay Keane, a full-time practice manager at Urban Village medical practice in Manchester, and the chair of the Institute of General Practice Management.

Dr Dickson: I am Jeanette Dickson, the current chair of the Academy of Medical Royal Colleges, a past president of the Royal College of Radiologists and a practising consultant clinical oncologist.

[Dr Johnson]

Q I should perhaps reiterate that I am a member of the Royal College of Paediatrics and Child Health. Dr Dickson, NHS England has responsibility for workforce and workforce planning. How will the Bill affect that, and what effect is the delayed and delayed and delayed workforce plan having on the ability to plan the workforce now and for the future?

Dr Dickson: I would go back to some of the comments that have been made before. It is the opportunity cost at the moment. We know that the workforce plan is being worked on in the background, but when you are unsure what the operating and delivery model will formally look like, there is a difficulty in seeing what the workforce for that will be. We are also talking about massive changes in the way we think about care delivery—movement into the community and a different way of working—so we need a different workforce.

Therefore, we need to put in some work to look at how curricula drive a different type of workforce, how we train people to work in a different way and how we empower them to see the opportunities to work in that way, when they do not have actual role models. We need a culture shift anyway, whatever is happening, but the abolition of NHS England is in many ways increasing the time. Things need to move, and they are moving, but they are not necessarily moving as fast as they should.

[Dr Johnson]

Q So, in essence, the fact that NHS England is being abolished, whether that is the right or wrong thing to do, will have an effect on the delivery of new services?

Dr Dickson: We are delivering services as normal, but that head space and the innovation to see what the future should be and to work towards that future actively are limited by not knowing what that future looks like.

Kay Keane: We do not know what the left shift that we keep hearing about looks like; we do not know what that is for practices. In general practice, we are very practical—we get on with what is in front of us—so the big organisational changes do not have a huge effect on the day-to-day seeing of patients and organising that, but understanding what is around us does.

[Dr Johnson]

Q I want to move on to the single patient record. Do you feel that general practice has had enough information about its role in terms of who is responsible, who is accountable, who will be editing and who will be responsible for checking that the editors are right on this single patient record?

Dr Dickson: The legislation is very much an enabler for a single patient record. The devil in the detail there is not entirely true. In my experience, if you ask most patients if they would like a single patient record, they feel that it is already there. They do not understand that we do not have the ability to share their data in a way that works for them. Therefore, the idea of a single patient record is very much a lodestone for medical practitioners and most patients. When you talk them through the detail of how you achieve that and who owns the data, it is a much trickier issue for many, including the professionals, but also the public.

Kay Keane: I agree. The detail is not there at all. At the moment, we look after the data that is in the GP summary care record. That creates lots of questions for our patients. They will see information in there that they are not sure about or that they want help with. They will perhaps be able to read some of their hospital letters within that record. However, lots of patients have a variety of health inequalities that might mean they cannot access that data. In general practice, our non-clinical staff often help them to navigate their way around all that information. We also have patients who will read something in their record on which they want clarity—maybe something that happened a long time ago that they cannot remember and want explaining to them.

All those things take time. Where will the responsibility for that go? It takes an awful lot of resources in general practice to educate and support patients and to help them navigate their appointments and the letters coming through. Where will that responsibility sit? At the moment, it is of course with the GPs, but practically it is practice managers, up and down the country, who take on the day-to-day responsibility.

[Dr Johnson]

Q I have one small question. Dr Dickson, even in paediatrics I have looked after patients who have ring binder after ring binder of notes. Clearly, when seeing a patient for 20 or 30 minutes in clinic, there is not time to read ring binders and ring binders of notes. To what extent will the single patient record oblige clinicians to have read and understood everything for every appointment? Is that really practical?

Dr Dickson: You need to believe that you have found out enough about a patient to deliver their healthcare. I would turn it around and say it is very difficult to deliver appropriate care to somebody on whom you do not have full information.

[Dr Johnson]

The question is, how do you find it within the way it is structured?

[Karin Smyth]

Q Dr Dickson, can you describe how you think the single patient record could be transformative for patient care, given where we are?

Dr Dickson: Part of it has been touched on by the previous panel, regarding patient experience. Patients come in, they give the same story again and again to different healthcare professionals in different settings, and that frustrates them. Patients are human. I forget what I did last week; patients forget what they did last week, let alone what they did 10 or 20 years ago, although that is still relevant, increasingly. If you go on holiday to Whitby, fall over and break something, have tests done and come back to your house in central London, you cannot see information about that; you cannot share that information.

The opportunity to see everything on a patient across primary care, secondary care and social care is a huge benefit to them in terms of their view of seamless care, but also in terms of safety. I have a chronic health condition; part of my care is delivered by general practice and part by a hospital. At the start of the pandemic I was exceptionally clinically vulnerable; it took the NHS six weeks to tell me that. That is not safe.

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[The Chair]

We will now hear oral evidence from the Health Services Safety Investigations Body. Again, we must stick to the timings, but we are doing rather well at the moment—let us hope we can stick to that. Would you be kind enough to identify yourself for the benefit of the record?

Dr Benneyworth: Good morning, everyone. My name is Rosie Benneyworth and I am the interim chief executive of the Health Services Safety Investigations Body.

[Dr Johnson]

Q Good morning, Dr Benneyworth. There seems to have been a bit of a muddle in how some of this has been expressed this morning. For clarity, could you explain how a regulator is different from an investigatory body, please?

Dr Benneyworth: We are a safety investigator. We have been modelled on other industries that have very successful safety records, and we have learned from those other industries. We investigate patient safety concerns of national significance, and we make recommendations into national bodies about what needs to be improved. We make very few recommendations—only small numbers—into those national bodies, but they are about what needs to change from a systemic point of view to make patient care better. That is underpinned by learning from other industries—the safety science, the human factors and the real knowledge about how you improve safety—and we are trying to embed that in the NHS.

Regulation is very different. That looks at individual providers. I used to the work for the CQC and regulate primary care. It looks at how individual providers are functioning. It makes recommendations to individual providers about what needs to change, and it judges an individual’s performance against a set of regulations. The two functions are completely different.

The other important thing for us is that we do not attribute any blame or liability in our investigations. That is vital, because we learn from what we see. We learn from those investigations, and we are trying to embed a continuous learning environment and culture within the system.

[Dr Johnson]

Q Earlier on it was asked what would happen if the HSSIB was rolled into the CQC, yet the problem with the healthcare was a failure of the CQC to properly regulate or investigate. I was a little bit lost for words at that point. How would that work in practice? Or would it not?

Dr Benneyworth: I think it will be very difficult. At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern. That includes the national system. In several of our investigations we have looked at how the national system, the regulatory system and NHS England are working, and how other parts of the system are working. We are unique in that, because a lot of those bodies do not get the scrutiny from any other part of the system, and they do not get that oversight and ability to look and understand how the national system works together.

If we were a directorate in the CQC, as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also concern about our ability to make effective recommendations to the CQC if we are a directorate within it.

[Dr Johnson]

Q Another question that has been raised about independence is the choice of what to investigate. The Secretary of State can direct, but the impact assessment suggests that the Government intend to direct the vast majority of investigations. Is it currently the case, or has it been the case in the past, that the vast majority has been directed by the Secretary of State, or has that been unusual?

Dr Benneyworth: That would be unusual. We have undertaken one very detailed set of investigations into mental health in-patients, which was directed by a previous Secretary of State. We would very much want to hear the patient safety concerns of the Secretary of State to understand what we investigate. We work extensively with stakeholders across the system. We want to be a constructive part of the system. We want to investigate the areas that people are concerned about. We work extensively with all stakeholders to hear their patient safety concerns and make sure that our investigations are informed by that knowledge and by what we are hearing from patients and families, as well as staff working in the system.

However, we need to make sure that we have the independence to investigate what we are hearing about. It is very important that we are not stopped investigating something, and it would be concerning if someone told us not to investigate something. We need to maintain that independence.

[Dr Johnson]

Q Earlier in this session we heard concerns that you keep some information secret. You have the safe space legislation in place. Does that improve or weaken safety?

Dr Benneyworth: There is no doubt that it helps to improve safety. That is something we have learned from 100 years of the air accidents investigation branch, which has had an immense impact on aviation safety, the rail accident investigation branch, and many others. Safe space, or protected disclosures, means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs.

We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns. We see in our investigations that we are still working in a culture of fear. In an ideal world, that would not be the case and people would feel able to speak up openly about what has gone wrong, but we are working in a culture where people are not in that place.

This enables staff working in the service and patients to talk to us freely about what they see on a daily basis that they think needs to change. Patients sometimes worry that they will be treated differently and not get the same care after they raise things. This enables patients to talk to us in the knowledge that they will not be named. The patients we work with who have been harmed from healthcare tell us, “We don’t want this happening to other families. We’ve been through this awful, terrible time, and we want to change the system.” This enables them to talk to us.

We do not name individuals in our reports and do not name organisations. We are now in a stage where we are growing that trust. We are coming up to being three years old as an organisation, and we are growing that trust with the system. When we launch an investigation, organisations right across the country say, “Please come and see what’s happening here. Please come and talk to us.” I worry that that might be impacted by the changes ahead.

[Karin Smyth]

Q What are the key things we need to get right to ensure that safety investigations in general and safe space in particular are made to happen in the new arrangements?

Dr Benneyworth: The two key things have been touched on already. The first is the independence to choose what we investigate and make recommendations to any part of the system. The second area is around protected disclosure. The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.

At the moment, the legislation talks about connected individuals having access to the protected materials. The clauses outlining connected individuals mean that anyone working in the CQC could potentially have access to protected materials. That is a very large number of people, and it will create risk. There needs to be a legal duty on the CQC to protect the safe space. There is also something about maintaining an identity that gives people confidence that when they are talking to us, their information will not automatically go into the CQC regulatory functions.

Some of that may be about perception rather than the reality of what is happening, but as we know, perception is very important. People will perceive that we are part of the regulatory system even if we have the same email address, for example.

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[The Chair]

We shall now hear oral evidence from Sir Jeremy Hunt MP. Again, we must stick to the timings and we have to finish at 11.25, so we have got just 15 minutes to put our colleague through the mincer. For the benefit of the record, would you like to identify yourself?

Sir Jeremy Hunt: Jeremy Hunt, former Health Secretary.

[Dr Johnson]

Q Good morning, Sir Jeremy, and thank you for coming to the Committee this morning. You are our longest serving Health Secretary and you focused much of your tenure on patient safety. I understand you are still part of the all-party parliamentary group on patient safety, so that focus is continuing now. How does HSSIB improve patient safety and what are your thoughts on whether moving it into the CQC is a good idea?

Sir Jeremy Hunt: As the Committee knows, the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned. My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.

The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn. So that was the principle behind it.

I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that. Secondly, the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made, and by the way not just by HSSIB but by public inquiries, prevention of future death notices, by maternity and newborn safety investigations reports.

We are the world champion at doing inquiries and reports. Unfortunately we are also the world champion at allowing those reports to gather dust without anything actually happening. What I would really like the Bill to do is something, whether through the National Quality Board or whatever, so that the public know that when HSSIB or MNSI or a Select Committee or a public inquiry makes a recommendation, the Government have to make a formal decision within a limited time period—“yes we are going to do this” or “no we are not”; no sitting on the fence about “this is under review and we will consider it, come back to it”, but a positive or a negative decision—and then if it is a positive decision, a timeline by when it will be implemented. That is not a party-political point, because this is a problem that was not fixed when I was Health Secretary and it has remained outstanding for many years. Families just put their heads in their hands in despair that they get these inquiries, get these recommendations, and nothing changes.

[Dr Johnson]

Q We have the Hughes report that is two years from recommendation and we have not got an answer to that one yet. Our previous witness talked about a repository for recommendations—a sort of national hub to put them all into. Do you have any thoughts on that?

Sir Jeremy Hunt: What HSSIB has done is positive but it is still trying to solve a bureaucratic problem with more bureaucracy. What there needs to be is a formal system with a legal obligation on the Government. I felt this when I was chair of the Select Committee as well—that Governments would kick recommendations that were awkward, usually things that cost money that they did not want to spend money on, into the long grass without actually saying whether they agreed or disagreed with them. There is a terrible phrase that is often used: “agree in principle”. I may have been the one who invented it, but it is really bad for accountability because it allows the Government to say, “Yes, we really understand where you are coming from, but we are not going to put any timeline or give you any commitment as to whether we are actually going to make the change”. I think we need a proper system—and if it is the National Quality Board, that would probably be a good place—for formally assessing all public inquiry recommendations, all Select Committee recommendations and HSSIB recommendations, and saying, “Yes, we’re going to do this” or “No, we’re not”, but if it is yes, it will happen by this date with this person being responsible.