Health Bill

Caroline Johnson Excerpts

Report stage & 3rd reading
Tuesday 8th September 2026 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I think the Minister has finished her remarks.

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

As is now routine, I 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. Yesterday the Government voted not to introduce a backstop to decide on the Hughes report. I submitted a written question that also had a deadline of last night to ask when they were going to respond, and they have not answered that either. Taking their time about something is one thing, but for the Government to completely ignore victims, refusing to give an answer and refusing to provide a backstop or a deadline, is frankly shameful.

Patient safety is really important, and one key element to improving it is striking a good balance between accountability and blame. If we do not hold people accountable for their actions, they may not be as careful, but if they feel that their superiors are looking to find fault, they will be defensive and may cover things up. That makes it hard to get to the root cause and prevent mistakes from happening again. The Health Services Safety Investigations Body, or HSSIB, was set up with this problem in mind. Like the Air Accidents Investigation Branch, it has a safe space. This means that people are not held legally responsible for what they reveal to that team. They can then get to the bottom of why things are going wrong and find system errors. People come forward because they know and trust that HSSIB is independent, but this Labour Government want to change that.

The Health Bill will abolish HSSIB and transfer all its functions to the Care Quality Commission—the body responsible for regulating health and social care. This is the same CQC that, according to Ministers, is not fit for purpose. Why are the Government doing this? Ministers cite a review by Dr Penny Dash that said that the patient safety landscape was “cluttered” and “fragmented”, but too many different organisations are producing too many recommendations. That report was narrow in scope, and the clutter is not caused by HSSIB. In recent years, 30 public inquiries produced 1,400 recommendations, but HSSIB produced just 56.

The Government have suggested that moving HSSIB into the CQC can improve the quality of care and safety, but it is not clear how. People come forward to HSSIB precisely because it is a safe space, and this Government are removing the confidence in that safe space. For the new set-up to work, frontline workers will need to believe that the new unit in the CQC is independent, despite the law making it clear that it is not. The Government’s impact assessment says that the national quality board will provide clear direction to the new investigations unit, but the national quality board is tied to the NHS, so how does that square with the new unit staying independent? The impact assessment also says that the vast majority of investigations are expected to be directed by the Health Secretary. How can we be sure that the new unit will have the power and resources to look at things that might be politically difficult for the Government? How will the people in charge of the CQC balance the responsibility of investigating with the responsibility of maintaining that safe space?

[Sir Bernard Jenkin]

On the question of how the CQC leadership becomes conflicted, will my hon. Friend reflect on the fact that, in an Adjournment debate I held in July, the then Patient Safety Minister, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the person responsible for deciding what safe space information might be released would be the chief executive of the CQC? If the chief executive of the CQC is to see all that information, how would he or she not be able to use it, or be tempted to use it, when he or she inspects hospitals for the purposes of the CQC? Would the safe space not then be hopelessly conflicted, and therefore lose public confidence?

[Dr Johnson]

Absolutely; my hon. Friend has obviously read my speech. What would happen if the new unit identified the CQC itself as the problem? Ministers have not provided good answers to these questions. To be honest, they cannot, because the Government cannot have their cake and eat it. Either HSSIB remains independent or it is folded into the CQC and loses its independence. The Government are either decluttering the landscape by removing an organisation or simply hiding it inside another organisation, to the detriment of both. We have tabled amendment 1 to protect HSSIB, and I urge the Government to support it in the interests of patient safety.

[Stuart Andrew (Daventry) (Con)]

My hon. Friend is making an important point about HSSIB. We have heard time and again that frontline staff value the safety that HSSIB provides to them and the confidence they have in reporting. Given that we in this Chamber have heard some harrowing stories about maternity services around the country, does she not think it is important that we listen to the staff, and not just one individual with a different point of view?

[Dr Johnson]

As always, my right hon. Friend is absolutely right.

HSSIB has recently produced a report, which it would benefit the Government to listen to. The House will be aware that the advice and guidance service provides GPs with specialist advice, which sometimes avoids referrals. However, Ministers have made it mandatory to ask for advice before certain types of referrals, and set an aim for one in four referrals to be diverted back. The Government said that they were not rationing care or meddling with waiting lists—that there was nothing to see here, and that the Opposition were spreading misinformation—but HSSIB has published an interim report linking this process to delays in patient care, including cancer diagnoses. New clause 141 asks the Government to suspend the new process until they have properly considered it.

[Layla Moran (Oxford West and Abingdon) (LD)]

The hon. Lady may be aware that the Health and Social Care Committee has a pre-appointment hearing with the incoming chair of the CQC tomorrow morning. One question I would like to ask them hinges on the answer to another question, on which I would have loved an update from the Minister. The previous Secretary of State said that HSSIB will not be merged with the CQC until the CQC is ready, but we have never had a list from the Government as to exactly what metrics they will use to decide when that happens. That will have a bearing on what kinds of questions we ask the chair and CEO. What specifically do the Government mean by “ready”? Does the hon. Lady not see that as a problem?

[Dr Johnson]

I absolutely do. The Government have said that the CQC is not fit for purpose, yet they are now asking it to do things it did not do before, including not only HSSIB but event healthcare management, as the hon. Lady will be aware. It is absolutely right that the Government pause and think this one through again.

One of our other amendments concerns puberty blockers. One of the first rules of medicine is primum non nocere—first, do no harm—and yet here we have a Labour Government sponsoring a £10.6 million trial to put 226 physically healthy children as young as 11 on puberty-blocking drugs. That was said to make the former Secretary of State, the right hon. Member for Ealing North (James Murray), “uneasy”. Why was he uneasy? Perhaps because these are powerful drugs that could cause serious long-term harm, because most children get better by themselves, because we cannot reliably identify which children will persist with a trans identity and which will not, because the huge increase in girls experiencing gender dysphoria has not been adequately explained or because the Tavistock data has not yet been reviewed in the data linkage study. There are many reasons for concern, but I am aware that we are short of time.

It is difficult for a clinician to tell which children’s symptoms will self-resolve and which will not. As a result, we risk putting a large number of children on puberty blockers to assess the effects on, as the former Health Secretary put it, a

“very small subset of a very small group”.—[Official Report, 22 June 2026; Vol. 788, c. 56.]

That means the results of the investigation may be unreliable, and it could cause unnecessary harm to children, so why are the Government not ensuring that the data linkage study is, at the very least, done first?

--- Later in debate ---

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank the hon. Member for giving way and the tone in which she is conducting this debate. Would she feel more comfortable, however, if a transgender man with balding hair and a full beard, who was behaving like a man and full of testosterone, was attending a female toilet facility at night at a motorway service station? I would not feel safe, but it seems she would feel safer in that situation than she would with a trans woman getting changed in front of nurses or attending a toilet.

[Dr Johnson]

I am not sure why the hon. Member has reached that conclusion. I am saying that this is based on biology, and people who are trans require the same protections as people who are not—that is what I have said very clearly.

The Darlington nurses were particularly brave in bringing their case forward. The cost was £187,000 in damages after an employment tribunal ruled in favour of them. That is a victory for dignity, for women and for common sense, but it is also a significant cost of public money to an NHS trust because it decided not to follow the law. That money could have been spent on patient care. What steps is the Minister taking to ensure that this guidance is fully and properly implemented across the NHS? How will she ensure that a repeat of the Darlington nurses case does not happen again, and what guidance has been given to NHS managers on how to handle this?

The Minister for Women and Equalities did not help matters. She had the responsibility to sign off the Equality and Human Rights Commission’s draft code of practice to inform businesses, services and public bodies how to implement the Supreme Court’s guidance in law. But for over a year, the Government failed to lift a finger to enforce the law. For over a year, businesses, hospitals, service providers and public bodies were left waiting for the Government to tell them what the official guidance said. Now that it is here, we need to know how it is being implemented. How will the Minister ensure that this guidance is implemented universally in our NHS? How will the Government ensure that single-sex spaces are protected? What provision will they make for transgender individuals? What reassurance can the Minister give to women working in our NHS that they are safe? Our new clause 143 makes it clear that both staff and patients in the NHS must have access to single-sex spaces to protect their dignity and their privacy. I hope the Minister will be able to support this; I cannot see why she would not.

The Government have also decided to abolish Healthwatch and reduce the number of local Healthwatch branches. Healthwatch England has been engaging with patients since 2013, with more than 150 operating in a hub-and-spoke model, but that is about to change. Why? One reason seems to be to avoid duplication. The Government are clearly not keen on lots of Healthwatch branches doing the same thing in different areas of the country and feel that some branches may operate better than others. They say that they want to bring feedback closer to decision makers, but is that a good idea?

The Government could have chosen to improve Healthwatch as it stands. In 2023-24, more than 925,000 people used Healthwatch to get advice and information, and more than 300,000 shared their experiences to improve services. They could have increased awareness further and developed a clear feedback chain, but instead they have decided to abolish Healthwatch altogether. That is of grave concern. How can patients be expected to complain to the system about the system? The Prime Minister previously wrote:

“People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.”

On that, he was right, and I ask the Minister to accept our amendment on this subject.

We have tabled a number of other amendments, including one on fracture liaison services, one that would produce a modern service framework for musculoskeletal care and others on radiotherapy, respiratory health, brain injury and the Government’s new medical devices regulations. However, I appreciate that we are short of time, so I will just make two short comments, if I may, Madam Deputy Speaker,

First, I of course agree with the intent of the Liberal Democrats’ amendment 140, but it requires the presence of HSSIB, and since the Government seem hellbent on removing that, I do not know how the amendment would work. New clause 81, a Back-Bench amendment that has been selected by Mr Speaker, relates to another really important issue. As a paediatrician, I see the importance of what it suggests. The regulations would need to be carefully drafted for those who have a brief illness, to define life-threatening illness more clearly and to avoid duplication of work, but in principle, it is an important amendment. I commend our amendments to the House.

[Several hon. Members rose—]