Underperforming NHS Trusts: Government Oversight

Caroline Johnson Excerpts

Wednesday 14th October 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Chelmsford (Marie Goldman) on securing this debate on a subject important not only to her constituents but to all of us right across the country. The performance of the NHS is key to the health of the nation. It gives us all the best chance of good health and recovery, which is important for our social wellbeing and brings economic benefits.

The first question is this: how do we know which trusts are performing well and which are not? First, we need to decide what good performance looks like. We can look at that in a couple of ways, in particular in relation to outcome and experience, both of which are important. The outcome, for example, may be a death. That will come to us all eventually, but the experience might be one of comfort, in line with the wishes of the individual—as good as can be delivered. Conversely, one could on the face of it have a good surgical outcome from a trust but a poor experience of care during that experience.

Experience is measured in a number of different ways: individual staff, such as consultants, have patient feedback as part of their appraisal and revalidation; the friends and family test enables people to give anonymous feedback; the number of complaints or compliments can be measured; and trusts do their own surveys—but those are all to some extent internal processes.

[Marie Goldman]

I would love to hear more of what the hon. Lady is saying, but none of us can hear her well. My plea to the hon. Lady is to speak up a bit.

[Dr Johnson]

Sorry, the microphone went off, but it has just come back on again.

The processes are mostly internal. Healthwatch is an independent patient voice, which looks at people’s experience across the health service in a way that is independent of Government. As part of the Health Bill, however, the Government plan to abolish Healthwatch and to bring it inside the Department. Will the Minister comment on whether they still plan to do that?

When he was Mayor of Greater Manchester and in charge of its integrated care board, the Prime Minister wrote to the Government to suggest that they might be on the wrong path. As Prime Minister, does he still think so? What instructions has the Minister had in relation to that? People are sometimes frightened to provide feedback to trusts, but they will be more willing to do so when they have confidence in being heard independently.

Other ways in which the Government measure experience relate to waiting times—how long it takes to be seen in clinic, how long it takes to be seen in A&E, how long it takes from the decision to admit a patient to actually admitting them, or how long it takes for a procedure or an operation. The Government produce lots and lots of figures but many of them, I am afraid, go in the wrong direction.

The Government have a dashboard for the referral to treatment statistics, and the waiting lists are rising. The number reached a low point in March 2026, just after the reports of exceptional numbers of removals, but it has now risen by 222,000 in the past four months. I am afraid that the numbers waiting for a procedure or operation are higher now than at the general election. This year, many more people than in 2024 waited more than 12 hours in A&E after a decision to admit them. Staff sickness rates, mentioned earlier in the debate, are also consistently higher than they were before the general election. Statistics across the NHS are not going in the right direction.

The Government also measure outcomes through the financial management of a trust, leadership and Government metrics, the number of procedures performed, the number of “never” events, and CQC inspections. Again, the Government are planning to fold HSSIB into the CQC, which many commentators have warned against; the Liberal Democrats and we the Opposition have spoken against the abolition of HSSIB. When the Government take the Health Bill through the Lords in Committee in the next week or two, I hope that they will think again. The Government also plan to roll a number of other things into the CQC at the same time, including events management; I wonder whether they are asking an organisation that they acknowledge has been struggling to take on too much.

If poor performance is identified, who is responsible? Is it the consultant or the matron? Is it the directors’ suite—the chief executive or the chair? Ultimately, if a trust is underperforming at the moment, governors are supposed to hold the board to account. The Health Bill abolishes those. The ICBs—the commissioners—can hold the trust to account but their budgets have been halved, so will they have the capacity to do so? Many of them have merged, and some of those mergers have been paused by the Government. This is all a distraction. NHS England has a role, but it is being abolished too. Apparently, the overall headcount in the DHSC and NHS England is to be halved. How will they have the bandwidth to provide the scrutiny that the Government say they will have?

Having identified the management of poor performance, the Government chose five trusts—North Cumbria, Mid and South Essex, Hull University Teaching Hospitals, Northern Lincolnshire and Goole, and East Kent—to have a special intensive recovery programme in March 2026. However, it is not clear what has been instituted in those trusts, what outcomes that programme is developing, how long it will last or what the Government will do for those trusts that fall just outside that group of five.

How will the Government improve the variability between trusts that do not fall into the bottom cohort? How did they choose the five trusts that were chosen? As we heard earlier, there are several metrics by which some trusts could be considered in the bottom five, but they were not chosen, and some metrics by which those that were chosen may not be in the bottom five. How has the Minister chosen those trusts and how does she intend to improve those that do not fall into her chosen few?

The Government have promised a workforce plan, but the workforce is the most important thing. Right hon. and hon. Members have spoken in this debate about the really good staff in their trusts working extremely hard in very difficult conditions. The previous Conservative Government developed a long-term workforce plan. This Government decided that they wanted their own workforce plan—they won the election so they are very much entitled to make one. But they have still not written it. They promised it by the end of 2025; we are rapidly approaching the end of 2026 and it is still not with us. Can the Minister—[Interruption.]

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On resuming—

[Dr Johnson]

Before the interruption, we were talking about the importance of workforce to the health service and to any improvements that we wish to make to services. The previous Conservative Government developed a long-term workforce plan. This Government decided to develop their own, which is fair enough, but it is very delayed. Can the Minister tell us, without using the words “in due course”, “imminently” or “soon”, when it will be published, preferably giving a date?

Returning to other plans, the Government say that maternity and neonatal care is their priority, which is good, but when they came into government, they said that they had a plan to improve it. They spent the first 12 months writing their 10-year plan, which said that they would produce a maternity and neonatal plan. They did a review, which took six months longer than it was supposed to. They were then two years into a parliamentary term. That plan says that they will have a commissioner, who they have yet to appoint, and another plan for a modern service framework, which is apparently due by Christmas. Can the Minister guarantee that, two and a half years into the Parliament, they will have a delivery plan for maternity improvements?

The bottom line is that I am concerned that the Government are too busy reorganising the NHS to deliver on their promises. NHS performance is declining in many areas. There is huge variability between trusts and departments. The Government picked five for intensive treatment. What about the others? Can the Minister clarify that it works? The Government are internalising patient experience, which means that it may suddenly look much better, but how will anyone have confidence in the figures if they are produced by the Government marking their own homework? The abolition of NHS England has been badly planned. ICB cuts, mergers and paused mergers are simply a distraction. The removal of the need for governors removes another layer of accountability and scrutiny.

The Government say they are working at pace, but it is a very slow pace. The workforce plan and the maternity plan have been delayed, but so have things like the Hughes report. People suffering from valproate and mesh have been waiting and waiting. It is getting towards three years since that report was published. They have waited long enough. I urge the Minister to say when the Government intend to respond to that report.

The Government need to get a grip of who is holding the trusts to account, so that when the Health Bill comes out the other side of the Lords, there is a clear chain of command. Perhaps it will lead up to the Secretary of State, but it is clear that they will not be able to micromanage every detail. There needs to be a clear path so that people know who is accountable, who will drive improvement, who to congratulate when improvements are made and who to hold accountable when it goes wrong.

[Graham Stuart (in the Chair)]

Thanks to the discipline of the speakers so far, there are some extra minutes for the Minister to take interventions if she so chooses.

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[Karin Smyth]

Thank you. It is a pleasure to serve under your chairmanship, Mr Stuart.

I want to try to get back to most colleagues. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this debate, and all Members who have spoken about the experiences of patients, because this is absolutely about the experiences of patients, families and the NHS staff in all our constituencies.

When an NHS trust underperforms, however we define it, the effects are very real. Patients wait longer, staff work without the stability and support they need, and public money is not used as effectively as it should be. Since becoming a Minister, I have made it clear that I think Members of Parliament should be part of conversations with local trusts. I commend my hon. Friend the Member for Ipswich (Jack Abbott) for hosting his trust in the way he has and seeing an improvement in his constituency, as he outlined, with mental health being considered as well as acute services. The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), spoke about her work in supporting her local trust and seeing those improvements. It can and does happen.

Many of the trusts that have been discussed today have faced problems built up over many years. In fact, I remember some of them from being a manager in the health service over the past 20 years or so. There is rarely one cause or a quick fix. There are varying problems, whether they be workforce shortages, poor estates, weak leadership, organisational change or rising demand, and some of those can reinforce one another. Let us be clear for patients and members of the public who are paying attention and for all our constituents: this Government will not accept poor performance, and we are determined to accelerate the recovery, particularly in the most challenged trusts.

I will just clarify some of the rules. Everyone knows that NHS England is an arm’s length body. That was a decision taken a number of years ago by my good friends the Liberal Democrats and the Conservatives when we were in opposition. The Health Bill, which is progressing through the House of Lords, changes that arrangement to put the NHS together with the Department of Health and Social Care. The Bill was not opposed in principle by any political party, because we all know that the arrangement has not worked.

As we bring the two bodies together, it is important to maintain the distinction between running large trusts and running the system as a whole, with operational performance oversight. It is a skilled job. It is hard to run a big trust. It requires good clinical and operational managers, and good leadership and knowledge. The complete separation of the Department and Ministers from NHS England meant that the oversight and what we could see in our constituencies as Members of Parliament was not linked up under the previous Government. That is one thing that will improve. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) just said, of course Ministers will not be micromanaging. It is a skilled job. The complete separation that removed oversight from local trusts has been a dysfunction of the system over the last decade.

To be clear, I regularly meet teams and Members of Parliament in my role. I want to share how some of that operational oversight works. I will highlight two major areas. One is the oversight framework, which provides a clear and consistent assessment of every NHS organisation. In her expertise, the hon. Member for Sleaford and North Hykeham recognised that there are many ways to judge performance, but the new framework looks at what matters most to patients and taxpayers: waiting times, quality of care, use of staff and money, and leadership capability in order to have good-quality patient care. They cannot be separated in my view. I have made sure that it is transparent for the public and Members of Parliament. That is quite controversial; some people do not like what they call league tables, but I think it is important that people can see that.

[Dr Caroline Johnson]

Will the Minister give way?

[Karin Smyth]

I will move through some of these points for the moment. For providers with the most entrenched financial, operational, leadership and structural challenges that impact patient care—that is what these trusts are about—we are taking a more holistic approach to that enhanced support because, as the shadow Minister asked, how do we choose? They are the most challenged long-term systems.

At a national level, the intensive recovery programme is providing short-term, intensive support for organisations to help strengthen their immediate operational and financial stability while developing an organisation-owned plan for long-term sustainability. We cannot keep going round in this circle; at the end of the day, these organisations need to be well run and well led, and local systems need to own that problem. That is also part of our wider devolution agenda. I think I outlined that in my letter to the hon. Member for Chelmsford in September, but I am very happy to meet again and go through that in more detail if that is helpful.

The first IRP cohort includes Hull, Northern Lincolnshire and Goole, East Kent, North Cumbria and Mid and South Essex. Each faces very different circumstances, so there is not a one-size-fits-all response. I will touch on some of them, for hon. Members have raised their own issues with them.

There is interest in Hull and Northern Lincolnshire and Goole. Following an independent review, the decision has been taken to dissolve the Humber health partnership arrangements. In Hull, the focus is on strengthening core hospital services, making the best use of specialist services, improving productivity and reinforcing clinical leadership and accountability. For Northern Lincolnshire and Goole, the priority is to move more care into neighbourhood and community settings, reflecting the demands in those areas. There are good signs of progress.

The hon. Member for Chelmsford and others who intervened highlighted Mid and South Essex. The 2020 merger of those three trusts has not delivered the planned benefits for 1.2 million people. Staff culture and morale remain a serious concern, with little improvement, as was highlighted in those terrible survey results over the past five years. We have heard those. The trust has long-standing performance problems linked to how demand is managed across the wider health system in that part of Essex. Work is under way to improve the long waits, improve patient flow, strengthen governance and make better use of the estate. I shared the analysis in productivity packs with everybody earlier in the year, and I am sure that everybody looked at them in detail, but I am very happy to go through them again. It identified more than £122 million of productivity opportunities. It is not simply about saving money.

Better organisation across sites and stronger clinical integration should improve patient experience, reduce delays and raise quality for patients. The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by £80 million for Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

I will touch on North Cumbria because, for the hon. Members for Westmorland and Lonsdale (Tim Farron), for Honiton and Sidmouth (Richard Foord) and for Yeovil (Adam Dance), the work going on there really highlights what can and needs to be done in rural healthcare. I remind hon. Members that hospitals in some of those areas are additionally funded to cope with some of those rurality issues. We highlighted that in our 10-year health plan. We absolutely understand that across the country, there are different issues with regard to rurality. I will not talk about Kent, because it has not been raised, but again, it has very different issues. That is why those areas have been chosen. They have long-standing and deeply entrenched problems.

My hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) raised ambulance handover delays. I did not know she was going to raise that today, but to assure her, the continued problem with the ambulances was raised with me in my oversight meeting with the team yesterday. Those issues are flagged by NHS England and its operational management across the country. They are long-standing issues, as she knows, but I gently disagree with her. She is absolutely right in her assessments of history, but this issue is not a failure of oversight and accountability. Good co-operation, collaboration and management are the responsibility of the services locally. The oversight has worked. We know that this is a problem. We and her constituents can see that. We very much want the services to work together to resolve that flow so that the ambulance handover works much better.

My hon. Friend the Member for Salford (Rebecca Long Bailey) highlights, sadly, her constituency’s downward improvement trajectory. She asked to meet me, and I am very happy to do that. My hon. Friend the Member for Darlington (Lola McEvoy) did the incredibly difficult job of raising the terrible distress for women in her constituency. She highlighted a terrible case, and I will make sure that she has a meeting with the Minister to go through how that can be supported on behalf of her constituents. I know that she will work closely to make sure that they are served better.

We are seeing early improvements through the IRP, but we need to demonstrate progress through safer care, better operation and financial performance. We have clear milestones and credible plans for stronger organisations. Support nationally is time-limited but proportionate, because trusts ultimately have to stand on their feet. Intensive oversight is not about naming and shaming. Staff in challenged trusts are working in exceptionally difficult circumstances. As we need to encourage people to work there, we must show them that it can be better. The purpose is to remove barriers to improvement, provide the right expertise and hold boards and NHS leaders to account for results.

The Government will continue to work with NHS England. I am committed to keeping Parliament informed of significant developments. We will judge our approach by its effect on patients and staff, not by the creation of more processes. The oversight framework and the intensive recovery programme provide a clear route from identifying the risk to taking targeted action. There is much more to do. It can only be done in local circumstances with co-operation and transparency, including working with Members of Parliament. Where we hear examples of trust chief executives not doing that, I am prepared to call it out. It is not acceptable.

There is more to do, but we want practical, safer and more timely care, and stronger organisations. I am pleased to have had the opportunity to debate this issue today. It is important for MPs to be part of the discussion. We want to improve all trusts, but we are focusing on those with long-term issues, sometimes having been affected for decades. The people in those areas deserve better, and we are determined to make sure they get it.