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.

Infants, Parents and Carers Bill

Caroline Johnson Excerpts

Wednesday 14th October 2026 Public Bill Committees

[Rachael Maskell]

I am grateful to the right hon. Member for his clarity. I hope that airing the issue in this debate will ensure that we measure the elements and secure the right environments.

A further issue that is particularly important to me, as chair of the APPG on adoption and permanence, is that of children at risk. We know that if early interventions are made to support parents through a pregnancy, we can diminish the risk of a child being taken into the care system. I spoke to our director of midwifery about the distress caused to midwives by trying to support a distressed mother as her child is removed. Reducing the risk of that happening is important.

Information sharing between health services and local authorities is absolutely crucial for interventions to be made to try to secure the relationship between the child and their parents, and for reducing the risk of a child being removed at birth or in the early days after it. I recognise that, in the lone local authority in my constituency, much is done to secure family bonds at the point the baby is born, but it is important that interventions are made during pregnancy to reduce the risk of a child being removed. The issue often stems from inequalities, so being able to measure them is incredibly important.

My final two key points look at input under clause 4(2). We know that the issue of workforce has been incredibly difficult to address at times, because we do not have a comprehensive workforce plan for the multi-agency teams involved in work around an infant. I therefore propose that the Minister consider creating an integrated, multi-agency workforce plan for the 1,001 critical day period to ensure real integration of service. That would also ensure that we do not see a workforce deficit, because clearly, not having the workforce there would have a huge impact on outcomes, particularly for more vulnerable families.

On how the report will be produced under clause 4, we need a pathway within the measurement, as it is important that parents and carers with lived experience have agency and voice in its formulation. I would appreciate the Minister commenting on that in her remarks, because we have demonstrated in York that when parents and carers are involved in providing feedback, services improve.

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

It is a pleasure to serve under your chairmanship, Dame Siobhain.

I start by congratulating my right hon. Friend the Member for New Forest West on introducing this important Bill. I also recognise the contributions of Members of both Houses, and that of the former Members of Parliament Andrea Leadsom and Will Quince, who have done so much work in this area. I declare an interest, Dame Siobhain, as a consultant paediatrician in the NHS and a member of the Royal College of Paediatrics and Child Health. I put on record that the Opposition support this Bill.

Child development is hugely important; that is why Committee members are here today. It is also why I am in this place at all, as it was a major motivator for me to become an MP. As a paediatrician, I saw the profound effect that children not receiving the care that they need in the early years can have. Some cases were of deliberate neglect, and I saw children who had delayed growth, delayed development or physical changes. I remember one little boy who was admitted with vomiting, but he was not ill with a medical condition. We discovered that he had learnt to vomit because nobody came when he cried. Those children need us to step up in a way that we do not always do at the moment.

There is a spectrum, and most of the children are thankfully not in that situation, but it does demonstrate the profound changes that can occur if children are not looked after. However, we also see the profound improvements that can occur if children receive all the things that they need to thrive to their best potential. Sometimes parents may not understand the importance of certain interventions, or they may need support to deliver them. That is where this Bill comes in.

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[Jess Brown-Fuller]

The shadow Minister is making a really important point. Does she also agree that representation in politics is so important and that having women in politics matters because they are able to talk about their unique experiences when it comes to breastfeeding? We need to make sure that we get lots of women into politics so that they can raise important points like she has just done.

[Dr Caroline Johnson]

I think it is important that we have both women and men in politics, because fathers have an important role to play with babies too, and gentlemen can talk about their experiences of fatherhood. One of the challenges that some babies face is the lack of that male role model. It is a balance between the two. And, of course, women and men can talk about each or either topic if they wish to do so.

The other thing I want to talk about is interaction and play—the serve and return. Being played with and stimulated is very important for brain development, and a lack of it can lead to reduced attention span, reduced memory and weaker impulse control in the long run. People might believe that interaction and play come instinctively, and to some they do, but to others less so. Support and understanding of what they can do to help their baby is something that I think women and men value, because almost everyone loves their children intently, so they will want to do the best for their baby, and sometimes it is helpful to know what that is. I often get patients in clinic who come with one problem, but if they have a small infant, they will often say, “While I am here, doctor, can you just look at this? Can I just ask about that?” I am sure the hon. Member for Stroud, as a GP, will tell us the same. Parents ask because there are so many questions, and having the opportunity to have them answered is very important.

I also want to talk about inequalities, because we have talked a lot about them this morning. There is now inequality between the services provided in cities and those provided in rural areas. Does the Minister have any comments on how those services will be provided in rural environments? Very often the average income for a postcode may be good, but there will be hidden poverty within it, because of discrepancies within postcode averages that are seen less in cities. Transport can also be more difficult in rural areas. How will the Minister ensure that the services are accessible to those who need them?

I want to talk about the money, because if we invest £1 in a child’s life at this age, we can get £10 in return owing to better outcomes in the long run. Will the Minister confirm that the money for those services will be provided in full, and that there will be a workforce plan to ensure that there is a workforce to deliver them?

The hon. Member for Washington and Gateshead South, who I know has done a lot of work in this area over the years and cares about it very deeply, talks about outcomes. Outcomes are important, but so is value for money, because we must be careful with taxpayers’ money. What interventions are making the most difference, and how do we focus on achieving them? We need to think carefully about what we measure. Overall, however, this is a good Bill that will help infants and children to develop their full potential and have equality of opportunity, and therefore I will support it.

[The Minister for Public Health and Patient Safety (Dame Diana Johnson)]

It is a pleasure to serve under your chairwomanship this morning, Dame Siobhain. We have had a very thoughtful and well-informed debate on the Bill. I am grateful to all hon. Members who have contributed, but I pay particular tribute to the right hon. Member for New Forest West for introducing the Bill and for the care, determination and constructive spirit with which he has championed it. I will follow his lead and deal with both groupings in my remarks.

We can all agree that every baby should get the best possible start in life, and I am delighted that last month the Secretary of State for Health and Social Care announced the expansion of Healthy Babies to every local authority in England. Like Sure Start before it, Healthy Babies will make enhanced health support available in every part of England, giving all families access to trusted, practical help throughout the critical 1,001 days from conception to age two. The Bill will complement the Healthy Babies expansion by creating a clear and enduring framework for support from conception to age two, providing long-term visibility and accountability.

A number of important points have been raised in the debate today. First, the hon. Member for Chichester asked whether those undergoing IVF would be included as prospective parents. The Bill focuses on support from conception to age two, as we have heard, therefore parents who conceive through IVF will be covered from the point at which a pregnancy is established, in the same way as any other prospective parent.

The hon. Member for Chichester also asked about breastfeeding, and there were a number of contributions on that very important issue. She asked whether there would be support for it in the secondary legislation that would come forward. Our starting point for the secondary legislation will be the Healthy Babies offer, which includes maternity, health visiting, infant feeding support, perinatal mental health support and parent-infant relationship support, while remaining open to considering other services that evidence might show babies and families actually need—so the answer to that is absolutely yes.

We also heard from my hon. Friend the Member for Washington and Gateshead South. I pay tribute to her for all the work she did in her previous role to make sure that the Bill could come before us today and will move through its stages in the House. She made a thoughtful and well-informed contribution—as ever—in support of amendment 1. My hon. Friend the Member for Stoke-on-Trent South also supports amendment 1, and spoke so movingly about the very sad case of her constituent Chloe Wilshaw. I am glad that Ministers will be meeting my hon. Friend shortly.

My hon. Friend the Member for Newport West and Islwyn talked about her experience as a paediatric physiotherapist, and how important the support that families and mothers get from conception onwards is to ensuring that babies get the best start in life. My hon. Friend the Member for York Central made, as ever, a considered speech. She raised a number of points, including whether environmental issues would be considered. I was interested to hear the exchange between her and the right hon. Member for New Forest West on that point, and his belief that it is implicit in the Bill’s drafting that environmental issues would be considered, among others. The sharing of data among health and local authorities in respect of children at risk is absolutely a key issue that we need to work at.

The hon. Member for Sleaford and North Hykeham raised the workforce plan. I am told that we will not have to wait too much longer and that a workforce plan will be published shortly, but I take the point made by my hon. Friend the Member for York Central about the need for integrated workforce planning in respect of babies and children. I also recognise the need to include the voice and agency of families, mothers, fathers and carers in this whole issue.

Finally, pre-conception health is of course very important, but the Bill is deliberately focused on the clearly defined period from conception to age two, when support can be directly linked to pregnancy, childbirth and infant development. Extending the Bill further would significantly broaden its scope and duplicate wider public health policy.

Let me turn to the clauses. Clause 1 establishes the scope of the framework set out in the Bill. It requires the Secretary of State to make regulations specifying the publicly funded infant support services to which the Act will apply, together with the functions connected with their provision. Those services must support pregnancy or childbirth, an infant’s health and development, or the relationship between an infant and their parent or carer. Crucially, the clause allows services and functions to be updated as needs and provisions evolve, thereby helping support to remain relevant to babies and families. Any change will be made through regulations subject to parliamentary oversight. That approach allows the framework to evolve as evidence, services and families’ needs change. The regulations will be subject to the affirmative procedure, so both Houses will have an opportunity to scrutinise and approve them.

Clause 2 puts the needs and experience of infants, parents and carers at the heart of national decision making. It helps to ensure that babies, whose voices are too often unheard, are not overlooked. We all know that the period from conception to age two is a golden opportunity to shape life, health, learning and happiness. The clause therefore requires the Secretary of State to assess the expected level of need for infant support services specified in the Bill. This is a practical, evidence-informed approach. So that it can respond to the needs of babies and families as they change, the clause deliberately does not prescribe every detail of the assessment. It does, however, establish a clear expectation that need will be understood and kept under review, thereby helping to inform decisions about services and resources.

Infants, Parents and Carers Bill (First sitting)

Caroline Johnson Excerpts

Committee stage
Wednesday 14th October 2026 Public Bill Committees

[Rachael Maskell]

I am grateful to the right hon. Member for his clarity. I hope that airing the issue in this debate will ensure that we measure the elements and secure the right environments.

A further issue that is particularly important to me, as chair of the APPG on adoption and permanence, is that of children at risk. We know that if early interventions are made to support parents through a pregnancy, we can diminish the risk of a child being taken into the care system. I spoke to our director of midwifery about the distress caused to midwives by trying to support a distressed mother as her child is removed. Reducing the risk of that happening is important.

Information sharing between health services and local authorities is absolutely crucial for interventions to be made to try to secure the relationship between the child and their parents, and for reducing the risk of a child being removed at birth or in the early days after it. I recognise that, in the lone local authority in my constituency, much is done to secure family bonds at the point the baby is born, but it is important that interventions are made during pregnancy to reduce the risk of a child being removed. The issue often stems from inequalities, so being able to measure them is incredibly important.

My final two key points look at input under clause 4(2). We know that the issue of workforce has been incredibly difficult to address at times, because we do not have a comprehensive workforce plan for the multi-agency teams involved in work around an infant. I therefore propose that the Minister consider creating an integrated, multi-agency workforce plan for the 1,001 critical day period to ensure real integration of service. That would also ensure that we do not see a workforce deficit, because clearly, not having the workforce there would have a huge impact on outcomes, particularly for more vulnerable families.

On how the report will be produced under clause 4, we need a pathway within the measurement, as it is important that parents and carers with lived experience have agency and voice in its formulation. I would appreciate the Minister commenting on that in her remarks, because we have demonstrated in York that when parents and carers are involved in providing feedback, services improve.

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

It is a pleasure to serve under your chairmanship, Dame Siobhain.

I start by congratulating my right hon. Friend the Member for New Forest West on introducing this important Bill. I also recognise the contributions of Members of both Houses, and that of the former Members of Parliament Andrea Leadsom and Will Quince, who have done so much work in this area. I declare an interest, Dame Siobhain, as a consultant paediatrician in the NHS and a member of the Royal College of Paediatrics and Child Health. I put on record that the Opposition support this Bill.

Child development is hugely important; that is why Committee members are here today. It is also why I am in this place at all, as it was a major motivator for me to become an MP. As a paediatrician, I saw the profound effect that children not receiving the care that they need in the early years can have. Some cases were of deliberate neglect, and I saw children who had delayed growth, delayed development or physical changes. I remember one little boy who was admitted with vomiting, but he was not ill with a medical condition. We discovered that he had learnt to vomit because nobody came when he cried. Those children need us to step up in a way that we do not always do at the moment.

There is a spectrum, and most of the children are thankfully not in that situation, but it does demonstrate the profound changes that can occur if children are not looked after. However, we also see the profound improvements that can occur if children receive all the things that they need to thrive to their best potential. Sometimes parents may not understand the importance of certain interventions, or they may need support to deliver them. That is where this Bill comes in.

--- Later in debate ---

[Jess Brown-Fuller]

The shadow Minister is making a really important point. Does she also agree that representation in politics is so important and that having women in politics matters because they are able to talk about their unique experiences when it comes to breastfeeding? We need to make sure that we get lots of women into politics so that they can raise important points like she has just done.

[Dr Caroline Johnson]

I think it is important that we have both women and men in politics, because fathers have an important role to play with babies too, and gentlemen can talk about their experiences of fatherhood. One of the challenges that some babies face is the lack of that male role model. It is a balance between the two. And, of course, women and men can talk about each or either topic if they wish to do so.

The other thing I want to talk about is interaction and play—the serve and return. Being played with and stimulated is very important for brain development, and a lack of it can lead to reduced attention span, reduced memory and weaker impulse control in the long run. People might believe that interaction and play come instinctively, and to some they do, but to others less so. Support and understanding of what they can do to help their baby is something that I think women and men value, because almost everyone loves their children intently, so they will want to do the best for their baby, and sometimes it is helpful to know what that is. I often get patients in clinic who come with one problem, but if they have a small infant, they will often say, “While I am here, doctor, can you just look at this? Can I just ask about that?” I am sure the hon. Member for Stroud, as a GP, will tell us the same. Parents ask because there are so many questions, and having the opportunity to have them answered is very important.

I also want to talk about inequalities, because we have talked a lot about them this morning. There is now inequality between the services provided in cities and those provided in rural areas. Does the Minister have any comments on how those services will be provided in rural environments? Very often the average income for a postcode may be good, but there will be hidden poverty within it, because of discrepancies within postcode averages that are seen less in cities. Transport can also be more difficult in rural areas. How will the Minister ensure that the services are accessible to those who need them?

I want to talk about the money, because if we invest £1 in a child’s life at this age, we can get £10 in return owing to better outcomes in the long run. Will the Minister confirm that the money for those services will be provided in full, and that there will be a workforce plan to ensure that there is a workforce to deliver them?

The hon. Member for Washington and Gateshead South, who I know has done a lot of work in this area over the years and cares about it very deeply, talks about outcomes. Outcomes are important, but so is value for money, because we must be careful with taxpayers’ money. What interventions are making the most difference, and how do we focus on achieving them? We need to think carefully about what we measure. Overall, however, this is a good Bill that will help infants and children to develop their full potential and have equality of opportunity, and therefore I will support it.

[The Minister for Public Health and Patient Safety (Dame Diana Johnson)]

It is a pleasure to serve under your chairwomanship this morning, Dame Siobhain. We have had a very thoughtful and well-informed debate on the Bill. I am grateful to all hon. Members who have contributed, but I pay particular tribute to the right hon. Member for New Forest West for introducing the Bill and for the care, determination and constructive spirit with which he has championed it. I will follow his lead and deal with both groupings in my remarks.

We can all agree that every baby should get the best possible start in life, and I am delighted that last month the Secretary of State for Health and Social Care announced the expansion of Healthy Babies to every local authority in England. Like Sure Start before it, Healthy Babies will make enhanced health support available in every part of England, giving all families access to trusted, practical help throughout the critical 1,001 days from conception to age two. The Bill will complement the Healthy Babies expansion by creating a clear and enduring framework for support from conception to age two, providing long-term visibility and accountability.

A number of important points have been raised in the debate today. First, the hon. Member for Chichester asked whether those undergoing IVF would be included as prospective parents. The Bill focuses on support from conception to age two, as we have heard, therefore parents who conceive through IVF will be covered from the point at which a pregnancy is established, in the same way as any other prospective parent.

The hon. Member for Chichester also asked about breastfeeding, and there were a number of contributions on that very important issue. She asked whether there would be support for it in the secondary legislation that would come forward. Our starting point for the secondary legislation will be the Healthy Babies offer, which includes maternity, health visiting, infant feeding support, perinatal mental health support and parent-infant relationship support, while remaining open to considering other services that evidence might show babies and families actually need—so the answer to that is absolutely yes.

We also heard from my hon. Friend the Member for Washington and Gateshead South. I pay tribute to her for all the work she did in her previous role to make sure that the Bill could come before us today and will move through its stages in the House. She made a thoughtful and well-informed contribution—as ever—in support of amendment 1. My hon. Friend the Member for Stoke-on-Trent South also supports amendment 1, and spoke so movingly about the very sad case of her constituent Chloe Wilshaw. I am glad that Ministers will be meeting my hon. Friend shortly.

My hon. Friend the Member for Newport West and Islwyn talked about her experience as a paediatric physiotherapist, and how important the support that families and mothers get from conception onwards is to ensuring that babies get the best start in life. My hon. Friend the Member for York Central made, as ever, a considered speech. She raised a number of points, including whether environmental issues would be considered. I was interested to hear the exchange between her and the right hon. Member for New Forest West on that point, and his belief that it is implicit in the Bill’s drafting that environmental issues would be considered, among others. The sharing of data among health and local authorities in respect of children at risk is absolutely a key issue that we need to work at.

The hon. Member for Sleaford and North Hykeham raised the workforce plan. I am told that we will not have to wait too much longer and that a workforce plan will be published shortly, but I take the point made by my hon. Friend the Member for York Central about the need for integrated workforce planning in respect of babies and children. I also recognise the need to include the voice and agency of families, mothers, fathers and carers in this whole issue.

Finally, pre-conception health is of course very important, but the Bill is deliberately focused on the clearly defined period from conception to age two, when support can be directly linked to pregnancy, childbirth and infant development. Extending the Bill further would significantly broaden its scope and duplicate wider public health policy.

Let me turn to the clauses. Clause 1 establishes the scope of the framework set out in the Bill. It requires the Secretary of State to make regulations specifying the publicly funded infant support services to which the Act will apply, together with the functions connected with their provision. Those services must support pregnancy or childbirth, an infant’s health and development, or the relationship between an infant and their parent or carer. Crucially, the clause allows services and functions to be updated as needs and provisions evolve, thereby helping support to remain relevant to babies and families. Any change will be made through regulations subject to parliamentary oversight. That approach allows the framework to evolve as evidence, services and families’ needs change. The regulations will be subject to the affirmative procedure, so both Houses will have an opportunity to scrutinise and approve them.

Clause 2 puts the needs and experience of infants, parents and carers at the heart of national decision making. It helps to ensure that babies, whose voices are too often unheard, are not overlooked. We all know that the period from conception to age two is a golden opportunity to shape life, health, learning and happiness. The clause therefore requires the Secretary of State to assess the expected level of need for infant support services specified in the Bill. This is a practical, evidence-informed approach. So that it can respond to the needs of babies and families as they change, the clause deliberately does not prescribe every detail of the assessment. It does, however, establish a clear expectation that need will be understood and kept under review, thereby helping to inform decisions about services and resources.

Baby Loss Awareness Week

Caroline Johnson Excerpts

Monday 12th October 2026 Commons Chamber

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

First, I must declare an interest as a consultant NHS paediatrician and a member of the British Medical Association and of the Royal College of Paediatrics and Child Health, and also that I have worked in neonatal intensive care in a number of different hospitals, including Nottingham University Hospitals NHS Trust, where I worked as a junior doctor, briefly overlapping with the initial period of the Ockenden review.

I congratulate the hon. Members for Rossendale and Darwen (Andy MacNae) and for Sherwood Forest (Michelle Welsh) and my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) for securing this important debate, and also charities such as Bliss, Tommy’s and Sands for their important work.

As has been said, this has become somewhat of an annual debate, and it follows the same pattern. We hear many stories—we have heard many emotional stories this evening from very brave Members who have put forward their words or the words of their brave constituents. We reflect on the babies that have been lost—their first words, when they would have taken their first steps, who they would have grown up to become. We talk in sorrow and in memory. But there is also some frustration, because 13 babies every day will die shortly before, during or after their birth. So although it is important to reflect, I firmly believe that families would like us also to focus on prevention and service improvements. I shall therefore focus in the rest of my remarks on the question of whether the Government are doing all they can to tackle baby loss, and are doing so as quickly as possible.

As a children’s doctor, I have been privileged to attend hundreds of births. Politics offers the opportunity to save more lives than doctors can across the whole country, because it has the power to make impactful change and save lives, and the Government must use it.

Just over a decade ago, my right hon. Friend the Member for Godalming and Ash, then the Secretary of State for Health and Social Care, set a target to halve the rate of stillbirths and neonatal and maternal deaths by 2030. He did not succeed completely but made encouraging progress. Stillbirths fell by 20%, neonatal deaths fell by 20% and maternal deaths fell by a third. As my right hon. Friend himself said earlier, that means that 700 additional babies a year are waking up today and tomorrow, loving their parents and being loved by their parents, and bringing great joy.

The new Health Secretary came into post last month and I welcome her to her place. She is right when said that

“it is time to put maternity and neonatal care and safety at the top of the NHS agenda, where they belong.”—[Official Report, 15 September 2026; Vol. 790, c. 1616.]

I know that this issue is important to her and we acknowledge that the Government have made progress in some areas. They have built on Conservative work by expanding baby loss certificates—we heard from the hon. Member for Lancaster and Wyre (Cat Smith) just how important and vital those certificates can be—and they have implemented Martha’s rule, so that people can have a second opinion.

I appreciate the Secretary of State is new in post, but her predecessors have acted too slowly. The Government came to power in July 2024 saying that they had a plan for the NHS, but it took them a year, until July 2025, to bring forward their 10-year plan. They said that they will bring forward a neonatal task force, but they took seven months to decide who was going to be on it. They said that a maternity and neonatal plan was going to be produced, and that a rapid review would produce a plan by December 2025, but it came in June 2026, almost two years after their election.

The national maternity investigation brought forward two key recommendations. The first recommendation is to appoint a maternity and neonatal commissioner, which the Government have promised to do. That promise was announced over three months ago, so will the Secretary of State tell us when that appointment will be made? Will it be delayed by putting it on a statutory footing or will she be able to make the appointment anyway? The second recommendation is to develop a modern service framework to establish minimum standards for maternity care. The Government announced that they were developing a national action plan on that, but it will not be ready until December 2026. Will the Secretary of State guarantee that it will be ready by December 2026, which is now very soon?

In the meantime, the Government have promised £41 million for maternity and neonatal buildings. Will the Secretary of State tell us how and where this money will be spent, and which hospitals will benefit? My hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti) talked about people experiencing baby loss or who had babies on the neonatal unit being placed on a ward next to people who were celebrating the births of healthy children, who were beside them. Will the Secretary of State say how she is going to manage that so it does not happen any more?

The Government have spoken about the black and Asian maternal mortality gap. In their manifesto, they committed to a target to close that gap. Will the Secretary of State tell us when that target will be published and how she will close that gap?

The workforce is key to delivering these outcomes. The last Conservative Government created a long-term workforce plan for the NHS, but this Government decided that they wanted to create their own workforce plan, which is absolutely their right to do so. We were promised that plan by the end of 2025. We are now deep into autumn 2026, and we are being told they will provide an update on the workforce plan “in due course”. Having previously been told it was imminent, that is somewhat disappointing.

The Government need to know and say how many midwives they are going to need, as well as how many obstetricians, gynaecologists and paediatricians. How will all those people be trained? How many more medical school places may be required? The Government promised time and again that they would double the number of medical school places, yet they have rowed back on that promise like it never existed. Will the Secretary of State tell us once and for all if the Government will be doubling the number of medical school places, or if that was just a 2024 general election promise? On what date will the workforce plan be ready and published? The manifesto also promised to train thousands of additional midwives. Will the Secretary of State tell us how many have been trained so far?

My right hon. Friend the Member for Godalming and Ash and my hon. Friend the Member for Rutland and Stamford (Alicia Kearns) spoke about the importance of listening to women and not having an ideological fixation on a normal birth or particular type of delivery, but instead looking for a good outcome. On training, will the Secretary of State elaborate on how she intends to encourage midwives and obstetricians to see themselves as one team? I know in some places they do, but in other places, tragically they do not. Will she set out how they can work together with the wider team of anaesthetists, paediatricians and other professionals to achieve the best outcomes for women, rather than a particular ideological outcome?

Some have talked this evening about the complexity of pregnancies in modern times. Can the Secretary of State talk about whether she feels nursing skills are required in midwifery, and to what extent? How does she intend to ensure that they are delivered? I know that the Government have their three shifts, one of which is prevention. Will she talk about vaccination and chronic disease optimisation before pregnancy and how they could help to reduce the number of babies lost?

On a wider level, the NHS is being reorganised. I appreciate that that was announced before the Secretary of State became the Secretary of State, but the abolition of NHS England and the shaking up of ICBs is causing disruption to health services. The abolition of Healthwatch, which she still has time to do something about, is removing the independent voice—the listening to women that we have heard about so much this evening.

There are many, many fantastic NHS staff, and many women—most women, in fact—get great care, but some do not, and the findings of recent investigations and investigations over many years have been hugely disturbing. I know that the Secretary of State cares very deeply about this topic, so I would like her reassurance that these plans will be published, the staff will be trained and the taskforce and commissioner will be effective, and that she will deliver on the maternity safety that everybody right across the House wants to see.

Sepsis Awareness Month

Caroline Johnson Excerpts

Tuesday 15th September 2026 Commons Chamber

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

I start by declaring my interest as an NHS consultant paediatrician, a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and a mother of three children.

I congratulate my hon. Friend the Member for Kingswinford and South Staffordshire (Mike Wood) on securing this debate, alongside the hon. Members for Dartford (Jim Dickson) and for Ashfield (Lee Anderson). In particular, I thank my hon. Friend for his speech, which was hugely moving. I cannot believe that it has been such a long time since his illness happened, but it is great to see him looking so well today. I express my condolences to the hon. Member for Carlisle (Ms Minns) and thank her for the brave speech that she gave.

I remember sitting in this Chamber a little over two years ago—I am sure you were there too, Madam Deputy Speaker—when the then Member for South Thanet, now Lord Mackinlay, received a rare standing ovation from the House and from the Gallery as he returned to Parliament following his remarkable recovery from sepsis. His journey has been incredible, and his story has brought renewed attention to a disease that kills nearly 50,000 people every year. For context, that is around the same number of people who die from bowel, breast and prostate cancer combined. However, with attention to prevention, early identification of infection, early diagnosis, better treatments and the avoidance of antimicrobial resistance, we can reduce that number and save people’s lives.

As I said, raising awareness of sepsis and how suddenly it can change someone’s condition is vital, and the previous Conservative Government got the ball rolling in that regard. My right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) adopted the UK Sepsis Trust’s “Just ask ‘Could it be sepsis?’” campaign in 2016 when he was Health Secretary. The Conservatives also backed sepsis research with more than £1 billion through the National Institute for Health and Care Research. Research is important, because it will help us to improve diagnosis and treatment and to better understand why some people get an infection and it makes them a little bit ill, but some people get an infection and it turns into sepsis.

That was a good start, but of course, as always with medicine, there is more to do, and it was pleasing to see the previous Starmer Government build on this work by introducing the modern service framework for sepsis. We have modern service frameworks for other diseases, and it seems good to have one for sepsis specifically. The guiding light of this framework is the Government’s ambition to reduce sepsis deaths by 25% by 2035, with which I think we could all agree. But simply saying it will not deliver it; it has to have a plan, and the plan has to be deliverable and funded. What funding have the Government committed to implement that framework?

As we know, early diagnosis is paramount, but sepsis is notoriously difficult to diagnose and very rapid. I remember seeing a patient whose mum had got up in the middle of the night to use the bathroom—not something she did normally, and she was not quite sure why she had on that particular night—and when she was walking back along the landing, she thought, “It’s a bit cold—I’ll just check.” She checked her son had his blankets on and was warm, but as she did so, just in the light from the landing she spotted a little mark on the little boy’s leg. She turned the light on, and saw that he was developing the rash, which does not blanch, that goes with meningococcal sepsis. She brought him in, and he survived and he went home well, but I shudder to think what would have happened if she had waited till she woke up routinely at 7 o’clock in the morning. So someone was watching to make sure he was safe, and I am so glad that was the case, but it is so very rapid, as others hon. Members have testified.

There is no single test. There is no single thing we can monitor or measure that helps. Flu-like symptoms mimic many other common illnesses, and on top of that, as we have heard, diagnosis and treatment are absolutely time-critical. The UK Sepsis Trust has developed the sepsis six—oxygen, cultures, antibiotics, fluids, lactate management and urinary output monitoring—and all these should be carried out within the first hour. The Government’s MSF commits to rapid diagnostic tools and more advanced genomic sequencing. What infrastructure and workforce investment is required by the Government to set this up, and over what timeframe do they envisage that it will be achieved?

Talking about the workforce, the Government decided to ditch the previous Government’s NHS workforce plan to create their own, which is of course their right. However, their replacement was originally due to be published in early 2025 and was most recently promised as “imminent” just before the summer recess, but we are now well into September 2026 and there is still no plan. The Minister in the other place was asked for more details about the workforce plan, but her written answer simply stated that the Government

“will provide an update on the 10 Year Workforce Plan in due course.”

Could the Minister please update us on when this plan is going to be published, preferably with a date rather than an expression of “soon” or “imminent”?

I want to mention group B streptococcal infection, which I have seen in paediatric practice, particularly in babies. It is a common bacteria that lives harmlessly in the gut or lower reproductive tract, but there is a risk that it can enter the bloodstream, causing neonatal sepsis when passed to newborns. The GBS3 trial is looking to prevent and reduce the impact of group B strep, and the Government’s framework commits to supporting that. Could the Minister tell us more about how the Government plan to do that?

I also want to talk about prevention, which the Government have said is one of their big shifts in medicine. Some sepsis can be prevented or reduced, and research has shown that, for example, if ibuprofen is given to children with chickenpox, it increases the likelihood of their developing sepsis. We know that completing the antibiotic course is important. We also know that handwashing technique is important, and that keeping things clean is important, particularly in preventing the sepsis that is acquired in hospitals. Management of chronic disease reduces the risk, too, and then there is vaccination.

Meningitis B is possibly one of the most scary infections and conditions that one sees as a doctor, because it progresses so quickly—and it can cause brain damage, amputations and death—but there is a highly effective vaccine, which was introduced for infants born from the middle of 2015 onwards. However, as the outbreak in Kent, Dorset and Berkshire showed last year, when three young people died, it can still come back in older children. The Joint Committee on Vaccination and Immunisation met in July 2026 and suggested an increase in the vaccination schedule for those young people. It recommended that young children who had had one dose of vaccine should have another at age 15; that those who had not had the vaccine should have two doses; and that older people starting university should have a catch-up.

Very shortly, it will be freshers week, and around 580,000 young people will head off to university for the first time with great excitement. University students are seven times more likely to get invasive meningococcal sepsis than people who do not go to university, and the Government have only managed to vaccinate 246,000 of those young people—something that the UK Health Security Agency issued a document about last week. It said that last year, 97% of invasive meningococcal disease in 15 to 24-year-olds was caused by meningitis B, so I will ask the Minister some questions that I asked her during last week’s vaccine debate and have not yet received an answer to. When is she going to review and respond to the requests for vaccines for younger children who have not had them yet—the doses at 15 and the two doses for those who have not had a dose yet? What is she doing to increase awareness among people starting university in the next week or so?

[Vikki Slade]

I am really grateful to the shadow Minister for raising this issue, which I also raised earlier in the debate. My son George and his girlfriend Maisie both had their two doses in the past few weeks as they turned 18, but my constituent Victoria asked me to write to the Minister a few months ago about education and awareness. I was really disappointed that the Department for Education did not think it was necessary to add meningitis awareness into the personal, social, health and economic education programme in secondary school. Will the shadow Minister support me in advocating for that?

[Dr Johnson]

It is clearly important that young people are aware of the signs of infection, particularly such a serious infection, so I agree with the hon. Member about that.

I am interested in what the Minister is doing to try to prevent these infections by ensuring that the right people have the right vaccines. The Government are changing the way in which vaccines are being commissioned from NHS England, which they are abolishing. [Interruption.] Madam Deputy Speaker seems to have a cough, so I will finish my speech. The integrated care boards are going to be responsible for vaccinations. How is that change going to impact vaccines, particularly for students who live in one place and go to university in another?

To sum up, the Government’s ambition to reduce sepsis and sepsis deaths should be welcomed, and it is good to have the modern service framework in place. However, I am sure that charities such as the UK Sepsis Trust and families affected by sepsis would be most grateful if the Minister could provide further clarity on the Government’s road map and the funding required to reach this important destination.

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—]

Health Bill

Caroline Johnson Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Before I call the shadow Minister, I must tell hon. Members that this debate is heavily oversubscribed; Back Benchers will immediately be on a speaking limit and not everybody will get in. I call the shadow Minister.

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

I will try to keep my remarks brief. I thank my right hon. Friend the Member for Daventry (Stuart Andrew) for all the hard work he has done over the past year in holding the Government to account on health and social care, the whole Conservative health team for their support, and every member of the Committee that, as the Minister said, scrutinised the Bill in detail in such a hot and sticky room before the summer. I also thank my parliamentary team for their support. Finally, I congratulate the Minister on her reappointment and thank her for the time that she has taken to engage with the Opposition on the Bill. I must also 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.

This is not a small Bill. It runs to more than 200 pages, and there are almost as many pages of amendments, with around 180 different MPs signing or supporting different amendments. I do not agree with every one, but I welcome thoughts and ideas from right across the House—well, from most of the way across the House; we did not see much from Reform. The Bill has scale, but does it have direction and clarity of purpose? Leadership sets direction—a destination—and from that follows a path, as smooth as possible, from A to B, with appropriate milestones. However, the Bill, like so many of this Labour Government’s, came as an announcement without enough thought.

Let us go back. The Government started with the Darzi report. I will not restate the arguments about why it was done or the weakness of the claims that it is independent, but suffice to say it is their report, published by a Labour peer and former Labour Minister for a Labour Government. It says a few things about reorganisation. Lord Darzi wrote that

“a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”,

yet the Government decided to abolish NHS England, restructure the ICBs and halve the ICBs’ budgets all at once, without properly planning for what would come next. That is clause 1—abolishing NHS England.

One of the main arguments provided related to the unnecessary bureaucracy and duplication of staff. As a Conservative, I accept that there is a strong case for efficiency: the Government must use taxpayers’ money wisely. In a letter that the permanent secretary sent to the Public Accounts Committee, officials estimated savings of £1 billion a year by abolishing NHS England and redundancy cost payments of approximately £1 billion to £1.3 billion, but we have not seen the calculations behind that. It was announced in March 2025 that the restructure would be completed in two years, yet we are now 18 months in and Ministers do not seem to be on track. From March 2025 to July 2026—a year, and three quarters of the time they have given themselves—total headcount across NHS England and the Minister’s Department decreased by 12.9%, which is nowhere near what the Government need to deliver their promised savings. We have therefore tabled amendment 102, which would require the Government to publish a full workforce transition plan, and new clause 153, which would require the Government to publish precisely how many people they make redundant.

I would like to raise a contradiction: the Government talk a lot about devolution and local decision making, but the Bill does the opposite. It will remove councils of governors from foundation trusts, give Ministers the power to hire and fire health leaders, and put an end to local Healthwatch. It will give the Secretary of State the power to set and adjust annual funding allocations for ICBs, and direct them to ringfence funding for service integration. It takes away local decision making.

The Bill is also inconsistent with what the Prime Minister said the other day. In response to a question about the Bill, he said:

“I do not like the idea of a postcode lottery in the national health service.”—[Official Report, 1 September 2026; Vol. 790, c. 61-62.]

But if decisions are taken locally, they will be different in different areas, which will lead to a postcode lottery. Will Ministers shed some light on what they actually believe? Do this Government want decisions made locally and accept that those will be different, or do they want decisions made centrally?

Lord Darzi said something else in his report:

“Constant reorganisations are costly and distracting. They stop the NHS structures from focusing on their primary responsibility to raise the quality and efficiency of care in providers.”

Indeed. In fact, that is not too dissimilar from what the Minister for Secondary Care herself previously concluded, when in opposition. She said:

“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2020; Vol. 680, c. 809.]

How is the NHS performing? Let us take a look. The total number waiting for appointment has gone down a bit, as the Government have said, but in trauma and orthopaedics, ophthalmology, cardiothoracic surgery, elderly medicine and gynaecology, it has gone up, and in some cases is higher than it was before the election. For those waiting for an admission who need a procedure or an operation, it is not only going up month on month and year on year; it is higher than it was at the time of the general election. What about accident and emergency? The number of people waiting for more than 12 hours after a decision to admit was 29% higher in July 2026 than in July 2024, and that is despite the fact that there were fewer such admissions in July 2026 than in July 2024.

How have the Government performed in other health areas? Childhood vaccination rates are in decline. The workforce plan has not been published, despite the Minister saying it was “imminent” months ago. Fracture liaison clinics have not been delivered, despite allegedly being one of this Government’s planned “first acts”. I could go on, but we do not have much time, and I think I have demonstrated the point: NHS reorganisation is distracting from delivery.

One of the things I want to talk about that the Government are not delivering is the response to the Hughes report. I thank Dr Henrietta Hughes, the Patient Safety Commissioner, for her hard work on the report. When the trauma and suffering that some people, particularly women, have experienced from mesh repairs, and the harm that children have suffered because of exposure to valproate in the womb, became apparent, we were all horrified. The previous Government changed the way that valproate was prescribed and commissioned regional surgical centres of excellence to provide care for women who suffer from the effects of a mesh repair. The Conservative Government also commissioned the Hughes report, published in February 2024, that investigated compensation schemes for those affected, but the general election was called just three months later, so delivering compensation and on the report became the Labour Government’s job.

Sadly, Ministers have dithered and delayed for more than two years now. We have had written question after written question, several debates and a lot of warm words, but still no response to the report. It is simply not good enough. Those suffering should not have to wait any longer, and that is why we have tabled new clause 145, which would provide a legal backstop, ensuring that the Government publish their response to the Hughes report within 30 days of the Bill becoming law at the latest. That is still not soon enough for those affected, but it is the only way of putting in an effective backstop so the Government can stop fobbing off victims and start delivering justice.

Let me turn to other amendments. The Government announced out of the blue that ICB running costs will be halved. Why 50%? I have no idea, but ICBs scrambled to respond. We know from those inside the health service that it has been a major distraction, with a massive opportunity cost for patient care. When the Bill came, Ministers chose to change the composition of ICBs, too, removing the voice of hospitals and primary care from boards as well as the voice of local authorities, severing that link with social care.

Integrated care partnerships will also be abolished. There will instead be a focus on mayoral representation, even for mayors where there is little role, if any, in delivering social care. In Lincolnshire, for example, instead of a local authority and an ICB on the same geographical footprint working together over the same area to cover health and social care, we now have the Government conspiring to give us an ICB covering three counties, with no voice for the local authorities, which are unsure after today’s announcement whether they will be split up. We discussed at some length in Committee the importance of health and social care working together, so I welcome the Government’s U-turn on day one of this term to reinstate local authority representation, but I urge the Minister to consider, as the Opposition parties have proposed, reinstating primary care and secondary care representatives, too.

Given the time, I will speak briefly to the three amendments on workforce. First, new clause 154 would require the Secretary of State to increase the number of medical school training places to 15,000 by 2031-32. Why? Put simply, because they promised they would and they have not. Secondly, new clause 152 is on merit-based applications. Doctors used to be allocated their first jobs through a system based on performance—that was the case when I was a junior doctor. Now it is done by computer algorithm prioritising choice. This is unfair, demoralising and destroys the incentive to study hard. We believe in meritocracy, and I urge the Government to accept the new clause.

Thirdly, I urge the Government to support new clause 144, which would address the plight of a small but significant group of people: a group of medical students subject to a great injustice. These are British citizens studying at a British university, predominantly Queen Mary University in London, who were told four and a half years into their degree that they would not be able to have places on the foundation programme but would be at the back of the queue. The Medical Training (Prioritisation) Act 2026 has meant that non-prioritised doctors got only 1.8% of the jobs—the last 1.8% left. That was the point of the Bill, but the Government should put this particular group of British citizens into the priority group.

We will no doubt talk about our other amendments in the Lords. New clause 155 on self-care would give people more autonomy over their own care. New clause 101 is on the national commissioning of low-volume, high-complexity services, and would ensure that the Government cannot just move them into ICBs without a proper consultation and plan. Amendment 95 on the patient choice duty would ensure that patients have choice over the care they receive in neighbourhood services as well as hospital services.

Amendment 88 is on the single patient record. The single has the potential to be truly transformative, bringing the NHS in line with other modern healthcare systems. It can prevent people from having to repeat themselves. But there are lots of questions for the Government that have not been answered. This is another example of making an announcement without thinking it through. How will existing health records be linked? How will patients, carers and clinicians have access? Who will control the data? How will it be kept safe? Amendment 88 would require the Secretary of State to publish a full plan before making changes.

There are some parts of the Bill that the Opposition can support, but in the Government’s hurry to make announcements, they often do not seem to think things through properly. That is the story of local government reform that we heard in the House earlier today; it is the story of the much-delayed workforce plan; and it risks becoming the story of this NHS reorganisation. In health, there are life and death situations, so we cannot afford for the Government to get it wrong. The Opposition have made a series of sensible amendments and will be grateful for the Minister’s support.

Infants, Parents and Carers Bill

Caroline Johnson Excerpts

2nd reading
Friday 4th September 2026 Commons Chamber

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

I congratulate my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) on bringing forward this important Bill and on winning first place in the ballot. I would like to put on record my thanks to the hon. Member for Washington and Gateshead South (Mrs Hodgson) for her work on this topic. I also thank Will Quince and Andrea Leadsom and the 1001 Critical Days Foundation for their work.

I must declare an interest: I am a consultant paediatrician, a member of the Royal College of Paediatrics and Child Health and a mother of three. The Chair of the Education Committee, the hon. Member for Dulwich and West Norwood (Helen Hayes), spoke of the importance of universality and concerns faced by all parents, especially first-time parents, and I agree. I was very familiar with babies when my first was born—I was working as a registrar in a large, highly specialised neonatal intensive care unit looking after babies with sepsis, babies born months early and those who were having surgical operations—but being a parent is different: the love, the joy, the sheer responsibility of looking after that little bundle of love. I am grateful to the midwives who provided me with support at that time, and I particularly remember Marie, who was good to me throughout all three of my pregnancies.

The 1,001 day window from conception to age two is crucial. It is where the human brain is most malleable. It grows and develops rapidly and is making literally millions of connections. The care received and the opportunities provided through that period affect brain growth and the child’s development. Positive interactions—play, reading, singing and cuddles—strengthen that process. They improve brain connections, support healthy development, and improve emotional regulation and social skills. This continues into the long term. Sadly, the converse is also true: unresponsiveness, neglect and trauma interfere with this biological process. They disrupt the white matter structure connections. They affect a child’s brain growth.

Successive Governments have recognised how crucial the early years are, and have tried a combination of various types of services—some universal, some targeted, but all with the same aim of improving children’s lives. Sure Start has been mentioned. The ringfence was removed, allowing local decision making—I believe that the new Prime Minister calls this “devolution”. The overall budget was strained, resulting in difficult choices, and under pressure, councils of all colours made some unwise decisions to cut some services. Previous Conservative Governments tried to support children with funded nursery and childcare hours, tax-free childcare and family hubs. In a recognition that children spend most of their time at home, the Hungry Little Minds programme supported parents in helping their children at home.

The 1,001 days from conception to two years are key, but I draw the House’s attention to the fact that care for a baby can start before conception. The national health service website advises women considering a pregnancy to ensure they have had a measles, mumps and rubella vaccine, smear test and sexually transmitted infection checks; have stopped smoking; and are a healthy weight. It advises them to take vitamin D and folic acid, and to discuss any prescription medicines with their general practitioner to see whether they are suitable for pregnancy. The Government have ensured that, by the end of this year, non-wholemeal wheat flour must be supplemented with folic acid, which will reduce the number of neural tube defects. The Tobacco and Vapes Act 2026, when it starts to have effect, will also help to reduce problems in pregnancy.

The Bill has been produced with the support of the Department of Health and Social Care, but it requires work across Government. It is not just the health service that will deliver better opportunities for children. There is obviously a role for the Department for Education, and things like air quality, transport services for people to access the services provided, and a strong wider economy are all important. My hon. Friend the Member for Bexhill and Battle (Dr Mullan) said that fewer people live near their extended family than was previously the case. That is something important to consider as we ensure that people have local support.

The Bill will put children’s services on a statutory footing, but regulations will determine what that means. I am particularly interested in whether the Bill would have helped to protect two services that were given to my constituents. The Safe Families edge of care service provided befriending, practical help at home and daytime care. It ended on 30 June and has not been recommissioned by the Reform county council. This service tried to help children and families who were in difficulty and whose children were at risk of being taken into care; it tried to keep families together while ensuring that the child was safe. That has been cancelled. Reform also stopped Lincolnshire county council’s voluntary youth services grant funding. I am interested in understanding the Government’s plan for the regulations, because although the Bill protects services, regulations will say what those services will be and whether they will be funded. I am interested in hearing from the Minister about that.

I am also interested in the use of the services themselves. We had a debate on vaccinations in Westminster Hall just the other day. Vaccinations are available for free for everyone, but not everyone takes them up. We can have the best services in the world, but if they are not used by the people who need them, they will not be effective. I am interested in understanding how the Minister intends to ensure a good uptake of the services.

Every single baby is precious. As we have heard, everyone across this House wants children to have great opportunities. We all want them to achieve their best potential. That requires teamwork—parents, wider family, friends, community and tax-funded services. We must all play our part. Supporting the Bill may help to support children, and I will support it today.

Vaccination Rates: England

Caroline Johnson Excerpts

Thursday 3rd September 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Mrs Barker. I congratulate the hon. Member for Uxbridge and South Ruislip (Danny Beales) on securing this important debate.

Why do we vaccinate? As we have heard today, we vaccinate because it prevents illness, it reduces the severity of illnesses that do occur, and it reduces complications. I should declare an interest as a consultant paediatrician in the NHS, as a parent of three children between 11 and 19 and as someone who was a volunteer vaccinator for many months at the local vaccine centre during the covid-19 pandemic.

Vaccines were first identified, or discovered, by Edward Jenner in 1796. He discovered the smallpox vaccine, which eliminated smallpox completely between 1958 and 1977. We have seen that happen with so many diseases. I have a list, but it is so long that I am not sure I have time to read it all out: diphtheria, tetanus, polio, haemophilus influenzae, pertussis, rotavirus, hepatitis B, tuberculosis, flu, respiratory syncytial virus, shingles, human papillomavirus, various strains of meningitis, rubella, mumps, coronavirus—I could go on. There are so many different things to which we now have vaccines that we did not have previously and that have reduced the incidence of death and serious illness in so many people. It is almost impossible to quantify how many lives have been saved.

I want to focus on measles, which several hon. Members have mentioned. My great-uncle Leonard died of measles at the age of 15 months. Pre-vaccine, it was a common condition that killed many people. Thankfully, now it is not—and why? Because of vaccines. Vaccination rates have fallen, however, and we have lost our measles-free status. We need to make sure, as far as possible, that everyone gets the vaccine. The concept of herd immunity means that if some children cannot be vaccinated because of a personal health condition, they will be protected to an extent by the fact of a large proportion of the population having been vaccinated, and by the reduction of that disease within the community in some conditions. If vaccination rates fall, there is a risk to those people, as well as to those who have just decided not to have the vaccine. I would be interested to know how the Minister will focus on measles in particular.

When we were in office, the Conservatives modernised the routine vaccination programme. In 2015, the UK became the first country to offer the Bexsero vaccine against meningitis B, which was given to babies aged eight to 16 weeks, followed by a booster around their first birthday. In 2017, we also switched to the hexavalent six-in-one routine vaccine programme so that babies could be protected against hepatitis B for the first time. Conservative Ministers expanded the HPV vaccination to boys, bringing the UK in line with other developed countries and preventing approximately 30,000 cases of cancer in males. The vaccine taskforce secured seven vaccines for the UK during the coronavirus pandemic, invested over £400 million in scaling up domestic manufacturing and mobilised more than 100,000 volunteers with sites right across the country. We also backed the Oxford-AstraZeneca vaccine with public funding and agreed a 10-year partnership with Moderna to invest in mRNA research and development. The previous Government supported vaccination in a number of ways; I look forward to hearing from the Minister what her Government will do to support it.

I also want to talk about meningitis B, which is a horrible, rapid disease that affects patients very quickly. It is one of the diseases that is quite frightening to see as a paediatrician because of the speed at which a child goes from being well to being critically ill. We have all heard about putting the glass across the rash to see whether it disappears, but I have watched that rash appear on children with lightning speed. The disease kills, and it leaves many children with severe, lifelong disabilities.

In 2015, the UK was first in the world to bring in a vaccine against meningitis for small children, but last year we saw meningitis B infections in groups of older children and young adults in Kent, Dorset and Reading. There were 21 cases in Kent and two deaths. The Government quickly brought in a local vaccine programme to treat people who might have been at risk, but there was also a stampede for private provision; Boots, Superdrug and other commercial ventures ran out of the vaccine within a few hours.

The Government have decided to bring in a system under which people born between 1 September 2007 and 31 August 2008, and those who are starting university or further education colleges for the first time this year, will be able to get the vaccine. However, the JCVI has suggested that children who have been vaccinated with one dose should be given a booster at age 15. That means those who were born after 1 May 2015, so the Minister has a little while to manage that, but the JCVI has also recommended two doses for adolescents who did not get the first dose. The Government do not seem to have taken up that recommendation yet. Will they do so? When?

A meningitis vaccine has also been brought in for men who have sex with men because, interestingly, it also has a 42% protective rate for gonococcal conditions. There was a record high of 85,000 cases in 2023. The vaccine has helped with those cases, but it would be beneficial to know when the Government will ensure that all our young children have the protection that they need against this frightening disease.

Other things are slipping, too. The flu vaccination is highly effective at reducing seasonal hospital admissions. The WHO recognises that it is the most effective way to prevent infection and severe outcomes from flu, but coverage among the elderly and at-risk groups has declined in England. I would be interested to hear why the Minister thinks that is, what her research shows and what she is going to do about it.

Respiratory syncytial virus affects not just children, but the elderly. The vaccine is incredibly effective in the elderly; last year, the JCVI recommended its extension to the over-80s. At the time, I asked Ministers whether the vaccine, having been recommended by the JCVI in the early summer, would be ready for last winter. My understanding, from what was said, was that they were going to work at pace. They reassured me that it would happen, but it did not. I believe that the vaccine will be available to older people this winter, but what is the Minister doing to make sure that they are aware of that so that they take it up? It will help to reduce admissions to hospital over the winter and reduce the pressure on A&Es and ambulance services, and it will mean that people are less unwell, which is obviously a good thing.

Many hon. Members have talked about vaccine hesitancy. Polling by Ipsos found that more than two thirds of adults believed that it was

“difficult for the public to spot misleading health information.”

It also found that those in the most deprived areas were more likely to be affected. According to a UK Health Security Agency survey, last year 47% of parents who reported seeing concerning information about vaccines said that they had seen it on social media. As hon. Members have said, those sorts of message, such as the suggestion that cancer in the royal family was caused by vaccines, were platformed by a political party at a conference.

It is important that we give responsible information about vaccines that we know to be true. We do not pretend that there are no risks. There is always a small risk to anything: we take a risk when we get up in the morning and come to work, and we take a risk every time we cross the road. Every aspect of our life contains risk, but we need to be honest with people and explain that the risks of vaccines are tiny and the risks of the disease are potentially much greater. That will mean that people can make informed decisions.

When patients who have not been vaccinated come to clinic—we check with all children whether they have been vaccinated when they come for their first clinical appointment—they have very often refused once and not been asked again. The reason why has not been discussed. No one has asked them why they are worried about the vaccine; it has just been accepted at face value. Very often, when we talk to parents about it, they will then have their children vaccinated. We need to make sure that when unvaccinated children do present to medical services, we take the opportunity to try to get them vaccinated.

I welcome the addition to the relationships, sex and health education curriculum of facts about vaccination and immunisation, but what is happening to provide public information to parents and other adults? It is said that vaccine uptake among ethnic minority groups is markedly lower. Does the Minister understand why? What is she doing to improve it? The Prime Minister has previously attested that Healthwatch is a key factor in engaging marginalised communities, but this Labour Government have placed it on the chopping block in the Health Bill, which is due back in the House next week. How does the Minister foresee that role being taken up by the patient experience body with which the Government intend to replace it?

From April next year, integrated care boards instead of NHS England will be responsible for vaccinations. I understand that that is part of the Minister’s strategic commissioning vision, but will that additional responsibility be met with additional resources? How will the Government ensure that it does not cause further slippage in vaccinations?

Finally, I want to mention the life sciences industry, which is struggling under this Government’s tax burden. Now that the Department for Science, Innovation and Technology has been abolished, what will the Minister do to ensure that the industry is given the support that it needs?

Occasionally during my career, a parent of a critically ill child has looked me in the eye, often as the child is being put in an ambulance to an intensive care unit, and said, “If I’d given my child the vaccine, they wouldn’t be this ill, would they, Doctor?” There is trauma and grief for those parents, and a regret that is completely unnecessary and can be prevented. It is in the hands of the Minister and of this Government to do what they can to prevent it. I look forward to hearing what the Minister plans to do.

Health Bill (Sixteenth sitting)

Caroline Johnson Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

[Helen Morgan]

I thank the Minister for outlining the existing statutory framework. I agree that it ought to be sufficient, but there are high-profile instances where it has not been, so I look forward to hearing more from her on Report about how the cultural change will be implemented so that further legislation is not necessary. I beg to ask leave to withdraw the new clause.

Clause, by leave, withdrawn.

New Clause 38

Single sex facilities

“The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff

(b) toilets and washing facilities for NHS staff

(c) wards for NHS patients

(d) toilets and washing facilities for NHS patients.”—(Dr Caroline Johnson.)

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients.

Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

This is a very straightforward new clause. The Secretary of State would be required to ensure that there are single-sex changing rooms, toilets and washing facilities for NHS staff and single-sex wards, toilets and washing facilities for NHS patients.

The UK Supreme Court unanimously ruled that a woman is defined by biological sex in 2025, and the Minister herself said:

“We are completely committed to single-sex spaces.”

However, it appears that the Minister for Women and Equalities did not get that memo. Despite having apparently been sat on her desk since September, the new draft code from the Equality and Human Rights Commission was not laid before Parliament until 21 May. One week before that guidance was published, a female NHS England employee in Leeds won her claims of indirect sex discrimination and harassment over a policy allowing transgender colleagues to use toilets and changing rooms that correspond to their gender identity rather than their biological sex. On 28 June, after the draft code was laid, it was reported that West London NHS trust had told patients that they could use single-sex facilities based on gender identity.

It has taken the current Health Secretary some time, but I understand that he has changed his mind on the issue and come to the same conclusion as others: that a woman is, in fact, a woman and that toilets and changing facilities must be protected. Will the Minister follow his lead and protect single-sex spaces in NHS trusts? The Supreme Court has ruled that a woman is defined by her biological sex. My party knows that. The Minister claims her party knows that too. It is time for her to show it by pulling the levers that only she can to ensure that patients and staff are protected right across our health service.

[Karin Smyth]

I am grateful to the hon. Member for bringing this discussion before the Committee. She is right that, following the For Women Scotland case at the Supreme Court in April 2025 and the recent laying of the Equality and Human Rights Commission’s updated code of practice on 21 May, ensuring the provision of single-sex facilities for patients and staff is a prominent issue. The Government welcomed the clarity provided by the Supreme Court judgment. The EHRC code of practice sets out how service providers may lawfully apply sex-based distinctions following the Supreme Court judgment. That guidance is applicable to services, public functions and associations and includes, but is not limited to, the services provided in the NHS.

Following that, NHS England drafted the revised guidance, “Privacy, dignity and safety in hospital accommodation”, which will align with the legal position and the EHRC code of practice and replace existing guidance. I know that many colleagues are impatient to see the existing guidance replaced following the Supreme Court ruling. It was important to wait for the EHRC code of practice to be published so that it could be considered in any guidance. The code of practice was published on 21 May. Following the publication, NHS England reviewed the guidance to ensure that it was in line with the code. The code was subject to a 40-day laying period before Parliament, which ended on 9 July. The Government expect the code to come into force in early August. Guidance for the NHS will be published shortly afterwards.

NHS England is also developing guidance on staff facilities, including changing rooms, toilets and washing facilities that should be used by trusts and ICBs. The provision of physical single-sex facilities for NHS staff is for NHS organisations to individually manage in line with their legal obligations. There is already legislation covering this issue, particularly the Workplace (Health, Safety and Welfare) Regulations 1992. Organisations should already be conducting assessments of their own estates and the needs of their workforce to decide what changes they need to make to comply with all legislative requirements.

On mixed-sex accommodation and breaches, there is a long-standing policy of same-sex accommodation. Individuals should not have to share sleeping accommodation with patients of the opposite sex unless appropriate. In practice, the proposed amendment does not allow scope for mixed-sex accommodation where clinically appropriate—for example, intensive care unit facilities or where it is necessary for patient safety. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.

Question put, That the clause be read a Second time.

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Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

New clause 40 would require the Secretary of State to publish a report detailing the business case for the use of public-private partnerships for neighbourhood health centres. This goes back to the use of the private finance initiative in the past, particularly during the last Labour Government when Ministers were attracted by the prospect of off-balance sheet financing. Although the idea looked good on paper, it proved a disaster in practice. Before the 2008 financial crisis, private finance initiative interest rates were 2.5% to 4.4% higher than public sector borrowing rates. After the crisis, PFI projects increased their rates by 20% to 30%. In the interests of time, I will not rehash the story I told earlier in Committee about the problems with simple things such as putting a whiteboard up, but PFI did create operational problems, too.

The previous Government rightly called time on PFI and announced in the 2018 Budget that it would not be used for future projects, which is why this Government’s plans are so peculiar. Labour Ministers have taken a trip to the graveyard of bad ideas, resurrected PFI and adorned it in new clothes: it is now PPP. The Government have tried to reassure the public that it is not a rehash of PFI, but the facts suggest otherwise. The funding of neighbourhood health centres is to be 80% through PPP. The Minister told the BBC we will be working with the private sector, particularly around construction and maintenance of many of the new centres. How is PPP different from PFI?

The Minister has previously told this House that the new scheme will draw on lessons learnt in the past, so could she please say what those lessons are? If they have been learnt, why did 53 academics write a letter urging the Government to abandon the proposal? Why did dozens of Labour MPs sign an early-day motion expressing grave concerns? And why have the Treasury Committee, the Public Accounts Committee, the National Audit Office, the Institute for Public Policy Research and the Institute of Economic Affairs all cast doubt over the value of money for such schemes?

No matter how Ministers dress things up, I am concerned. The Government need to publish a business case for the proposal to show how it will work in practice and demonstrate they have learnt lessons from the past. If they have, Members have no good reason to object to the amendment. It only asks Ministers to show their workings-out in full view of the House openly and transparently.

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[Karin Smyth]

I thank my hon. Friend for that. Across the east of England, where we now have so many Labour MPs, everyone has been trying to rectify the mismanagement that local people have seen, particularly of the capital estate. I will not detain the Committee on the capital estate—one of my favourite subjects—for very long.

The hon. Member for Sleaford and North Hykeham is aware that the decision on neighbourhood health centres was announced in the autumn. The decision-making process was supported by a business case to examine the feasibility of developing a new model, learning the lessons of the past on public-private partnerships specifically to build neighbourhood health centres as part of our 10-year plan. That informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with the Treasury’s five case model. We are now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn.

I recognise the interest in making the business case available to both Houses, but that must be balanced with the need to develop an effective policy. Publication while policy development is ongoing would limit full, candid and proper deliberation. Civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications. Their candour in doing so would be affected by their assessment of whether the content of such discussions would be disclosed.

We are committed to building neighbourhood health centres across the country. That is what patients and the public deserve. We will obviously be mindful of public money and subject to the usual processes of the House, including the Public Accounts Committee. We will learn those lessons. We are in full discussion with NISTA. For those reasons, we are committed to developing good estate across our country. That is what our constituents deserve. I therefore ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

[Dr Johnson]

For the record, I am a member of the Royal College of Paediatrics and Child Health and work as a consultant paediatrician at North West Anglia NHS foundation trust, which will have a new hospital. I would like to press the new clause to a vote.

Question put, That the clause be read a Second time.

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Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

This new clause asks the Government to use private providers to help get waiting lists down. We are told that waiting lists are falling, but the Government’s own figures show that waiting lists are higher than they were last month, and if we look at the group of people who are waiting for admission for a procedure or operation, they are higher than they were last month, last year or indeed at the general election in 2024. There were 76,250 women waiting for gynaecological treatment at the end of July ’24, when this Labour Government took office; that rose by more than 6,000 patients to 82,623 as of May 2026. Private providers have capacity that may be able to help with that.

The deployment of private providers is about using all the resources and capacity on offer across the country to get waiting lists down. The NHS uses private providers to perform some surgeries and scans, mental health support, GPs and dentistry, but it is a sensible measure to ensure that all hands are on deck when it comes to treating patients. I look forward to hearing how the Minister can use private providers to get more patients seen more quickly as opposed to wiping them from waiting lists at record rates.

[Karin Smyth]

Again, I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. This new clause would require the Secretary of State to make regulations about how the NHS uses private provision to support access to treatment and reduce lists. I understand the point that she is making, but I assure her that this is an unnecessary new clause.

ICBs already can and do use private healthcare providers to offer patients treatment in their area and boost capacity to reduce lists. Our approach is pragmatic, not ideological: in the 10-year health plan, the Government committed to continuing to use private sector capacity where it is available; that is not because we favour the private sector but because we are committed to using capacity wherever it is available. Our priority is treating patients in a timely manner, not favouring one form of provider over another. Under existing legislation, patients must be offered a choice of provider for their first outpatient appointment, where the duty of choice applies. If a person’s needs are not met by local services or waiting times are high, they can use that choice to see an appropriately qualified provider.

However, we must resist the temptation to apply a one-size-fits-all approach here. ICBs are responsible for the financial sustainability, planning and strategic commissioning of services for their local populations, so they are best placed to decide how private premises should be used to meet a population’s needs. For example, high waiting times, which we obviously inherited from the Conservatives, for a particular specialty may result not from a lack of capacity but from increased demand from GP referrals. The ICB must have the flexibility to improve how advice and guidance—referral support, for instance—is working for GPs, rather than being required to wastefully spend NHS funds on increasing capacity with the private sector.

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[Karin Smyth]

That is why I was clear in outlining that ICBs have a duty to make sure that they are financially sustainable and that their planning and strategic commissioning meets the needs of their local population. They need to balance those requirements.

Under the new clause, there is a risk that the Secretary of State, by setting blanket requirements, would contravene the level playing field provisions in clause 10 of the Bill. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.

[Dr Johnson]

The previous use of private providers was to remove debt from the Government’s balance sheet. That is not the same as providing guidance and regulations on how to increase capacity and use the spare capacity of private providers to reduce waiting lists, which are currently rising. In response to the point made by the hon. Member for Bury St Edmunds and Stowmarket, the workforce plan is important. Despite that plan being “imminent” for several weeks now, it has not been published. I will press the new clause to a vote.

Question put, That the clause be read a Second time.

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Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss the following:

New clause 75—Transition strategy for the abolition of NHS England—

“(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the ‘strategy’).

(2) The strategy must—

(a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities;

(b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England;

(c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and

(d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services.

(3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy.

(4) A report under subsection (3) must include—

(a) progress on workforce retention;

(b) arrangements for the transfer of knowledge, expertise and institutional capability; and

(c) any identified gaps in capability and the steps being taken to address them.”

This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy.

Amendment 37, in clause 71, page 48, line 28, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the conditions in subsection (3B) are met.

(3B) The conditions are that—

(a) the Secretary of State has published a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the ‘operating model document’); and

(b) the Secretary of State has published a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the ‘workforce transition plan’).

(3C) The operating model document must include—

(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;

(b) the governance and accountability arrangements for the exercise of those functions;

(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and

(d) the proposed timetable for the transition.

(3D) The workforce transition plan must include—

(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;

(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and

(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.

(3E) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3F) Before laying a draft instrument under subsection (3E), the Secretary of State must allow a period of at least 60 days beginning with the date of publication of the operating model document and the workforce transition plan (whichever is the later) before the draft instrument is laid.

(3G) A period during which Parliament is dissolved, prorogued or adjourned for more than four days are not to count towards the 60-day period in subsection (3F).”

This amendment would prevent the abolition of NHS England before the production of an operating model for the merged DHSC/NHSE and associated plan to manage personnel.

Amendment 38, in clause 71, page 48, line 28, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) has been met.

(3B) The condition is that the Secretary of State has published an impact assessment in respect of the abolition of NHS England that complies with subsection (3C) (a ‘qualifying impact assessment’).

(3C) A qualifying impact assessment must include—

(a) a quantified estimate, expressed in monetary terms, of the total transition costs of abolishing NHS England, including in particular—

(i) redundancy costs;

(ii) the costs of integrating data, digital and information technology systems;

(iii) the costs of reorganising and rehousing staff and functions; and

(iv) productivity losses during the transition period;

(b) a quantified estimate, expressed in monetary terms, of the ongoing annual costs of the restructured Department of Health and Social Care following the abolition of NHS England, including any costs falling on integrated care boards as a result of the transfer of functions to them;

(c) a quantified estimate, expressed in monetary terms, of the estimated annual savings arising from the abolition, including savings from the elimination of duplicated corporate functions and reduced administrative costs;

(d) a quantified estimate, expressed in monetary terms, of the net present value of the abolition, being the difference between the total costs under paragraphs (a) and (b) and the total benefits under paragraph (c) over a period of not less than ten years;

(e) a statement of the key assumptions underlying the estimates in paragraphs (a) to (d) and an assessment of the sensitivity of those estimates to changes in those assumptions;

(f) an assessment of the risks to the delivery of the anticipated benefits, including the risk of disruption to NHS functions during the transition period; and

(g) a statement of the methodology used to produce the estimates, including any data sources relied upon.

(3D) Before publishing a qualifying impact assessment, the Secretary of State must submit it for independent scrutiny to the Regulatory Policy Committee (or any successor body) and must publish the Committee's opinion on the assessment alongside it.

(3E) The Secretary of State must lay the qualifying impact assessment and the Committee's opinion before both Houses of Parliament.

(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3G) A draft instrument under subsection (3F) may not be laid unless at least 60 sitting days have elapsed since the qualifying impact assessment was laid under subsection (3E).”

This amendment requires the Secretary of State to publish, and submit to independent scrutiny, an impact assessment on the abolition of NHS England, containing quantified cost and benefit figures, before making regulations to abolish the body.

Amendment 39, in clause 71, page 48, line 28, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) is met.

(3B) The condition is that the Secretary of State has published a plan setting out how health services provided by or under arrangements made by NHS bodies are to work alongside and be integrated with the social care system in England (the ‘health and social care integration plan’).

(3C) Before preparing the health and social care integration plan, the Secretary of State must have regard to—

(a) the recommendations made by the Independent Commission on Adult Social Care chaired by Baroness Casey of Blackstock (or any successor body undertaking that Commission’s work) in any report published by the Commission before the plan is laid; and

(b) the need to reflect any such recommendations in the content of the plan so far as they are relevant to the interface between health services and adult social care.

(3D) The health and social care integration plan must include—

(a) a description of the structural and operational arrangements for joint working between NHS bodies and local authority social care services following the abolition of NHS England;

(b) proposals for how the transfer of NHS England’s functions to the Secretary of State will affect the coordination of health and social care commissioning, including in particular the commissioning of services for people with complex needs spanning health and social care;

(c) arrangements for reducing delayed discharges from hospital attributable to the absence of suitable social care provision;

(d) proposals for how the funding flows between the NHS and the social care system, including NHS Continuing Healthcare, will be managed following the abolition;

(e) the workforce implications for the health and social care sectors arising from the abolition and the steps to be taken to address them; and

(f) a timetable for implementing the arrangements described in the plan.

(3E) The Secretary of State must lay the health and social care integration plan before both Houses of Parliament.

(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3G) A draft instrument under subsection (3F) may not be laid before either House of Parliament until at least 60 sitting days have elapsed since the health and social care integration plan was laid under subsection (3E).

(3H) In this section—

‘NHS body’ has the same meaning as in the National Health Service Act 2006;

‘social care system’ means the system for the provision of care and support under the Care Act 2014 and services provided by local authorities in the exercise of their functions relating to adult social care.”

This amendment requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using their powers for its abolition. The plan must address joint commissioning, funding flows (including NHS Continuing Healthcare), delayed hospital discharges, and workforce.

[Dr Johnson]

New clause 46 would require the Secretary of State to publish the number of staff in the Department of Health and Social Care and the number of people made redundant following the abolition of NHS England. New clause 75 would require the Secretary of State to prepare and lay before Parliament a formal transition strategy. Amendment 37 would prevent the abolition of NHS England before the production of an operating model. Amendment 38 would require the Secretary of State to publish and submit to independent scrutiny an impact assessment on the abolition of NHS England containing quantified cost and benefit figures before making regulations to abolish it.

Amendment 39 would require the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using the powers in the Bill for abolition. The plan must address joint commissioning, funding flows, delayed hospital discharges and the workforce. The problem is essentially that Ministers marched off into a battle without a plan and continue to fight without one.

In this Committee, we have heard consistently about the number of times that things have not been thoroughly planned out and properly considered, particularly in relation to social care. I know that Members on all sides of the House are concerned about how social care will interact with the health service under the proposed new regime. In March 2025, Ministers and officials were going to work to determine what was needed, and in March 2026, they were still progressing to develop the design—12 months later, there was a change in tense but still no proper plan.

When putting the Bill before the House, the Government published an impact assessment, but where there should be numbers quantifying how much this is all going to cost us, there is simply “N/A”. How is that any way to conduct a reorganisation? That is why I tabled amendments 37, 38 and 39. They would apply the brakes until the operating model had been established by requiring the full publication of a proper impact assessment, a detailed plan of how the health service will work alongside social care, and the publication of redundancy figures. They would ensure that the Government have worked out what they are going to do before they get on and start doing it.

[Karin Smyth]

The Government of course recognise the importance of clarity and assurance as we undertake this significant transformation, including on how functions, governance and the workforce will operate in the future. That is essential for ensuring that our staff and other stakeholders understand the new role of the Department.

On new clause 46, we recognise the importance of transparency around departmental workforce numbers and the impact of abolishing NHS England. The Government remain committed to significantly reducing headcount across NHS England and the Department of Health and Social Care, but I put on record my thanks to all the staff and talented professionals working in both organisations; this is a difficult time for them. However, this new clause is not necessary. Workforce information is already published both monthly and through the Department’s annual report and accounts, alongside wider Government transparency publications. Placing a further reporting requirement in legislation would risk duplicating existing transparency data, so it is unnecessary to include it in the Bill.

On amendment 37, I reassure the Committee that we will consult on the proposed structure for the new Department of Health and Social Care, and that is also required under existing employment law. The structure will clearly explain what every part of the new Department will do and set out every post we think we need. The target operating model is an internal document that sets out the proposed purpose, role, governance and organisational structure of the future Department. It will be shared internally, following engagement with staff and stakeholders, including trade unions. The chair of NHS England, Dr Penny Dash, has committed to sharing it with the Health and Social Care Committee once it is finalised.

The target operating model will be used to guide detailed organisational design and will iterate over time. The proposed design of the new organisation will be subject to consultation. The target operating model does not implement changes that remain subject to parliamentary approval through this Bill.

On workforce transition, we will follow TUPE-like principles whether TUPE or any other transfer mechanism applies, in line with the Cabinet Office statement of practice on staff transfers in the public sector. That means that recognised trade unions will be formally consulted and engaged with on measures related to the transfer. No changes to contractual terms and conditions will be made without proper consultation and engagement.

We are committed to maintaining an ongoing dialogue with trade unions and staff throughout this period of change, and we are updating them as often as possible. Where appropriate, we are also committed to working with staff networks on the changes, particularly on how we can best support staff. Given those commitments, I hope that the hon. Member for Sleaford and North Hykeham agrees that placing further requirements in the Bill would be disproportionate.

On amendment 38, we agree that it is important to be transparent about the costs and benefits of this programme. The Department has been open about the initial estimate of around £1 billion of savings per year, and we published an impact assessment alongside the Bill. The detailed timing and scale of costs and savings from the programme depend on factors such as the take-up of voluntary exit and redundancy schemes, which are under way. We will continue to refine our assessment of costs and savings as the programme progresses and as we move towards the abolition of NHS England. We will continue to be open about those figures.

The savings will support continued investment in frontline services. The timescales set out in the amendment would risk delaying the abolition of NHS England and, as a result, would delay the transfer of savings to frontline services and the stability and certainty we need for our staff.

On amendment 39, the Government are committed to supporting the integration of health and social care so that people experience more joined-up, person-centred care. Key planning frameworks, including for the better care fund and for neighbourhood health, already stress the critical importance of strong join-up and integration. We expect those frameworks to continue to guide the health and care system following the abolition of NHS England. Most importantly of all, we are committed to developing neighbourhood health approaches as an essential part of reforming the health and care system. That approach will deliver more integrated services across health, local government and wider partners, including the voluntary and community sector.

The Bill simplifies existing complex legal frameworks to make collaboration easier and emphasises the role of health and wellbeing boards as a focal point for that collaboration. However, partnership and collaboration take many forms depending on local circumstances, and they cannot simply be prescribed through a centrally developed plan. Instead, we should encourage areas to develop effective, productive relationships in the interests of the people they serve. We have discussed that in this Committee, and hon. Members from all parties have a key role to play there.

Turning to new clause 75, we absolutely recognise the need to ensure that critical functions, expertise and organisational capability are identified, retained and effectively transferred during this period of change. That is essential to maintaining continuity of services and supporting the delivery of key health programmes, including vital services such as cancer care.

I reassure the Committee that that work is already well under way. We are carefully mapping all areas of current activity across NHS England, assessing what capabilities we need to deliver them in future and putting processes in place to support the retention and transfer of expertise. This includes the phased approach we are taking to workforce changes, alongside a robust and consistently applied process for voluntary redundancies and voluntary exits, to minimise disruption and protect critical skills. We are also committed to ongoing monitoring and oversight through the transition, and as part of our programme of governance, there is ongoing consideration of skill retention, knowledge transfer and organisational capability, and we will take action where gaps are identified.

As drafted, the new clause would introduce a new statutory requirement to produce and lay before Parliament a formal transition strategy before the abolition of NHS England and the implementation of transfer schemes, alongside new ongoing reporting obligations. While well-intentioned, it would add another unnecessary step into what is already a complex and carefully sequenced programme. It would reduce the flexibility needed to adapt workforce organisational decisions as the transformation progresses. For those reasons, the Government believe that the objectives of the new clause are already being delivered through existing programme arrangements, without the need to place further requirements in the Bill.

[Dr Johnson]

I listened carefully to what the Minister said, but I do not know where the Government have transparently published all these numbers and calculations. A lot of parliamentary questions have been asked on the detail of this transition, so I think it is important that the detail is published so we can see it, and that the detail is planned, before the abolition process takes place. I therefore want to press the new clause to a vote.

Question put, That the clause be read a Second time.

--- Later in debate ---

Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

The new clause would require the Secretary of State to publish a plan for securing the provision of universal fracture liaison services across England. As we get older, our bone density naturally decreases, increasing the risk of bone fractures and possibly osteoporosis, which affects 3.5 million people across the UK.

Fracture liaison services identify people aged 50 or over who have broken a bone, and they provide treatment to reduce the risk of further debilitating fractures. Of those over 50, one in two women and one in five men will break a bone because of osteoporosis. Heartbreakingly, 2,000 people die each year from preventable fractures. When the former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), claimed that delivering universal fracture liaison services would be one of his first priorities if elected to Government, many people hoped to see this happen, but it has not.

The previous Conservative Government began rolling out fracture liaison services, and it is an indicator of just how little progress the current Government have made that 97% of today’s fracture liaison services were delivered by the Conservatives. What have the Labour Government been doing? What is more, one in two NHS trusts, following freedom of information requests, tell me that they have no fracture liaison service at all, which is quite literally an accident waiting to happen. I am very grateful to the Royal Osteoporosis Society for its campaigning on this issue. By its calculations, at the current rate of delivery, it will take 38 years for the Government to deliver universal fracture liaison services, which is obviously far too slow.

We have tabled the new clause because the Government need a plan. The former puppeteer of this Government, Morgan McSweeney, made it clear that Labour did not have a plan for government. The new clause would require the Secretary of State to deliver a plan within 90 days, not just to secure the provision of universal fracture liaison services but to deliver on his predecessor’s very clear and very deliberate promise to do so.

The Minister in the other place was asked whether an implementation plan for fracture liaison services was needed. The answer was, effectively, no. What is the view of the Minister before us in Committee? There are so many critical questions in this area that have no answers and that a plan would and should address. What are the Minister’s annual milestones for achieving universal access to fracture liaison services by 2030? How will the Minister’s plans to cut ICB budgets by 50% impact that key promise? An important question on the promise is whether the Minister’s plans to merge ICBs mean that fewer services will now be delivered. How will that impact patients? What extra workforce, diagnostic and NHS estates capacity is required to deliver it?

Yet again, as so often with this Government, we are left with a headline-grabbing promise with no plan behind it. The consequence is that more than 40,000 people are predicted to die from hip fractures that could have been prevented through timely national implementation.

[Dr Prinsley]

I am listening carefully to what the hon. Member, who is a medical colleague of mine, has to say. Although I think that a fracture liaison service is an excellent idea, there are many, many aspects of medical care that require careful attention, such as the management of people with hearing loss—my own field—or the assessment of people with chronic renal failure. Does the shadow Minister believe that all aspects of each individual disease category require some sort of primary legislation?

[Dr Johnson]

Not necessarily, no, but this one does, because the Government clearly made a promise before the election. The former Secretary of State was clear that it would be one of his first acts—that is what he said—and it has not happened, so in this case we need to hold the Government to account. It is our job to hold them to account on their promises, and I am afraid that they are failing on this one.

To sum up, the Government need to get their act together, because otherwise more and more vulnerable people will come to unnecessary and potentially fatal harm. I look forward to hearing the Minister’s plans to accelerate the delivery of the Government’s promise—and fast.

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq. I welcome the Minister back from her son’s graduation —I hope it went well.

I rise to state my support for new clause 47, which would require the Secretary of State to publish a clear roll-out plan for fracture liaison services across England and report annually to Parliament on progress towards universal coverage by 2030. It is not about creating a new target, because the target already exists: both this Government and the previous Government committed to achieving 100% fracture liaison service coverage by 2030. The question before us, as proposed by the shadow Minister, is simple: how will that promise be delivered, and how will Parliament know whether meaningful progress is being made?

Fracture liaison services are one of the most evidence-based interventions in osteoporosis care. They systematically identify people aged over 50 who suffer a fragility fracture; assess their bone health; initiate treatment where appropriate; and monitor patients to reduce the risk of subsequent fractures. Given that around half of patients who sustain a hip fracture have previously broken another bone, those services represent a vital opportunity to intervene before a life-changing injury occurs. The human cost is considerable. Osteoporosis affects millions of people, particularly older women, and fragility fractures can result in a loss of independence, reduced mobility, social isolation and significant pressure on health and social care services. The National Institute for Health and Care Excellence estimates that around 180,000 fractures each year in England and Wales are attributable to osteoporosis.

There is also a compelling economic case: the Royal Osteoporosis Society estimates that investing around £30 million in fracture liaison services could prevent approximately 74,000 fractures over five years, including 31,000 hip fractures, saving the NHS around £665 million and freeing up some 750,000 bed days. Few preventive interventions offer that combination of better patient outcomes and substantial savings for the NHS.

The Government frequently point to their commitment to universal coverage by 2030, but as the shadow Minister pointed out, progress has been achingly slow. When the Secretary of State appeared before the Health and Social Care Committee last week, I questioned him on that issue directly. While he confirmed that the Department remains committed to meeting that 2030 target, which was first established by the previous Conservative Government, no plan—or indication of when a plan would come—was given. A commitment alone is not a delivery plan.

There are also growing concerns that the Government have overstated the progress that has already been made. The Royal Osteoporosis Society has confirmed that more than 97% of the fracture liaison services counted by the current Government were already in place before the change of Government. So, rather than that representing any significant expansion in national coverage, this Government have gone slow. I think it is therefore very reasonable—to answer the question from the hon. Member for Bury St Edmunds and Stowmarket—for Parliament to be entitled to ask what additional progress has actually been made since the commitment was reaffirmed.

New clause 47 would also require the Secretary of State to publish an assessment of access in every integrated care board area. It would also require annual milestones, because, at present, there is no publicly available timetable showing where the services will be established, or which areas will be prioritised or progressed between now and 2030.

Crucially, the new clause would require the Government to set out how integrated care boards will actually be supported. Ministers rightly point out that fracture liaison services are commissioned locally by integrated care boards, but if the responsibility for delivery rests locally while responsibility for national targets rests with central Government, there clearly needs to be a well-thought-through national framework explaining how those boards will be supported through funding, guidance, workforce planning and accountability.

This is, therefore, a straightforward request for transparency, accountability and, most importantly, delivery. If Ministers are committed to achieving this by 2030, they should have absolutely no objection to publishing a plan that shows how they intend to get there. For those reasons, I support the new clause.

[Karin Smyth]

I will partly agree with the Opposition to start off with: they are absolutely right that osteoporosis is a really important issue, particularly for older women. The hon. Member for Farnham and Bordon outlined some of the economic case, but crucially, it is a strong health issue. I worked and campaigned on this issue in opposition myself, because it predominantly affects older women. It also very much fits into our 10-year health plan regarding prevention. That is why we have also, for example, increased access to DEXA—dual-energy X-ray absorptiometry—scanners.

It is rather disappointing, though, for a subject on which there is obviously so much agreement to be used as a political back-and-forth here today. Let me be clear. I think some of the comments show why some of this has got a bit confused, including for people who genuinely care about this rather than just wanting to make it a political issue. Again, it is entirely the Opposition’s job to oppose the Government, and I do not have any problem with that, but there is a serious issue here about how this is monitored.

We are absolutely committed to having coverage across the country by 2030, as the Secretary of State has recently said. That is why we are rolling out more DEXA scanners and so on, but with the clustering of ICBs, 92% of the country is now covered across those clusters.

[Dr Johnson]

rose—

[Karin Smyth]

That is why it is important that we look at what is actually happening on the ground and how we are moving forward. We are committed to supporting this cohort, and particularly those patients for whom this condition is largely preventable. Care closer to home, based around our 10-year plan, is absolutely the right way to go about that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I was going to outline the points, but I am happy to give way if the hon. Lady wants.

[Dr Johnson]

Can the Minister be clear on the point about ICBs? There is a concern that, where there are perhaps three ICBs, one of which has a service and two of which do not, and they merge together, the Government then say, “Aha! This ICB area now has coverage,” but that is for part of it, not all of it. What is important for a universal service is that it is available to all.

[Karin Smyth]

Again, the hon. Lady has intervened, but that is exactly my point. There is a danger here of the Conservative party focusing on a target or number and totally missing the point, which is to have good, locally available services accessible to this predominantly female and predominantly older population through our 10-year health plan. If one counts the new clustered ICBs in that target, 92% of areas are covered.

We want to get to the heart of this issue. Integrated care boards are the commissioners of local health services and remain best placed to make decisions according to local need. Commissioning these services at a local rather than national level—which is the entire thrust of our 10-year health plan, and indeed this Bill—means that ICBs are best placed to commission holistic, integrated care that wraps around the patient’s need, where the patient is.

We have been very clear in our 10-year health plan, and indeed in this Bill, that we are not expecting patients to fit in with models of care that have been devised over a period of time and in hospitals that are largely located far from their homes. We are looking at a close-to-home service and building models of care around peoples’ needs. A legislative requirement for a national implementation plan would cut across that responsibility, undermining local ability to tailor services to patient needs and causing confusion for delivery. That is why we do not think the new clause is necessary.

The renewed women’s health strategy sets an expectation that ICBs prioritise community-based models when commissioning new fracture prevention services. The Department will continue to work closely with NHS England and ICBs to explore a range of options that provide better quality, and better access to, important preventive services. I therefore ask the shadow Minister to withdraw the motion.

[Dr Johnson]

I am afraid I am not reassured at all. The Minister seems to be saying that the ICBs will do it—the same ICBs where she is cutting their budgets, making them change the board and making them merge with each other all at the same time. The target is behind schedule and it is important that we hold the Government to account on it. Therefore, I will press new clause 47 to a vote.

Question put, That the clause be read a Second time.

--- Later in debate ---

Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss the following:

New clause 53—Cancer treatment: waiting times—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision for every patient to have access to cancer treatment within 62 days following referral.

(2) The Secretary of State must establish a scheme to support NHS hospital trusts in meeting the requirement under subsection (1).

(3) As part of the scheme, the Secretary of State must expand the capacity of the Medicines and Healthcare products Regulatory Agency.

(4) The Secretary of State must make an annual statement to Parliament on progress on meeting the requirement under subsection (1).

(5) Any statement made under subsection (4) should be made as close as reasonably practicable to 4 February.”

This new clause gives patients a right to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this. It also requires the Secretary of State to update the House on progress against the target on/around the time of World Cancer Day.

New clause 54—Cancer Survival Research—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must by regulations establish a Cancer Survival Research Programme.

(2) Regulations under this section must—

(a) require government co-ordination and funding for research into cancers with a five-year survival rate below 20%, and

(b) establish a fellowship programme for foreign academics in cancer research.

(3) Any programme established under paragraph 2(b) must make provision to waive visa fees for entry into the UK for participating academics.

(4) Regulations under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rate.

New clause 65—National framework on radiotherapy treatment

“(1) Within six months of the passage of this Act, Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must include minimum standards, established by the Secretary of State, against which—

(a) integrated care boards must measure and report their investment in, and delivery of, radiotherapy services, and

(b) the Secretary of State must assess the performance of integrated care boards.

(3) The minimum standards under subsection (2) must include standards regarding—

(a) waiting times for radiotherapy (including time to definitive treatment),

(b) patient travel times to radiotherapy services,

(c) the number of cancer patients receiving radiotherapy and the quality of such radiotherapy,

(d) the age, capability and replacement needs of radiotherapy equipment,

(e) access to modern radiotherapy techniques and technologies,

(f) access to treatments recommended by the National Institute for Health and Care Excellence,

(g) radiotherapy treatment capacity against current and projected population needs,

(h) variation in access to radiotherapy services between integrated care board areas,

(i) workforce capacity to deliver radiotherapy treatment,

(j) the level of investment in radiotherapy services and the extent to which such investment reflects clinical need.

(4) For the purposes of subsection (3)(d) the Secretary of State must set a maximum proportion of linear accelerators that are more than 10 years old or otherwise beyond the recommended replacement age.

(5) Each integrated care board must publish an annual report on its performance against the minimum standards in the framework.

(6) Where an integrated care board fails to meet at least one of minimum standards it must publish a remedial action plan setting out the steps it will take to achieve compliance.

(7) Before publishing or revising the framework, the Secretary of State must consult all persons with clinical, technical, operational and patient expertise in radiotherapy the Secretary of State considers appropriate.

(8) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework.”

New clause 100—Single patient record: review of flagging for early cancer diagnosis—

“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must lay before both Houses of Parliament a report on the feasibility of using patient records held by the health service to indicate, to a person providing health care to a patient, cases in which a patient has presented symptoms on more than one occasion which may indicate the presence of cancer.

(2) The report under subsection (1) must consider—

(a) the potential for such indication to support early diagnosis of cancer in patients aged under 50 years of age, and

(b) any implications of such an indication requirement for clinical responsibility and patient safety.

(3) In preparing the report the Secretary of State must consult—

(a) NICE, and

(b) any other persons as the Secretary of State considers appropriate.”

This new clause would require the Secretary of State to report on the feasibility of using patient records held by the health service to indicate, to a person providing health care to a patient, cases in which a patient has presented symptoms on more than one occasion which may indicate the presence of cancer.

[Dr Johnson]

New clause 48 would require the Secretary of State to

“publish and maintain a national framework for improving access to radiotherapy services in England.”

One in four people can expect to need radiotherapy in their lives. That is a lot of people who will need consultation, assessment, pre-treatment planning and treatment delivery. Data published a few years ago showed that Scotland, Wales and Northern Ireland have more linear accelerator machines per million people than in England. Can the Minister confirm whether that is still the case? Last year, Radiotherapy UK had research indicating that more than 60,000 cancer patients are not getting the radiotherapy they need and I know particular areas of the country are struggling. Can the Minister provide an update on the roll-out of the new LINAC machines at 28 hospitals, which she spoke about in May 2025?

We were also told that by March 2027, up to 27,500 additional treatments will be delivered. Can the Minister share some information on how that will be achieved? The Labour Government have now been in power for two years. They have raised taxes by more than £60 billion and they do not have much to show for it. They have not produced a workforce plan. They have said that one will be imminent; can the Minister confirm whether it will be published today before we break for the recess? Is the intention to publish it during the recess or will we have to wait until the autumn?

There is a 31% shortfall in clinical radiologists. New clause 48 essentially requires the publication and maintenance of

“a national framework for improving access to radiotherapy services”.

This Government have essentially shown that if a requirement is not in legislation, plans just get delayed, diminished and disowned, but patients cannot afford to wait any longer.

[Helen Morgan]

I rise to speak to new clauses 53 and 54, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire), and new clause 65, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron).

New clause 53 would give patients a right to start cancer treatment within 62 days of referral and require the Secretary of State to establish a scheme to deliver that. It would also require the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day. New clause 54 would require the Secretary of State to introduce regulations requiring the Government to co-ordinate research into cancers with the lowest survival rate.

--- Later in debate ---

[Karin Smyth]

This is an important debate, as many of them are today. I understand that waiting for a cancer diagnosis, as I have had to do myself, is very stressful. The national cancer plan sets out how the Government will change that experience for patients and their families. Crucially, the plan is driven by evidence and shaped by the voices of more than 11,000 patients, charities and professionals who responded to our call for evidence.

The plan covers the entirety of the pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention and research and innovation, and tackles the key issues raised in the new clauses. Delivery of the plan will be monitored by the national cancer board, with an independent co-chair reporting to the Department.

On new clauses 48 and 65, let me be clear that improving access to high-quality radiotherapy services is a priority for the Government, and one that we are already delivering. In May last year we announced the roll-out of new linear accelerator machines, we have committed to meeting all cancer waiting time targets by the end of this Parliament, and timely access to radiotherapy is central to the 31-day and 62-day treatment standards. We will go further by reviewing the targets, once they have been met, to consider whether they should be strengthened. That will include considering what data is needed to support improved performance. A separate statutory framework would duplicate the established performance regime.

We are well aware that radiotherapy performance is below that of other treatment types, as the hon. Member for North Shropshire outlined. We are also aware of the serious variation between different parts of the country. We have at our disposal the Getting It Right First Time programme and national interventions to address those issues at a local level. The national cancer plan also tackles unwarranted variation through robust national data and oversight from the national cancer board, while ensuring that service configuration remains clinically led.

We have committed to improving the productivity of radiotherapy services, including by using artificial intelligence to streamline treatment. We will make a £70 million investment in state-of-the-art radiotherapy machines by 2027 through a managed national replacement programme. Imposing fixed legislative limits on the age profile of equipment would reduce the flexibility required to manage that programme effectively. Additionally, the NHS is already under a clear statutory duty to fund NICE-recommended interventions, supported by national commissioning guidance. Additional minimum standards would duplicate those safeguards without improving outcomes.

New clause 48 also suggests metrics to track radiotherapy performance. I assure the hon. Member for North Shropshire that high-quality and detailed data already helps us to understand emerging issues and to monitor performance. The National Disease Registration Service in NHS England collects diagnosis, treatment and outcome data on cancer patients in England. It routinely reports incidence, prevalence, survival, routes to diagnosis and treatment data on all cancers. NHS England also publishes monthly radiotherapy performance data.

On workforce capacity, we are already seeing increases in key roles, including clinical oncology doctors and radiologists, and the Getting It Right First Time review of radiotherapy services will report later this year. The new clauses risk duplicating efforts already in train to improve the oversight of radiotherapy services, workforce, data quality and coverage, and would create additional bureaucracy and divert resources away from patient care.

I turn to new clause 53. Improving performance against cancer waiting standards is a priority for this Government. We have made year-on-year progress with cancer waiting times, but we know that there is some way to go. Cancer incidence is about 15% higher than when the 62-day standard was last met, in late 2015. There are more than 200 distinct cancer types, and each is complex. The cancer waiting time targets, including the 62-day referral-to-treatment target, are not set at 100% for several reasons, including patient choice, clinical guidelines and the complexity of diagnosis and treatment planning. That means that not every patient can or should be treated within the waiting time standard. We therefore do not think the new clause is appropriate.

Change, including improvements to the cancer pathway and to tackle variation in performance, cannot be delivered overnight. The national cancer plan sets out the concrete actions that we are taking to get there. We have already demonstrated our commitment to transforming diagnostic services by investing £2.3 billion in diagnostic capacity. That will support us in achieving the 62-day standard through faster diagnosis. We recognise that the provision of cancer services, including treatment, varies across the country. The national cancer plan addresses how to tackle that variation.

To accelerate breakthroughs in cancer treatments, we will explore innovative procurement methods. That will aim to stimulate the development of new diagnostic tests, targeted therapies and more effective treatment for rare cancers, ensuring that the NHS remains at the forefront of medical innovation.

We believe that new clause 54, in the name of the hon. Member for North Shropshire, is unnecessary because the Department already has the National Institute for Health and Care Research and the national cancer plan underpinning its cancer research strategy. The Department invests about £1.8 billion each year on research through the NIHR. Cancer is a major area of its spending, at £141.6 million in 2024-25, reflecting the fact that it is a high priority. The NIHR does not usually ringfence funds for research in specific conditions; it welcomes funding applications for research into any aspect of human health and care, including cancer. Research is funded through open and fair competition and peer review to ensure that the highest-quality proposals most likely to deliver real impact for patients are funded without imposing financial targets or limits.

The national cancer plan is the first plan to have a dedicated chapter on rare cancers, which is important to many hon. Members across the House, including my hon. Friend the Member for Blaydon and Consett, who has done great work. The plan includes a commitment to make progress on rare cancers as one of six key research priorities to tackle stubbornly low survival rates. Our aim is to be in the top quartile across 28 countries for survival of 14 rare and less common cancers. Through the NIHR, the Department is the largest funder of clinical academic training. The NIHR plays a key role in attracting training and supporting the best clinical academic researchers, providing comprehensive research career pathways for clinicians across all career stages, from undergraduate level through to professional appointments.

New clause 100 would require the Department to publish a report on the feasibility of using data in patient records to flag symptoms. I understand the concerns behind it. We fully support using the single patient record and other data to improve cancer care and diagnosis, but we have largely covered the issues raised by the new clause in the cancer plan. We understand that there are concerns in some areas. The Government have introduced Jess’s rule, which instructs GPs to rethink a diagnosis if a patient presents with the same symptoms. That followed a campaign on behalf of the family of Jessica Brady, who tragically died after symptoms of her cancer were not recognised. The single patient record will give clinicians timely access to a single trusted record, which is why it is such an important part of the Bill. We envisage that the Bill, together with the cancer plan, will enable more personalised insight into cancer risk, for example, through the NHS app. For those reasons, we do not think the new clause is necessary.

[Dr Johnson]

If I heard the Minister correctly, she said that the ICBs would provide NICE-approved treatment, which they have to do within 90 days at the moment. At an earlier sitting, we debated an amendment tabled by the Minister that would enable the Secretary of State to delay the provision of NICE-approved treatment, which was agreed to. I am not quite sure how that is congruous, but in either case we would like to press new clause 48 to a vote.

Question put, That the clause be read a Second time.

--- Later in debate ---

[Dr Johnson]

I beg to move, That the clause be read a Second time.

I will be brief, because we have a lot to get through. The new clause would require the Government to produce a modern service framework for respiratory disease within 18 months and, in essence, to make a plan for providing and improving treatment for those with respiratory disease. The previous Government had a major conditions strategy, which looked at the six major causes of ill health, one of which was respiratory disease. This Government paused that when they came into office to consider their own plans, but have not responded with a plan for respiratory disease in any detail. The new clause would require them to do so.

--- Later in debate ---

[Karin Smyth]

My hon. Friend tempts me to go down the path that we went down in another Committee. I recognise that the Tobacco and Vapes Bill took a long time to come through Parliament, despite having been started by the Conservatives under the right hon. Member for Richmond and Northallerton (Rishi Sunak). It faced a lot of opposition, but we are absolutely clear that that is the single most beneficial piece of work. The hon. Member for Sleaford and North Hykeham asked me about the future, in terms of vape shops and so on, and I have corresponded back to her on that issue.

Instead of what is proposed in new clause 49, we have established a robust, expert-led process. The national quality board will assess all proposals for new MSFs against a clear set of criteria, ensuring that we prioritise those areas where an MSF will deliver the greatest impact for patients. Alongside developing the first wave of MSFs, we are further strengthening the process, including by setting out a clear and consistent approach for assessing future proposals. Embedding an MSF in respiratory health in primary legislation would risk limiting that flexibility, rather than strengthening our ability to improve care, as my hon. Friends the Members for Blaydon and Consett and for Bury St Edmunds and Stowmarket have outlined, by taking the action that is so necessary to help and support people with respiratory disease.

[Dr Johnson]

The Minister talks about momentum, but as I understand it, there is a severe mental illness MSF, for which timelines are to be published in due course; a sepsis MSF that was expected in the spring but is now anticipated in the summer; a frailty and dementia MSF expected sometime this year; a palliative care MSF that was published in June as an interim update, but will not be complete until the autumn; and a cardiovascular MSF. I do not see very much momentum there, given that the Government have been in office for two years.

[Karin Smyth]

It is a lot faster than the 14 years in which it was not done under the Conservatives.

[Dr Johnson]

Actually, there were plans, changes and improvements in respiratory care. One of the more obvious ones for lung cancer was the start of the lung cancer screening programme. I do not think the Government have the momentum and vigour that is required. Of course, they have also paused the long-term conditions strategy, which was already written and would have delivered. This is important, and we will press new clause 49 to a vote.

Question put, That the clause be read a Second time.

--- Later in debate ---

Brought up, and read the First time.

[Dr Johnson]

I beg to move, That the clause be read a Second time.

The new clause would require the Secretary of State to produce a delivery plan for the transformative technology commitments in the 10-year plan. The 10-year plan took a lot of people a year to write, and there is plenty of ambition in it, but so far the delivery is rather suspect. The Government are right to say that technology can be game-changing, but it is one thing to ask civil servants and special advisers to draw up a grand plan and a nice brochure, and another to actually deliver on those ambitions. The Labour party came into government without a plan, and we are about to have a new Prime Minister but we do not know what his plan is, or even if he has one, either.

We have seen IT outages take down health systems, hospitals fail to communicate critical information after patients are discharged, and warm weather take down MRI scanners and radiotherapy machines. The new clause would require the Secretary of State to produce a delivery plan for the transformative technology commitments in the 10-year health plan, and would provide a clear road map for data quality and interoperability, artificial intelligence, genomics and predictive analytics, wearables, and robotics. Let us be clear: the Opposition support introducing new technology to make the NHS more efficient and improve patient care, but we need clarity from the Government on how they will do that.

Ordered, That the debate be now adjourned.—(Emma Foody.)