Health Bill (Seventeenth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 16th July 2026 Public Bill Committees

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

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

The new clause is a probing amendment. The aim is to press the Government to explain why the Bill does not include provisions to implement statutory regulation of NHS management, as they had said they would, and to commit to a timetable for bringing the regulations they promised into force.

I am an NHS consultant paediatrician and am regulated as such by the General Medical Council. The GMC regulates doctors, the Nursing and Midwifery Council regulates nurses and midwives, and different bodies represent other professionals in the health service—but not managers. The Government said that there would be such a register. I know that there are many excellent managers—the Minister was one—but as in every profession, bad apples need to be identified and managed appropriately.

The Times has reported that senior bosses at Leeds teaching hospital NHS trust asked consultants and nurses to work in ways that lie outside the national service recommendations. We have also heard from Donna Ockenden that of the 66 former senior staff members in Nottingham she approached, only 35 agreed to be interviewed. The former Secretary of State for Health and Social Care, the right hon. Member for Ilford North (Wes Streeting), has said that he finds it

“unconscionable that people who worked for the NHS would deny them”—

the families—

“an honest account of what went wrong”.

Establishing a register would be the first step in ensuring that bad apples can be held to account. Those who bully staff, cover up problems, endanger patients or misappropriate funds should not be allowed to fail upwards. The NHS benefits from having outside experience, including from the private sector and the armed forces, so I am looking not for full occupational licensing, but simply for a register of those who are not suitable to be appointed. We should not see managers going from one trust to another and another after they fail at the first. I should finish by declaring that I worked at Nottingham University hospitals NHS trust during late 2012 and early 2013.

[Karin Smyth]

May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.

[Karin Smyth]

I thank my hon. Friend and the shadow Minister for their comments about NHS managers. I agree that they often get a bad press, and often from politicians as well. We cannot run the health service without both clinically and non-clinically trained managers, so we need to ensure that they have the right support to do their difficult job. My experience is that when the partnership with clinicians works well, it is really powerful. I have certainly learned a lot from working with some fantastic clinicians in my career.

We are absolutely committed to introducing a statutory barring system. We will do that by introducing secondary legislation within this Parliament to enable the Health and Care Professions Council to operate that barring system. We intend to do so as part of the planned secondary legislation to modernise the framework that governs the Health and Care Professions Council.

Changes to this legislation are subject to a statutory three-month consultation period, in addition to which this legislation will be novel and complex. It will require extensive stakeholder engagement to ensure that we develop a barring system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation governing the work of NHS senior leaders. For those reasons, a 12-month timeline to bring forward the section 60 order is unfeasible. The new clause also sets out prescriptive duties on the content of the section 60 order; we would not wish to pre-empt the outcome of detailed policy development and consultation.

I welcome the support of the hon. Member for Sleaford and North Hykeham for the broad programme of initiatives to professionalise and increase the accountability of managers and leaders in the NHS. Although we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which those measures will be delivered, officials in the Department of Health and Social Care and in NHS England are already working in partnership with organisations across the health sector and will set out more on the individual timelines in due course. For those reasons, I ask the hon. Member to withdraw her new clause.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 52

Access to dental provision: Dental deserts

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (‘the Scheme’).

(2) The purpose of the scheme is to end dental deserts.

(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.

(4) The scheme must make provision to support integrated care boards to—

(a) guarantee emergency access to an NHS dentist,

(b) provide free dental checks up for—

(i) children,

(ii) mothers within one year of having given birth,

(iii) pregnant women, and

(iv) low-income households, and

(c) guarantee dental appointments for persons commencing—

(i) surgery,

(ii) chemotherapy, or

(iii) transplant procedures.

(5) The Secretary of State must, before publishing the scheme, issue a reformed dental contract.

(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”—(Helen Morgan.)

This new clause would establish a scheme to support integrated care boards to end dental deserts.

Brought up, and read the First time.

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

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[Dr Johnson]

I rise to discuss new clause 104, which stands in my name. The Labour Government’s general election manifesto made a bold pledge:

“Never again will women’s health be neglected.”

The Government have been in power for two years, and I am not convinced that they are doing all they can for women’s health. The latest NHS statistics show that waiting lists are rising under this Government. The trend is particularly acute for gynaecology services. More women are awaiting admission to hospital for gynaecology treatment or procedures than in July 2024. How does that square with the Government’s ambition to improve and prioritise women’s health?

We talked this morning about fracture liaison services, which is another treatment that would predominantly have benefited women if the Government had kept their promise and rolled it out as they said they would. The previous Conservative Government commissioned the Hughes report. The Labour Government have repeatedly pledged to address the issue at the earliest opportunity, but when will the Minister respond to the women who have been waiting so long? The Government published their renewed women’s health strategy in April, but where are the timelines, steps and milestones to deliver and implement improvements to women’s health? Where is the plan to reduce gynaecology waiting lists? Where is the timetable for delivering on long-acting reversible contraceptives, for example?

I have no doubt that the Minister has a desire to improve outcomes for women and improve their care, but I am concerned about the actual delivery, which has been a theme throughout the day. I tabled new clause 104 because this Labour Government have made promises to women that they need to keep, and that they need a plan for how they will keep them. My new clause would ensure that they have a plan to deliver, rather than just making promises in glossy brochures.

[Karin Smyth]

Hon. Members have brought to the Committee a really important discussion about women’s health. I am very happy to have that discussion, because the Government are committed to prioritising women’s health. That is why I am so proud that we published a renewed women’s health strategy earlier this year.

I say in response to the Liberal Democrat spokeswoman, the hon. Member for North Shropshire, that we renewed the strategy partly because—to be absolutely fair to the Conservative party—we agreed with much of what it put in place under its women’s health strategy. We did not see the need to start it from scratch, so to speak. There had not been a men’s health strategy, so they are very different propositions.

Much of the direction had been covered, but the implementation had not. On the point made by the hon. Member for Sleaford and North Hykeham, we wanted to go further and faster and acknowledge some things, as the former Secretary of State did, about medical misogyny, as well as the need to renew that strategy.

I fully agree with new clause 57 that women should get equal access to high-quality elective care. We are committed to tackling the long waits for services primarily affecting women; I am acutely aware that women can wait disproportionately longer for a wide range of treatments, although none solely impacts women more than gynaecology services. The Government recognise that injustice. That is why we have implemented measures to improve gynaecology services and women’s access to care, including piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding, increasing the relative funding available to incentivise providers to take on more gynaecology procedures, and using surgical hubs to help endometriosis patients to get quicker treatment. Those measures have helped to improve 18-week referral-to-treatment times for gynaecology by 5.1 percentage points over the past year.

We will go further over the course of this Parliament, including by launching NHS Online clinical services from 2027. That will initially prioritise nine conditions, including women’s health conditions such as severe menopause symptoms and menstrual problems that may be a sign of endometriosis or fibroids. Patients will have the choice of getting the specialist care they need from home, and we will provide additional appointments to reduce waiting times.

More broadly, we have committed to returning to the NHS constitutional standard by March 2029 so that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment across all patient groups and specialties. Delivering against this standard would also require the waiting times for a diagnostic test to improve significantly. We recognise that, which is why in the medium-term planning framework, the NHS target is to ensure that by March 2029 no more than 1% of patients are waiting more than six weeks for a diagnostic test.

On new clause 58, we acknowledge that women’s health has been neglected and that women deserve better. We acknowledge that there have been longstanding failings in women’s health outcomes, experiences and access to care. That is why we published the renewed women’s health strategy, making it clear that women’s voices and choices are central in healthcare. We will transform NHS performance in the services that matter most to women, support all women to live healthy, prosperous lives, and create an approach to research and development that works for and empowers women.

Reducing inequalities is hardwired throughout the strategy. Actions are targeted by deprivation, ethnicity and unmet need, with a focus on marginalised women, community-based services, neighbourhood health models, and transparent data. The renewed women’s health strategy marks a decisive shift from identifying problems to delivering change. By listening to women’s voices, improving performance where it matters most, and tackling the drivers of poor health and inequality, we will ensure that women and girls receive the care, respect and outcomes they deserve. As a result, we do not think that conducting an independent inquiry into women’s health provisions and outcomes in England at this time would add value. Instead, now is the time to deliver the change that we all know and agree is absolutely needed.

I recognise the intention behind new clause 104, but I do not believe that it is necessary to publish an implementation plan. The action summary tables in the renewed women’s health strategy clearly highlight the responsible delivery organisation and the planned timeframe for all 117 actions. Some actions are already under way or funded for this year; others will be delivered over the next two to five years, and more fundamental reforms will be phased in over the next decade, aligned with the 10-year health plan.

Progress in the renewed strategy will be judged against three overarching outcomes: reversing the decline in healthy life expectancy since the 2010s, raising healthy life expectancy in the poorest regions to at least 61 years, and reducing the time women spend in poor health, particularly where inequalities are greatest—something I see very starkly in my Bristol South constituency. We will also be transparent on progress through a new women’s health data dashboard, publishing neighbourhood-level data on performance, access, outcomes and experience.

This Government have already undertaken extensive engagement to inform the development of the strategy. We had nearly 100,000 responses to the 2022 women’s health strategy call for evidence, more than 400 submissions from individuals and organisations with expertise in women’s health, and analysis from the Change NHS engagement exercise, where roundtables brought together women with lived experience, clinicians, academics and expert organisations. I was part of some of those roundtables and it was very instructive. I thank them for the work they did to get us to this point. We will continue to engage and to listen to women through the new women’s voices partnership and through patient-reported experience and outcome measures, which will help to shape and improve services.

Creating a new statutory duty to publish an implementation plan risks diverting attention and resources away from delivering the actions in the renewed strategy, which should now be our priority. It is for those reasons that I ask hon. Members not to press their new clauses.

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[Karin Smyth]

Usually, I say that I am grateful that a discussion has been brought before the Committee and that I am happy to have it, but it is unusual to have a discussion on a clinical trial in a political environment. I stand to be corrected, but I do not think that there has ever been a clinical trial subject to a parliamentary vote. There has been an Opposition day debate about this, in which many issues were rightly aired, so we will not spend much time discussing it this afternoon.

The safety and wellbeing of children and young people is paramount. Children’s healthcare must always be led by evidence and expert scientific and clinical advice. We all know that that was not the case in some of the instances at the Tavistock over time, in the late 2010s. We pay tribute, as we have done several times, to the then right hon. Member for Bromsgrove when he was Secretary of State for Health—in 2022, he finally took action on that particular service and what went on there, commissioning Dr Hilary Cass’s review, which we supported on a cross-party basis, for the health, safety and wellbeing of children. Hilary Cass’s interim review in 2022—which bears reading, for those who have not read it recently—found the evidence for the service model and the clinical base to be woefully lacking. In the 2010s, that was allowed to continue for a long time, but fortunately started to be stopped in 2022.

Ever since, we have had cross-party agreement in support of Dr Cass’s review. She found that the evidence on the use of puberty-supressing hormones for children and young people for treatment of gender incongruence is “remarkably weak”. Based on the available evidence, NHS England introduced a new clinical policy in March 2024 that means that puberty-suppressing hormones are no longer available routinely in the NHS for children and young people with gender incongruence. In December 2024, for non-NHS prescriptions, the Government introduced an indefinite ban on the sale and supply of puberty-suppressing hormones to children and young people for the purpose of gender dysphoria or incongruence. That followed independent advice from the Commission on Human Medicines.

Clinical practice should be based on evidence. When evidence is lacking, clinical research takes place to improve the evidence base. That is why, to properly understand the impact of puberty-suppressing hormones to treat gender incongruence, the Cass review recommended a clinical trial. In line with the Cass review’s recommendation, a trial has been developed and has now secured updated study approvals from the MHRA and the Health Research Authority.

This country has a well-deserved international reputation for academic and scientific excellence, with robust independent regulatory processes in place to properly scrutinise and assure the scientific rigour and ethics of publicly funded clinical trials. That helps to ensure that individuals receive evidence-based care, based on the highest quality research, regardless of their clinical diagnosis. I therefore disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, clinical trials for those types of medicines must be subject to the scrutiny and approval of both Houses.

[Dr Johnson]

A couple of points. Does the Minister recognise that the cancel culture associated with much of the work in this area, and in looking after those vulnerable groups of children, means that the tendency among those who get involved is to have a particular view? How has she worked to ensure no bias among those on the committee involved in producing the trial? Does she recognise that by choosing a cohort of children—226 of them—to do this experiment on, she is selecting a group of children of whom most will have a gender incongruence that will get better by itself? There are two effects of that. First, these children will have unnecessary treatment. Secondly, even if there were in theory a benefit to the small group of children who would have persisted in a trans identity, that would affect the reliability of the results; therefore, whatever the results, people would think them unreliable.

[Karin Smyth]

I think that was yet another addition to the hon. Lady’s speech. Initially, she asked whether I recognised the cancel culture in this area. I have already alluded to, absolutely, recognising that what occurred in the 2010s at the Tavistock and around was not acceptable. Under the stewardship of the Conservative party of the NHS and so on, it took until 2022 to start rectifying that situation in order to give good treatment to children and young people. She is herself a clinician, so I am somewhat surprised at her. Noting what I set out, I am surprised that she does not recognise that a clinical trial has never—I stand to be corrected—been subject to a vote in Parliament, whereby politicians who are not experts have a say; but we can come back to that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I am going to move on.

Noting what I have set out, having such a vote would set an uncomfortable precedent that would be likely to significantly compromise the value and reputation of UK research, as well as creating an inequity unique to individuals with gender incongruence or gender dysphoria. For those reasons, I ask the hon. Lady to withdraw the new clause.

[Dr Johnson]

I am not aware of any clinical trial that has provided potentially extremely harmful medication to children who have a self-limiting issue and who are physically healthy, to change their physically healthy bodies by changing puberty or anything else to a physiologically abnormal state from a physiologically normal one. These are children going through normal, physically healthy puberty. Their normal puberty is being stopped. I think the trial is badly designed, and I wish to press the new clause to a vote.

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

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[Karin Smyth]

I thank my hon. Friend for bringing his experience to bear on this matter. I absolutely agree. New clause 82 stems from that resident doctors dispute. One of the first things that we did was to agree the 10-point plan with regard to the management in trusts. I have said before how truly shocking the working conditions are in many trusts not just for resident doctors, but for other doctors and professionals. There is no ability to take a break, have a rest or get away. Some of the equipment that they are dealing with is also shocking, as are the levels of the estate. Those are some of the many things that have driven and continue to drive poor industrial relations, along with the fact that there is no one to speak up for them.

[Dr Johnson]

The Minister says that if doctors want to go on strike, that is a failure of the system. The consultants have just balloted to go on strike. What failure in the system does she think has caused that?

[Karin Smyth]

I think I said that it is a failure of representatives on both the management side and the union side to agree a solution. That is what I meant by a failure of the system. Ultimately, strike action, as my hon. Friend the Member for Lichfield would attest, is a sign of the failure of good, conducive relationships and partnership working. That is why we never want to see it.

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[Dr Johnson]

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

In their final months in office, the last Labour Government introduced the Equality Act 2010. That consolidated several pieces of anti-discrimination legislation, which was welcome, but it also introduced a new public sector equality duty, requiring public authorities to have “due regard” to preventing unlawful discrimination and fostering equality of opportunity between groups. The public sector equality duty also requires authorities

“to…encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.”

Unfortunately, that has become a vehicle for social engineering. It was designed, I believe, to improve equality of opportunity, but it is being used to gerrymander equality of outcome instead. That can mean discrimination—against different groups of people, but discrimination nevertheless.

That is clinically objectionable, because it means that health and social care staff may be recruited for reasons other than their clinical abilities, which are what we need and are most important. We have parts of the health service spending their time working on cultural learning classes and pushing paper around, rather than on patient care.

We must get the health service back to basic healthcare, ensuring that it delivers the very best healthcare, free at the point of use, to all individuals based on their clinical need, not their ability to pay. We need to focus on clinical need and the best possible staff, not on trying to gerrymander some sort of social engineering.

[Karin Smyth]

With new clause 83, I think the hon. Member for Sleaford and North Hykeham would like to exempt organisations that receive public funding to provide health and social care services from the public sector equality duty. I do not agree with the intent of this measure.

The duty under the Equality Act 2010 was designed to ensure that public authorities

“have due regard to the need to…eliminate discrimination…advance equality of opportunity”

and

“foster good relations”

in the exercise of their functions. That includes when designing and delivering services. It is not an unnecessary addition but part of good service design and delivery.

The duty is not there to dictate a particular outcome or set of priorities for the decision maker; it is there to help decision makers understand and take account of the consequences of their choices. It ensures that issues of discrimination, equality of opportunity and good relations between different groups of people are not overlooked during complex decision making. That is why it is important for publicly funded providers of health and social care to have due regard to the duty.

The public sector equality duty should always be applied in a proportionate way. It should not create an administrative burden. If a provider of health and social care is taking a decision that has little or no consequence to equality outcomes, it needs only to note that. It is for that reason that I ask the hon. Member to withdraw her new clause.

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[Karin Smyth]

I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee again today. The safety recommendations are an important mechanism for improving services and securing better outcomes for patients. We support the aim of bringing greater clarity to the recommendations landscape, and we are already taking forward work in this area.

The Dash review of patient safety across the health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost-benefit analysis, which is why the 10-year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the national quality board. In line with the Dash review, work is progressing on a recommendations hub that will sit within the Department.

The hub will include a repository to hold all national-level recommendations relevant to care quality, including safety, effectiveness and patient experience. It will provide an efficient system for co-ordinating, prioritising and overseeing recommendations made by the national quality board. The hub will record responsibility for implementing prioritised recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, which is something I think we all welcome. This new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes.

Where reviews or reports commissioned by the Secretary of State make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within the overall co-ordination retained by the Department. Our existing plans meet the intention behind new clause 85; in fact, they go further by prioritising national-level recommendations for the NHS in a proportionate way, without being bound to specific timescales. They will provide the greater clarity that the new clause seeks without the need for legislation.

On the specific question, I am sorry to disappoint the many campaigners on this issue and Opposition Members by saying that we will not be announcing anything in the next two hours, but the point has been well made. I responded to a Westminster Hall debate myself, and the Minister responsible for patient safety has previously responded to the commissioner and made public the work that the Government are doing. Due to the cross-Government nature of the work, we cannot give exact timelines.

We have heard the calls for clarity, speed and decisive action, and we have committed to setting this out at the earliest opportunity. I have not had a chance to speak directly with my right hon. Friend the Member for Makerfield about this issue, but I am sure many conversations on many subjects will be coming our way soon. As both my right hon. Friend and the Prime Minister made clear during Tuesday night’s debate on the Hillsborough law, redress and patient trust are important aspects of rebuilding the confidence of the public and those who have been wronged in all parts of the state. We are committed to getting this out as soon as is credibly possible. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

[Dr Johnson]

The new clauses ask the Government to respond to recommendations on patient safety, and to say within six months whether they will implement them. As I said, we have been waiting several years for the Hughes report response. All new clause 98 would require is that the Secretary of State must, within 30 days of the Bill’s passage, publish the Government’s response to the report. That, in itself, is not immediately soon; it is 30 days after the Bill is passed, and it is still yet to go through the Lords and return to the Commons. The new clause would effectively provide a backstop or legal end date—it is still too far away—after which the Government cannot go any further. I will be very disappointed if the Government are not prepared to do that, so I would like to press the new clause to a vote. These people have waited long enough.

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

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[Dr Johnson]

If they are, they can use the advice and guidance service. The point is that when a general practitioner wants to refer his or her patient to a consultant on the basis of their clinical need, they should be able to. That is the purpose of the new clause.

[Karin Smyth]

As someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion while everybody else watches us for the next hour and a half, but I am not going to do that.

Some interesting points have been raised. To add my two pennies’ worth to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, the change in practice is partly due to increased specialism among consultants, which makes it harder to refer. When we set up a referral management service in Bristol, two issues were the pressure on general practice and the use of locums, who were perhaps working temporarily in the area and did not know the full range of available community services. That was some 12 years ago, so greater support on advice and guidance is long overdue as we roll this out.

At the end of the day, the aim is to support patients getting the right clinical care in the right place as fast as possible. We want patients to have timely assessment of their care needs and clear next steps in the right settings. GP referrals and support for GPs in making those referrals is crucial.

The advice and guidance model, which allows GPs to seek rapid specialist input into a patient’s care without an initial face-to-face appointment, and the single point of access model, which will be rolled out in October, support GPs and hospital specialists to work together and make the best treatment plans for patients while reducing unnecessary referrals and increasing waiting lists.

Trusts and integrated care boards must ensure that local GPs, GP leaders, local medical committees and interface groups are involved in the design and ongoing refinement of elective single point of access pathways. In my experience, that is important because we gain their expertise and there is more buy-in to making the pathways a routine part of their work. Advice and guidance is already a routine part of much GP practice. GPs continue to be able to make clinical decisions to refer for specialist care where that is in the patient’s best interests. Advice and guidance and the single point of access do not alter the clinical threshold for a referral, and a GP’s clinical decision to refer remains unchanged. All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight.

We are clear that GPs should continue to make a clinical decision to refer to specialist care where that is in the patient’s best interests. The model is intended to support decision making, not override it. To be clear to the hon. Member for Sleaford and North Hykeham, the intention was never to mandate. There is a difference, which I think was made clear in subsequent guidance on the system. The diversion rate, as she calls it, is an estimate of the potential of patients who are not referred to the right place in the first place. It is not compulsory. What the new clause proposes already exists and does not need to be set out in primary legislation. For those reasons, I ask her to withdraw it.

[Dr Johnson]

If the hon. Lady is correct, she will not be perturbed by the new clause, which simply says that general practitioners must be able to directly refer patients to consultants when clinical need requires it. 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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[Dr Johnson]

New clause 87 would amend the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. Prioritising British students in the selection process would have been the right thing for the Government to do, but way the Medical Training Act has been drafted places British students who studied at international branch campuses of British universities at a disadvantage.

On Second Reading of the Act, a Member spoke of a constituent who had been given

“a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus.”—[Official Report, 27 January 2026; Vol. 779, c. 801.]

Another Member said that he had

“representations from all quarters, both in the UK and in Malta, about the impact on Malta of this.”—[Official Report, 27 January 2026; Vol. 779, c. 802.]

My right hon. Friend the Member for South West Wiltshire (Dr Murrison) asked about

“British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service”. —[Official Report, 27 January 2026; Vol. 779, c. 803.]

The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke of a constituent who was schooled and grew up here and was

“given a guarantee by the university that she would face no disadvantage compared with students on the London campus.”—[Official Report, 27 January 2026; Vol. 779, c. 842.]

These concerns are shared across the House.

Young British people who have trained at a British or London-based university and gone to study in Malta, perhaps in an adventurous spirit—it is a beautiful place to go—and have graduated with a British degree have found themselves at the back of the queue, unable, round after round, to get jobs in the foundation programme in their home country. That will not just be the case for students who are due to start their degree; it is the case for students who have just completed their degree. They have done the five years of training, they have worked really hard and they have passed their exams, but suddenly they cannot get a job on the foundation scheme in their home country to complete their full registration with the General Medical Council.

Our new clause would ensure that British citizens who studied at international branch campuses of UK higher education institutions can be prioritised. I invite Members to do right by our constituents and the NHS and to vote for it.

[Karin Smyth]

I appreciate the intention behind new clause 87, but the Government cannot support it. The Medical Training (Prioritisation) Act is designed to support a sustainable medical workforce that can meet population health needs and deliver the best patient care while reducing the UK’s reliance on an unpredictable international labour market. By creating a clear pathway for medical school to speciality training, we also strengthen domestic talent and improve retention.

What matters is where a doctor is trained, not where they were born. Data shows that domestic graduates are more likely to stay in the country they trained in than those trained internationally. Doctors trained primarily in the UK are also likely to be better equipped to deliver healthcare that is tailored to the UK’s population, because they have a stronger understanding of UK-specific epidemiology and NHS practice.

In addition, the Government set UK medical school places based on future health system needs. Student intakes and graduate outputs of overseas campuses are not included in our domestic workforce planning. If we prioritised British citizens for foundation training regardless of where they studied, it would undermine our aim to build UK-trained capacity while ensuring that we do not provide more foundation programme places than we need.

I would like to emphasise—this is an important point—that prioritisation does not mean exclusion. Non-prioritised applicants can still apply for the foundation programme and will be offered places if vacancies remain after prioritised applicants have received offers—I understand that is already happening for the 2026 recruitment round. For individuals who do not secure a foundation post this year, there remain alternative routes to pursuing a medical career in the UK. Those include obtaining GMC registration through the established pathways, such as completing an approved internship in the country where they trained and entering the UK healthcare system through a locally employed doctor role or other non-training posts. I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clauses.

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[Dr Johnson]

It would amend the relevant part of the Medical Training (Prioritisation) Act 2026, so that when people are put forward for these jobs in the foundation programme, it should be done on the basis of merit. At the moment, as the hon. Member is aware, it is done on the basis of random allocation—preference-informed allocation—which I think is wrong. I would be interested to know the Minister’s thoughts on the subject.

[Karin Smyth]

This is an area of some discussion, some of which we have heard, but we do not think it is necessary, where we are now, to put such a measure in primary legislation. The Medical Training (Prioritisation) Act establishes a statutory process for prioritising certain groups for training posts; it is not intended to change eligibility for training or the high standards that applicants must meet. Embedding some of these provisions in primary legislation would leave them inflexible to future workforce needs or standards of education and training. If Parliament wishes to change how recruitment processes themselves operate, that is best done outside legislation through established routes.

The preference-informed allocation system was introduced in 2024 following stakeholder engagement, because the previous system was felt to be unfair and stressful for applicants, with a lack of standardisation across schools. Since its introduction, as I understand it, 82% of applicants have been allocated their first choice of foundation school this year, up from 71% in 2023. NHS England has committed to a review of the system, which will commence later this year. Prescribing the allocation method in legislation would pre-empt that review and limit our ability to make future changes to ensure that the system remains fit for purpose. On that basis, I ask the shadow Minister to withdraw the new clause.

[Dr Johnson]

The new clause deliberately says that applicants would be prioritised based on merit, and it gives examples of ways in which merit might be judged. I understand what the Minister says about some people getting the job of their choice, but the people who do not have no control over the process, and no ability to influence it through their own hard work and effort. That is fundamentally wrong in principle. Although I recognise that the current method was brought in as a result of consultation, I feel confident that the same consultation, done now, would reject it. We would like to vote on the new clause.

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.

During a Westminster Hall debate in December, a Government Minister said:

“In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan”.—[Official Report, 4 December 2025; Vol. 776, c. 472WH.]

We are now in the second half of 2026. Members may be familiar with the charity Headway UK, which does phenomenal work to support people affected by brain injury, including people in my constituency. Headway has called for the Government to treat the plan as a priority, reiterating that every delay has real consequences and that survivors need support now. The all-party parliamentary group for acquired brain injury, which the hon. Member for Blaydon and Consett has done a great deal to support, has called for the Government to take action.

So why is action not forthcoming? Why have the Government failed to deliver another policy on time? It is part of a pattern. The Government spent a year writing a 10-year plan. They spent another year working on a workforce plan, which still has not been published. It is simultaneously “imminent” as of 30 days ago and non-existent today. They are behind on the Hughes report, the modern service frameworks, universal 24/7 mechanical thrombectomy, fracture liaison services and more.

The new clause would simply commit the Government to delivering on their promise to the 1 million people living with the effects of acquired brain injury. I struggle to see how the Assistant Whip can compel Members to vote against that.

[Karin Smyth]

I think all Committee members can recognise the importance of this issue. An acquired brain injury is a life-changing event for those affected, and for their families and loved ones. Its treatment involves co-ordination between primary, community, secondary and specialist care, and is personalised to the needs and life circumstances of the individual. Its effects are not limited to a person’s health: it can impact their journey through education, their employment prospects and so many other aspects of life. Because of that, they rightly expect coherent, joined-up support from across Government.

Therefore, as we have discussed, we are working in partnership with eight other Government Departments, ABI charities, patient representatives and the NHS to develop an ABI action plan. We also continue to work closely with the United Kingdom Acquired Brain Injury Forum, which is the umbrella organisation for brain injury charities, as the plan develops and moves towards publication.

[Karin Smyth]

I thank my hon. Friend for her work on and commitment to this issue, as was highlighted by the shadow Minister. I thank her also for her work on the APPG and with organisations such as Headway, to which we pay tribute for its work supporting patients and the public, and for her work with Members of Parliament and the Government on getting this right, which is legion. My hon. Friend has made similar comments in the House. The Minister responsible is continuing to work on the action plan, which I will talk about as we continue our consideration.

The new clause raises the issues of prevention, identification, acute treatment, rehabilitation, long-term support, care planning, workforce capability, data and research, all of which are being considered in the work being done across the eight Departments. The Government agree that there should be a plan, and the relevant Minister, to whom I will of course pass my hon. Friend’s comments, will be working on that.

The question is whether the proposals in the new clause are best placed to ensure that any plan will be robust, sustainable and timely for the patients it is designed to serve. I say gently to the shadow Minister that I think they are not. First, setting an arbitrary 30-day timeline for publication risks causing either an unnecessary delay or a duplicate plan. Secondly, as I hope she will appreciate, we have engaged more widely than with just the three Departments named in the new clause. As I have said, as many as eight Departments are contributing, which reflects the wide range of areas that are impacted by brain injury.

Let me give the shadow Minister the assurance that I believe she is seeking, as are others: a plan will be published as soon as possible. That plan is being developed with the breadth, rigor and pace that the issue demands and is receiving input from across the health system, as well as from other Departments responsible for supporting people with acquired brain injuries and sector-specific stakeholders and organisations. I hope that she will work with us to support the plan once it is published, in the interests of our constituents, who desperately require a new approach to ABI prevention, care and support. I ask her to withdraw the new clause.

[Dr Johnson]

The Minister said that the plan is being developed with the pace that is needed, but it is not. It was due to have been published already, but it has not been. It was due to have been published, then a later promise was made, and now she is making another promise with an uncertain date. I just do not think it is good enough. A theme of our consideration this afternoon has been all the different things the Government have promised but have failed to deliver.

--- Later in debate ---

[Dr Johnson]

New clause 109, tabled in my name, is very simple, requiring hospice funding to be provided in three-year blocks. Hospices are struggling under the weight of the national insurance rise in the Government’s first Budget, so they would benefit greatly from having a bit more certainty over how much their funding will be from year to year. I am interested to hear the Minister’s response to the new clause.

[Karin Smyth]

This is a really important subject, as everyone approaching the end of their life deserves dignified, compassionate and high-quality palliative and end-of-life care. Hospices provide extraordinary care, and hon. Members are right to highlight the issues the sector faces. That is why the Government are committed to developing a modern service framework for palliative care and end-of-life care. The final framework will be published in the autumn.

New clause 108 would require integrated care boards to collect and report data on people who died while waiting for end-of-life care. It would also require the Department of Health and Social Care to publish that information nationally. New clause 109 would impose a single statutory three-year funding period on hospice funding. Both new clauses are likely to be answered by work already under way or included in the modern service framework.

On funding, we recognise that the sector faces a serious challenge, and the Public Accounts Committee found in March that integrated care board funding ranges from 0% to 80% of an individual hospice’s income, and that commissioning relies on grants and block contracts. There are also wider funding issues, such as the reliance on historic grants.

The Government are acting on those issues, and we have provided around £80 million over three years for children and young people’s hospices, or at least £26 million a year to 2028-29, adjusted for inflation. We have also provided a separate £125 million capital boost for both adult and children and young people’s hospices. That is the largest investment in hospices for a generation.

The MSF will support commissioning away from grants and block contracts to sustainable contracts based on integrated assessment of population need. It will consider contracting arrangements more widely, including a move away from short-term grant funding as part of the more comprehensive reform that the sector agrees it needs.

We are also strengthening data and evidence. We commissioned the National Institute for Health and Care Research’s policy research unit to build the evidence base on palliative and end-of-life care, including on inequalities in access and the identification of need.

We also expect the MSF to give us better insight into the performance of the system. Its metrics and accountability framework are being co-developed with people with lived experience and partner organisations from across the sector. It will measure identification, access, quality, outcomes and inequalities.

In the context of that ongoing work, the new clauses are not necessary. The MSF will give the House and the public a far more comprehensive picture of access to care than a single count could. It will also do so as part of improving the entire patient journey for people who need palliative and end-of-life care. Because this is a non-statutory approach, there will be more flexibility to adapt and change over time, rather than the system being required to follow requirements set out in primary legislation. I hope that that gives hon. Members the reassurance they need not to press their new clauses to a vote.

--- Later in debate ---

[Dr Johnson]

Under the previous Conservative Government, the NHS constitution was updated with a commitment to guarantee that

“those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside.”

The previous Government also introduced the veterans’ strategy action plan, committing NHS England to providing millions of pounds for specialised support services. Ministers also introduced a single point for veterans to access mental health services and support. The previous Conservative Government also created an armed forces covenant duty. Today, we need to see the principles the covenant brought to life at all levels of Government.

Only last week, I received an email from a constituent who has moved around because of her husband’s service in the armed forces and who was struggling to access specialist services for her child’s health as a result. That is why we need new clause 112, which would require the Health Secretary to report on how they are meeting the duties under the covenant. Members will know that I am cautious about mandating any more paperwork, but veterans are being let down. We need some accountability. That report would hopefully achieve that, so I commend the new clause to the Committee.

[Karin Smyth]

On new clause 110, the Government are proud of the courage and dedication of our armed forces. We must all play our part in upholding the armed forces covenant, including for our armed forces veterans. The original covenant was under a Labour Government; I was proud, as part of my commissioning duties in Bristol, to work with the Royal British Legion to implement that more than a decade ago, and the work continues. I am therefore sympathetic to the intention to promote the health and wellbeing of our armed forces veterans, but I can assure hon. Members that the new clause is not necessary.

The Government’s vision for veterans is clearly set out in the veterans strategy, which recognises veterans as one of the UK’s greatest strategic assets. Furthermore, the existing armed forces covenant duty already places a legal obligation on integrated care boards to give due regard to the unique obligations and sacrifices of the armed forces when carrying out their statutory duties.

--- Later in debate ---

[Karin Smyth]

I will respond to the hon. Gentleman in a moment, but first I will address clauses 68 to 72, as well as amendment 77, which was tabled by the hon. Member for North Shropshire.

Clause 68 will allow the Secretary of State, by regulations, to make provision that is consequential on this Bill. Amendment 77 would amend that provision. The Government recognise the importance of parliamentary scrutiny of the significant changes proposed in the Bill. While the Bill contains some new regulation-making powers, the majority are existing powers that have been amended in the light of the abolition of NHS England. They will therefore be uncontroversial and consequential, so we consider it proportionate for the same parliamentary scrutiny arrangements to continue to apply in respect of those powers.

However, where we are introducing new regulation-making powers, we have carefully considered what parliamentary scrutiny arrangements should apply. For example, any regulations that are made to facilitate the single patient record will be subject to the affirmative procedure, because we understand the importance of debating that issue in both Houses. Furthermore, any statutory instruments made under clause 68 that amend, repeal or revoke provisions made by primary legislation will be subject to the affirmative procedure and will need to be debated and passed by both Houses. I hope that the hon. Member for North Shropshire agrees that a blanket requirement for the affirmative procedure would be disproportionate. She said that she will not press amendment 77 to a vote, but I hope that what I have said provides her with the reassurance she was seeking.

Clause 69 is a standard clause that appears in Bills that provide for the expenditure of public money. It simply provides for any expenditure incurred by the Secretary of State as a result of changes made under the Act, once it has received Royal Assent, to be paid out of money provided by Parliament.

Clause 70 sets out the territorial extent of the Bill. While most of its provisions extend only to England and Wales, some are UK-wide. The clauses in the Bill largely apply to England only, and in previous sittings we debated the consequences for Wales, Scotland and Northern Ireland, and any issues relating to devolution, as and when they have arisen. Amendments to other legislation made by this Bill will have the same territorial extent as the legislation that will have been amended.

Clause 71 sets out when provisions in the Bill will come into force once it has received Royal Assent. As is usual, the clause provides the Secretary of State with the power to commence the majority of the Bill’s clauses on a date to be set out in regulations. It may also be appropriate to bring different provisions in the Bill into force at different times, and the powers in clause 71 will allow for that. The powers will also enable the Secretary of State to make saving or transitional provision in connection with the coming into force of any provision, which will enable the commencement of the Bill to operate smoothly and efficiently.

Under clause 63, as the Committee has heard, the Care Quality Commission will be able to take action to bring proceedings against a health and social care provider for a serious breach of regulations. However, that provision will apply only to new offences. To ensure that we can act to prevent cases falling through the gaps, we are committed to bringing in the measure as soon as possible after Royal Assent, while respecting the routine two-month window, as is set out in the Bill.

Clause 72 is self-explanatory and provides that, once passed, the Bill may be cited as the Health Act 2026. I commend the clauses to the Committee.

Before I conclude, I put on record my thanks to you, Ms Lewell, and to the right hon. Member for Herne Bay and Sandwich (Sir Roger Gale), my hon. Friend the Member for Ealing Central and Acton (Dr Huq) and the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), for guiding this Committee—[Hon. Members: “Hear, hear.”] I also thank the Clerks for everything that they have done behind the scenes. This is the first Bill that I have taken through a Public Bill Committee, and the work really is quite legion. The Clerks’ expertise is second to none and a delight to see closely.

Equally, I thank the officials in the Department of Health and Social Care and the lawyers, some of whom have worked on several Committees over the years. Again, I have learned so much from them and their expertise. It is a dedicated team, and their hard work and expertise on Bills over many years is good to see. I thank them for their support in making this Bill go forward.

I thank the hon. Members for Farnham and Bordon and for Sleaford and North Hykeham for their kind comments and good wishes. I also thank members on both sides of the Committee for their contributions over the past few weeks. Despite the heat, I, too, have enjoyed our discussions. I think that we have given the Bill a very good airing and there has been constructive engagement and scrutiny. They have given us lots of food for thought, which we have taken careful note of, regardless of whether we have taken up the amendments.

[Dr Johnson]

I echo the Minister’s thanks to the Clerks, House staff and others, as well as members of the Committee. Leaving aside the heat, I have also enjoyed our exchanges. I hope that the Minister has a good recess and that she does well in the upcoming reshuffle.

[Karin Smyth]

I thank the hon. Member for her kind comments. As the former Minister, the right hon. Member for Melton and Syston, recognised, I have been on the other side when considering a previous Bill. Opposition is hard work—the process is quite hard work on this side—and I commend Opposition Members for conducting that important scrutiny. I thank Members for their contributions and I think the Bill is stronger for those efforts.

Health Bill (Sixteenth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 16th July 2026 Public Bill Committees

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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 ---

[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 ---

[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 ---

[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.

Health Bill (Fifteenth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Karin Smyth]

I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health.

My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel.

In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking.

The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages.

Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.

[Dr Johnson]

The Minister is very, very aware of my views and opinions on the Tobacco and Vapes Act, particularly on vaping and stopping vaping among children. That Act, a bit like this Bill, left lots of opportunities for the Government to provide for regulations. Anyone who has been in a shop in the past few days will have seen vapes still behind the counter, still very visible, very colourful and in lots of different flavours and suchlike. Can the Minister update the Committee, and therefore the House, on when she expects the regulations provided for by the Tobacco and Vapes Act to come into force, so that we can actually apply the law, as opposed to just having it sat on the statute book?

[Karin Smyth]

Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.

--- Later in debate ---

[Karin Smyth]

I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it.

Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery.

What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there.

On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances.

Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause.

As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed.

On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities.

Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted.

Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister.

The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.

[Dr Johnson]

I understood that one of the Government’s greatest priorities was to reduce waiting lists, but one of the things that people are waiting for the most is musculoskeletal or orthopaedic treatment. Why is it not a priority for the Government?

[Karin Smyth]

There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken.

She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.

[Dr Johnson]

I am not opposed to the principle of GPs seeking advice or guidance; the issue is the compulsory nature of that and GPs not being able to refer.

[Karin Smyth]

The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that.

The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.

--- Later in debate ---

[Karin Smyth]

Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House.

The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do.

I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important.

I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.

[Dr Johnson]

I thank the Minister for her good wishes. The council has not just proposed closing Swallow Lodge; it has also recently closed the memory support service. I listened to what my hon. Friend the Member for Isle of Wight East said about services for people with dementia, and this is another area where people will suffer because of the closure of vital services.

[Karin Smyth]

When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents.

We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers.

Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.

--- Later in debate ---

[Dr Johnson]

The hon. Member for Dewsbury and Batley (Iqbal Mohamed), who tabled new clause 25, asked me to speak to it, which I shall do briefly. This is a very serious issue. Critically ill children are infants, children and adolescents with life-threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and major surgery such as spinal surgery. I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior—now called a resident—doctor.

The new clause as drafted does not, I think, do what the hon. Member was aiming for. When I read it through, I think he is looking at cases such as the tragic one of little Charlie Gard, whom we all remember died of encephalomyopathic mitochondrial DNA depletion syndrome, known as MDDS. It is incredibly rare. That tragic case highlighted the potential for disputes between parents and doctors, which, thankfully, are unusual.

The new clause is headed, “Parents of critically ill children: communication and involvement in decision-making”. Of course parents should be involved in decision making about their children, but it is worth noting that the median time that children spend in ICU is two days and that, thankfully, most of them get better—very few do not. The new clause talks about teachers being involved, which in most cases is unnecessary and impractical; in many cases, a child may be admitted on a Friday and discharged from the ICU by the Monday. In the majority of cases, there is no practical reason for teachers to be involved.

I understand the desire for parents to be part of every meeting, but sometimes clinicians need to be able to talk frankly about cases. Sometimes they will have multidisciplinary meetings where they talk about a plethora of different cases, or they may compare one case with another in terms of what they have seen, the findings of scans and the like, so it is not possible to have parents in every single meeting, although it is of course desirable for them to be aware of the discussions.

Other parts of the new clause, including provision for parents to know about everything and to set out how communication and language needs may be met, seem reasonable. It mentions independent mediation where there is disagreement, which is a beneficial way to go about things, but we must not legislate so as to get in the way of urgent care, because most critically ill children in intensive care have urgent care needs that need dealing with now, not in a week’s time. Forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care.

I think the hon. Member for Dewsbury and Batley is aiming for legislation that relates to chronically mechanically ventilated children with significant medical conditions, rather than children with an acute critical illness, but I said I would move the new clause and I have. I think he is trying to provide better care for some of the sickest children. That is a desirable aim and I know he cares deeply about it, but the new clause as drafted would not do what I think he aims for, and it could get in the way of paediatricians and others managing some of the sickest children in the country, so I will not press it to a vote.

[Karin Smyth]

I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee.

I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible.

New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time.

Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child.

To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.

[Dr Johnson]

The Minister is setting out the important guidance that can be provided to clinicians managing the care of children who are seriously unwell. I want to add for the record that I am a member of the Royal College of Paediatrics and Child Health, which is producing that guidance; I am grateful to her for setting out its importance. End-of-life-care decisions are very difficult. They need to be taken in conjunction with families but—the Minister is absolutely right—they must be made in the best interests of the child in all cases.

[Karin Smyth]

I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system.

There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 28

Appeals against health and social care provision in EHC plans

“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).

(2) After regulation 42, insert—

‘42A Other matters relating to EHC plans against which appeals may be brought

(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).

The matters are—

(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;

(b) where an EHC plan is maintained for the child or young person—

(i) the child’s or young person’s health care or social care needs as specified in the plan;

(ii) the health care provision or social care provision specified in the plan.’

(3) In regulation 43 (appeals), after paragraph (2) insert—

‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);

(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).

(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;

(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;

(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and

(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.

(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);

(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).

(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;

(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;

(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and

(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.

(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.

(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.

(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—

(a) the child's parent or the young person, and

(b) the local authority that maintains the EHC plan.

(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.

(11) A response under paragraph (9) must—

(a) be in writing,

(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and

(c) give reasons for any decision not to follow the order, or any part of it.

(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.

(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.

(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.

(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’

(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.

(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—

(a) regulation 10(3)(e);

(b) regulation 14(2)(e);

(c) regulation 201(11)(e);

(d) regulation 21(10)(e);

(e) regulation 22(5)(e);

(f) regulation 25(2)(e); and

(g) regulation 31(3)(e).”—(Dr Chambers.)

This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.

Brought up, and read the First time.

Health Bill (Fourteenth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Dr Johnson]

I agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.

[The Minister for Secondary Care (Karin Smyth)]

It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.

There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.

The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.

Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.

--- Later in debate ---

[Gregory Stafford]

It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.

It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.

I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.

That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.

Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?

[Karin Smyth]

Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.

On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.

NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.

As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.

On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.

At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.

There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.

The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 12

Corridor Care Accountability

“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.

(2) A report under subsection (1) must include—

(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,

(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,

(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and

(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.

(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—

(a) patients,

(b) bereaved or affected families, and

(c) frontline NHS staff who have been impacted by corridor care.

(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.”

This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff.—(Helen Morgan.)

Brought up, and read the First time.

--- Later in debate ---

[Dr Johnson]

I am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.

[Karin Smyth]

To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.

[Dr Johnson]

I think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.

Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.

Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.

Health Bill (Thirteenth sitting)

Debate between Caroline Johnson and Karin Smyth

Tuesday 7th July 2026 Public Bill Committees

[Karin Smyth]

I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I want to make some points first. I will pick up any outstanding points I do not cover.

The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.

Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:

“by bringing HSSIB into the CQC, you can align the work of the two.

For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]

to enable best action. These organisations can learn better from each other.

Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.

--- Later in debate ---

[Karin Smyth]

I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

[Dr Johnson]

My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?

[Karin Smyth]

I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.

The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.

New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.

Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.

As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.

I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.

The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.

The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.

The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.

Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.

[Dr Johnson]

The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?

[Karin Smyth]

We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.

Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.

I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.

Question put, That the clause stand part of the Bill.

--- Later in debate ---

[Karin Smyth]

Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.

On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.

NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.

This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.

This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.

[Dr Johnson]

I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?

[Karin Smyth]

My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.

Question put and agreed to.

Clause 62 accordingly ordered to stand part of the Bill.

Clause 63

Time limit for bringing proceedings

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.

Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.

The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.

A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.

[Dr Johnson]

As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.

[Karin Smyth]

Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?

[Dr Johnson]

The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.

The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.

The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?

[Karin Smyth]

Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.

Question put and agreed to.

Clause 63 accordingly ordered to stand part of the Bill.

Clause 64

Abolition of Healthwatch England

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Karin Smyth]

Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.

At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.

This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.

As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.

Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.

[Dr Johnson]

As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.

There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?

The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?

The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.

The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?

The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?

Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.

--- Later in debate ---

[Karin Smyth]

I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.

These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.

New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.

Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.

The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.

The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.

New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.

New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.

Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.

In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.

[Dr Johnson]

New clause 91 would amend the Medicines and Medical Devices Act to enable regulations

“to refer to both international agreements and standards and standards developed in the United Kingdom”

and enable the Secretary of State

“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”

New clause 92 would amend the definition of “mutual recognition agreement” so that

“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”

New clause 93

“amends the duty to consult in relation to regulations about human medicines and medical devices.”

That means that instead of a public consultation, it

“gives the option of consulting such persons as the relevant authority considers appropriate”.

I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.

New clause 94

“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”

That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.

Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.

[Karin Smyth]

I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.

Question put and agreed to.

New clause 91 accordingly read a Second time, and added to the Bill.

New Clause 92

Medical Devices Regulations 2002: mutual recognition agreements

“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.

(2) For regulation 1A (Schedules) substitute—

‘1A Schedule

Schedule 2A has effect.’

(3) In regulation 2 (interpretation), in paragraph (1)—

(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;

(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.

(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)

This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.

Brought up, read the First and Second time, and added to the Bill.

New Clause 93

Consultation about medicines and medical devices regulations

‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.

(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.

(3) After subsection (1) insert—

“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—

(a) carry out a public consultation, or

(b) consult such persons as it considers appropriate.”

(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.

(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)

This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.

Brought up, read the First and Second time, and added to the Bill.

New Clause 94

Medicines and medical devices regulations: parliamentary procedure

‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—

“(3) Regulations under Part 1 are subject to the draft affirmative procedure.

(3A) Regulations under Part 2—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on section 6(1)(a) (fees);

(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);

(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—

• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),

• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),

• Schedule 15 (requirements for specific products subject to general sale),

• Schedule 16 (patient group directions and vaccine group directions),

• Schedule 17 (exemption for sale, supply or administration by certain persons),

• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),

• Schedule 19 (medicinal products for parenteral administration in an emergency), or

• Schedule 21 (medicinal products at high dilutions);

(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;

(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);

(b) are subject to the made affirmative procedure if they—

(i) contain only provision that is made in reliance on section 7 (emergencies),

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and

(iii) are not within paragraph (a);

(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).

(3B) Regulations under Part 3—

(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).

(3C) Regulations under Part 4—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on—

• section 17(1)(a) (fees), or

• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);

(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;

(b) are subject to the made affirmative procedure if they—

(i) contain only provision made in reliance on section 18 (emergencies), and

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;

(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)

This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).

Brought up, read the First and Second time, and added to the Bill.

New Clause 95

Medical devices etc: parliamentary procedure for certain fees regulations

‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—

(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.

(b) after sub-paragraph (1) insert—

“(1A) Provision falls within this sub-paragraph if it relates to—

(a) altering the amount of a fee or charge to reflect changes in the value of money,

(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or

(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).

(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—

(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or

(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,

as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)

This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.

Brought up, read the First and Second time, and added to the Bill.

New Clause 1

National Maternity Commissioner

“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.

(2) The functions of the National Maternity Commissioner are to—

(a) oversee NHS maternity services;

(b) act as an independent voice for women and families;

(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;

(d) promote consistency, safety and accountability across NHS maternity services; and

(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.

(3) The person appointed as Commissioner must—

(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;

(b) have first-hand experience of working in maternity services, so far as reasonably possible; and

(c) not be a sitting Member of Parliament.”—(Helen Morgan.)

This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.

Brought up, and read the First time.

--- Later in debate ---

[Dr Johnson]

As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.

New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012 and 2013.

I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.

The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.

My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.

I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.

[Karin Smyth]

I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.

Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.

That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.

As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.

I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.

The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.

As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.

[Dr Johnson]

We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?

[Karin Smyth]

I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.

On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.

Health Bill (Twelfth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Karin Smyth]

Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.

My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.

The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.

We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions.

Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.

The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.

Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.

The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.

The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.

Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.

Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.

Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.

[Dr Johnson]

These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.

When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.

Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.

One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.

That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.

At the time that HSSIB was established, there was consensus about it. The General Medical Council said:

“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”

The British Medical Association told Parliament:

“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”

Similarly, NHS Providers told Parliament:

“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”

Indeed, the Minister for Secondary Care herself is on the record as having said:

“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.]

I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.

In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.

Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that

“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,

and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.

The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that

“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”

Health Bill (Eleventh sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

Wherever possible, the single patient record will build on source records such as GP records. As such, it will include relevant patient information and, where appropriate, digital markers such as those suggested in the amendments. We have had some useful discussion as a result of the amendments, but such considerations are generally operational, and legislation is neither necessary nor practical.

On amendment 71, Members will know that the Government have been doing significant work in support of a digital medical marker for firearms. Medical information for firearms licensing provided by the applicant has been a mandatory requirement for every firearm and shotgun licence application since November 2021, as we have heard, when the new statutory guidance for chief officers of police on firearms licensing was introduced. When any individual applies for a firearms licence, the applicant’s doctor must provide details of any relevant medical conditions, such as depression, dementia, mental health conditions or drug or alcohol abuse.

A digital maker is placed on the GP patient record when a certificate is granted, and a GP can alert the police if a licence holder has a relevant medical condition. The digital marker automatically flags to the GP if a patient is suffering from a relevant medical condition and is a firearms certificate holder. It is true that the marker is not legally mandated, but it is supported by the British Medical Association and the Royal College of General Practitioners, and the former issues guidance to GPs about the firearms marker.

GPs already have professional duties to consider patient and public safety, and existing firearms licensing arrangements support GPs to share relevant concerns with the police where appropriate, while the responsibility for licensing decisions rests with the police. Data shows that, since its introduction in 2023, the marker is being used and that GPs are notifying police of medical issues that have arisen. There is nothing to suggest that the system is not effective.

[Dr Johnson]

Is it not also the case that anyone who is aware that an employee or relative has a licence and is concerned about their mental health can make such a report?

[Karin Smyth]

I am afraid I do not know the answer to the hon. Lady’s question, but if it is relevant, I will try to get back to her on it.

People applying for a licence must now indicate whether they have seen a medical practitioner other than their GP. The Government also intend to make a statutory instrument to require licence holders to inform the police if they consult a third-party medical practitioner who is not their GP.

The single patient record will build on and connect with information from GP source records where appropriate; no new provision is needed for that to happen. That process should be agreed as part of operational arrangements with the profession, in line with the current approach to markers in the GP record. If it is agreed that it would be beneficial for health and care professionals to have wider access to the firearms marker, the single patient record could facilitate that, but we do not intend to fill the Bill with detailed operational requirements such as that.

We do not believe that the SPR is the appropriate vehicle for having a debate about regulations requiring a report on the merits of a mandatory marker. As the hon. Member for Farnham and Bordon said, we should not expand the clearly defined scope of the single patient record—the scope is limited to direct care—to include a debate about what is stored more generally in NHS records. For those reasons, I ask the hon. Member for Winchester to withdraw amendment 71.

On amendment 72, as I have already outlined, the single patient record will build on and connect with existing source records, such as GP or hospital records, wherever possible. Where a person’s status as a military veteran is recorded, it will be possible to make that information available in the single patient record. Therefore, the provisions already ensure that the information is made available, where veterans opt to have that status recorded—that addresses some of the other issues raised by the hon. Member for Farnham and Bordon. There is no need to make any statutory requirement to ensure that staff have that information and consider any necessary adjustments or potential treatment options that may be relevant to ensure safe and effective care.

In addition, the clause contains powers to make regulations to allow people involved in the provision of an individual’s direct care, including that of any veteran after they have left the military, to access their single patient record. We want the single patient record to improve the accessibility and effectiveness of care for everyone. That includes making sure that military veterans can access necessary support and that staff can provide them with appropriate care. Furthermore, duties in the Armed Forces Act 2006 require the NHS and local authorities to have due regard to the armed forces covenant, which, of course, I fully support. For those reasons, I ask the hon. Member for Winchester not to press amendment 72.

--- Later in debate ---

[Dr Johnson]

I am advised to declare that, although I am not a licence holder of a shotgun or a rifle, my husband has both a shotgun and a firearms licence.

[Karin Smyth]

I am grateful to hon. Members for this debate. Meaningful public engagement will be key to the success of the single patient record—we absolutely understand that—in building awareness and in designing the system. It has to have digital inclusion at its heart, but adding statutory requirements for public awareness campaigns and risk assessments is not the way forward. Amendment 49 seeks to put such a requirement on a statutory footing. I want to reassure the Committee and all Members: as the right hon. Member for Melton and Syston said, public awareness is absolutely key and will be integral to success. Work is already under way to ensure that we do that; we do not need to wait, nor should we be constrained by the proposed amendment.

In 2024, we began extensive public engagement on the use of data across health and social care, which showed strong support for the single patient record. We have heard that most people felt it was

“long overdue and a necessary step towards better care”.

The public engagement findings indicated support to progress at pace on the concept of a single patient record, to resolve the frustrations that patients and the public have when they have to repeat their story at multiple health and care settings.

As we move towards our ambition to give all patients in England access to a core set of their data through the single patient record from 2028, we will maintain a sustained drumbeat—as they say in the jargon—of public communications to raise awareness of the single patient record. We have heard some examples of where the Government do that well. Of course we want to learn from such examples across the country and from previous Government campaigns that have worked well, to explain the benefits and safeguards in plain English, and to signpost accessible information and feedback routes for patients and the public. I heard the comments made about people who may be excluded or have particular disabilities, including some older people—from conversations with my own constituents, it is often older people or those with multiple disabilities who can have their experience enhanced. We should make no assumptions about who does or does not feel excluded in this space; we need to learn from them all.

Furthermore, we have already published public-facing single patient record information and a dedicated feedback route. We will continue to co-create plain English, easy-read and translated materials, frequently asked questions and “voices heard/action taken” updates with public panels and patient groups ahead of roll-out. We will build on what we learn from that ongoing work as we develop the regulations. For those reasons, I respectfully ask the hon. Member for Sleaford and North Hykeham not to move amendment 49.

On the lead amendment, moved by the hon. Member for North Shropshire, we recognise, as I hope I have assured the Committee, that digital inclusion is an important issue. To quote another Member, we are eager to get it right, and we are taking it very seriously. Digital inclusion is a key driver in addressing health inequalities, supporting individuals and empowering people to better manage their health, which is at the heart of our 10-year plan. It is a system-wide issue, and one that the health and care system is taking action to address. We have considered this as part of the equality impact assessment of the single patient record provisions in the Bill, and will continue to keep those issues and potential mitigations under consideration throughout the development and implementation of the SPR. Therefore, although we agree with the aim of the amendment, we do not consider it necessary. Indeed, it would duplicate work that has already been done.

--- Later in debate ---

[Karin Smyth]

This is another important discussion to have on the record to give patients and the public confidence as we introduce the vital single patient record. I start by stating that the security and privacy of people’s health data is paramount, and we will build the strongest safeguards possible into the record. Members from across the House have asked how those safeguards will be built into how the system is designed and operated, which is what we are doing.

It will operate on a roles-based access control model, similar to other NHS patient record systems where access to patient information is restricted to the authorised user only. The single patient record will go a step further by applying advanced cloud-based audit and oversight capabilities, enabling near real-time monitoring of system access and detection of unusual or inappropriate patterns. That will allow NHS security teams to track and detect access patterns, and to quickly intervene if specific records are accessed by staff who have no clinical relationship with the patient in question.

The single patient record will ensure that just because a clinician has permission to view a specific patient record, that does not mean they are authorised to do so without a clinical need. The security and access arrangements will be set out in the regulations themselves, which will be debated, rightly, in Parliament. Therefore, it is not necessary to set them out in a plan beforehand.

Furthermore, there are already existing enforcement arrangements that provide sanctions for inappropriate access to patient data, which will also include accessing the single patient record. I commend my hon. Friend the Member for Ashford for his extremely helpful intervention, in which he highlighted his own experience in this field. Some of the examples that we heard again today, including Southport, Nottingham, the recent case in Cambridge and others, are truly shocking to people. Clearly, that should never happen, but sadly it has. As my hon. Friend rightly outlined, there are provisions in place for training people on information governance and tracking when that happens.

Additionally, I want to be clear that the Computer Misuse Act 1990 makes it an offence to use a computer to access information in an unauthorised manner, such as a person accessing information without a legitimate reason. Inappropriate or unauthorised access to health records—often referred to as snooping—is a serious offence that can lead to severe penalties, including dismissal, criminal prosecution and financial penalties. Regulated healthcare professionals, such as doctors, nurses and pharmacies, can be reported to their respective professional bodies, which can result in them being struck off in serious cases.

The information commissioner also has powers to investigate and take action against infringements of data protection legislation, which can include monetary penalties, enforcement notices, undertakings, prosecutions and reprimands. Furthermore, patients have a right to access data that is held about them under the data protection legislation, and those rights will continue to apply to the single patient record. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment.

[Dr Johnson]

We think this is an important issue, so we would like to divide the Committee.

Question put, That the amendment be made.

--- Later in debate ---

[Karin Smyth]

Clauses 49 and 50 explain our approach to the transfer of NHS England’s existing data and information functions to the Secretary of State. Slightly counterintuitively, I will start with clause 50 before turning to clause 49.

Clause 50 inserts schedule 7, which takes existing NHS England information functions and transfers them to the Secretary of State for Health and Social Care, as part of a single centre for data and digital policy in the NHS. The schedule also includes changes to existing information functions. This will support the shift from analogue to digital and allow us to make the most of opportunities from data and AI, as set out in the 10-year health plan. The changes will not weaken the fundamental safeguards in place to protect health and care data, nor fundamentally change rules relating to how confidential patient information can be used.

I will now outline some key changes made by the clause. It will ensure that information systems for the NHS are set up, where appropriate, not just for the collection and analysis of data but for processing more generally. This will make it easier to support machine learning and artificial intelligence activities, among other uses of data.

The clause extends the extent of chapter 2 of part 9 of the Health and Social Care Act 2012 to the whole of the UK, and provides for the Secretary of State to establish information systems in the interests of the health service or adult social care in England, or in connection with the provision of care across the British Isles, as NHS England currently can.

The clause enables the Secretary of State to issue guidance to health and social care bodies on the processing of information. It transfers to the Secretary of State NHS England’s powers to require and request information, and such requests will be able specify the form, manner and time within which the information requested is to be provided.

The clause also allows the Secretary of State to publish information obtained in the operation of an information system, including information about service providers. Where NHS England had a duty to publish such information, it is right that the Secretary of State should retain discretion in that regard. Obviously, there may be circumstances in which the publication of data would not be appropriate, and the clause does not give the Secretary of State complete freedom to publish personal information. The Secretary of State may publish personal information without patient consent only where it is for the protection of life or health, or for the protection of public safety or security. It is possible that there could be circumstances—for example, in relation to infectious disease—in which information is published that could lead to an individual being identified. None the less, the change simplifies the process of publication while maintaining a high bar for the publication of personal information.

The Secretary of State’s power to disclose information—for example, to health bodies—other than by publication will be slightly different from NHS England’s current power. The grounds for disclosing personal information will largely mirror the current grounds, with a few additions, including in respect of facilitating clinical trials or other research. This will help to address barriers to data access for research while preserving existing rules on confidentiality. As with his powers of publication, the Secretary of State will also be able to disclose information for the protection of life or health, or for the protection of public safety or security.

The Secretary of State will be bound by certain existing duties on NHS England, including a duty to have regard to any relevant advice from the Confidentiality Advisory Group when publishing or disclosing information in accordance with his data functions. The Secretary of State will retain the regulation-making power to establish an accreditation scheme for information service providers, which will now include a broader range of providers, including public bodies.

Clause 49 permits the Secretary of State to delegate certain functions relating to health and care information. Currently, some of those functions can be delegated by NHSE via arrangements with third parties or under regulations. The clause will insert new section 251ZF, which allows the Secretary of State, by arrangement, to delegate to persons specified in regulations functions relating to information standards.

Information standards help to reduce fragmentation in digital and data services. They include mandatory requirements for how information is recorded, shared, governed and supported by IT. Increasing interoperability and consistency in digital and data is essential to increasing value for money, reducing the burden on staff and, ultimately, improving the quality of care. The continued use of information standards is key to the 10-year health plan’s aim of improving the interoperability of digital and data services across the health and care system. This will provide the Secretary of State with the flexibility to delegate such functions to persons who have the required technical expertise, where necessary.

Clause 49 will also insert new section 277G, which enables the Secretary of State to direct public bodies to exercise a wider range of his information functions, defined as “relevant information functions”. This includes not only information standards but other information functions, such as the Secretary of State’s duty to establish and operate information systems. The measures will provide the Secretary of State with important flexibility to delegate such functions to persons who have the required technical expertise, where necessary.

In all, the changes are necessary not just to effect the transfer of data functions to the Secretary of State but to enable better data use for the benefit of the NHS now and into the future.

[Dr Johnson]

I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary?

Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception. Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?

Health Bill (Tenth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Karin Smyth]

These clauses will make a series of vital changes to the NHS financial framework following the abolition of NHS England, strengthening funding arrangements and financial accountability. First, clause 43 will enable funding to flow to integrated care boards following the abolition of NHS England while simplifying the powers to direct how resources are used. The first change in new section 223G will transfer the responsibility to fund integrated care boards from NHS England to the Secretary of State, maintaining continuity of allocations and allowing in-year adjustments where needed.

We will also simplify the existing power in new section 223GA to direct integrated care boards in how resources are used, making it clearer and easier to use. That will ensure that safeguards can be applied consistently, such as the ability to recover funding where there is a failure to comply with a direction. Transparency will be maintained through the requirement to publish directions.

The clause will also introduce new section 223GB, setting how the direction powers in new section 223GA can be used in relation to expenditure on service integration across health and social care. At present, service integration funding must be placed in a pooled budget with local authorities, even if that is not the most effective approach. The current legislation allows for only one model, even where that may introduce unnecessary bureaucracy or delay. The clause will remove that mandatory requirement, giving the Secretary of State discretion each year on whether integration funding should be pooled.

That will not remove pooled budgets; they will remain the default where they deliver better outcomes, and local areas will still be able to enter section 75 agreements voluntarily. This clause will introduce proportionate flexibility and enable the Secretary of State to decide, transparently and through published directions, whether funding should be pooled in particular circumstances. That will ensure that we can act quickly when needed, for example in responding to urgent pressures, so that the Secretary of State is not constrained by a blanket legal requirement that does not always add value.

Clause 43 will also make necessary consequential changes following the transfer of functions from NHS England to the Secretary of State. That will include replacing “NHS England” with “The Secretary of State” in section 223GC, which concerns the power to give directions about integrated care board expenditure limits, and repealing section 223K on quality payments, as the Secretary of State can use other powers to deliver payments for quality improvement purposes.

Having set out a clearer and more streamlined framework for allocating and directing NHS resources, we now turn to how integrated care boards and providers will be held accountable for managing those resources. Clause 44 will omit sections 223M and 223N from the National Health Service Act 2006, which require each integrated care board and its partner NHS trust and foundation trust to balance their finances collectively. By removing sections 223M and 223N, we will ensure that one organisation’s deficit can no longer be obscured by another’s surplus, while preserving the Secretary of State’s ability to set joint financial objectives for integrated care boards and their partner trusts where system-wide alignment is needed.

If we are to achieve the ambitious aim set out in the 10-year health plan, of getting most providers to achieve a surplus by 2029-30, we must place the onus back on individual organisations. Each NHS organisation should be unambiguously accountable for managing its own finances, rather than relying on collective system balances to absorb overspends.

Importantly, that does not mean abandoning collaboration. Clause 44 amends section 223L of the National Health Service Act 2006 to enable the Secretary of State to set joint financial objectives for integrated care boards and their partner NHS trusts and foundation trusts, where local system-wide alignment is genuinely required.

This approach supports the wider policy direction for ICBs to operate as strategic commissioners. With clearer organisation and financial accountability, ICBs can focus on population health outcomes, prioritising prevention, reducing health inequalities, shaping services around need, and driving better value for money through more effective commissioning.

These clauses make a clearer, more disciplined framework, where individual accountability is strengthened, ambiguity is reduced and national oversight is more coherent, while retaining targeted tools to support collaboration where it adds value. I therefore commend clauses 43 and 44 to the Committee.

[Dr Johnson]

Clause 43 is particularly long: it runs to almost two pages of text. Essentially, clause 43 transfers the responsibility for funding ICBs, and deciding how they use the resources, from NHS England to the Secretary of State. In many cases, that is consistent with the Government’s plan to abolish NHS England, take decisions and responsibility in-house, and get some more control.

One thing that does not make sense to me is that the Government are talking about devolving control and decision making, yet this clause gives the Secretary of State powers to control spending, direct how ICBs spend money in different areas, and penalise them if they do not do what they are told. The Minister has also talked in this Committee about a vision for the future in which ICBs are consistent with mayoral authority areas, and mayors sitting on ICBs to provide some sort of democratic accountability. But how can mayors be held democratically accountable if they are, or might be, overruled by the Secretary of State? How does the Minister see that working?

Also, greater financial intervention powers for the Secretary of State, if used, could expose ICB budgets to short-term political pressure, such as funding for a specific health area that has received celebrity or media attention. How would the Minister guard against that?

If the Secretary of State is able to contest financial decisions taken by ICBs, will that slow down decision making and make things more “sticky”? Essentially, the changes seem to go against the Government’s stated aim of a more devolved and autonomous operating model for the health service. I would be grateful for the Minister’s comments on that.

Clause 44 is a little shorter. It essentially makes changes to the joint duties of ICBs and providers. Some of those changes are again necessitated by the abolition of NHS England; keeping some of the sections would result in overlapping systems, so those make more sense. But the duties requiring ICBs and their partner trusts to achieve overall system balance are repealed. That goes against the collaborative principle behind the creation of integrated care systems, and makes it more difficult to manage financial pressures across a geographical footprint. If, in a particular year, there is financial pressure in one area of an ICB but less so in another, it is not able to transfer things so easily between those areas. How does the Minister expect that to work?

Clause 44 also allows the Secretary of State to set objectives for “one or more” partners. Is that discretionary or are there criteria for it? If it is discretionary, what would prevent the Secretary of State from selectively choosing which trusts are bound by joint objectives and which are not? How will that decision be made? How will trusts know whether it is likely to be made, or in what circumstances it could be made? This could undermine consistency of treatment across different ICBs and trusts. I will be interested in the Minister’s comments on those points.

--- Later in debate ---

[Karin Smyth]

Clause 45 adds an additional purpose to those already listed in the Health and Social Care Act 2012 under which the Secretary of State can set or modify conditions in the provider licence. It will allow the Secretary of State, who will be responsible for licensing following the abolition of NHS England, to set licence conditions that promote or secure compliance with statutory obligations.

The NHS provider licence was first introduced in 2013 for NHS foundation trusts and in 2014 for eligible independent providers of NHS-funded care. It set clear rules and expectations around a range of matters, such as pricing and governance, for providers of NHS services. It also provided a mechanism for regulatory action when failures occurred at those organisations.

Licence conditions can be set only for specific purposes set out in legislation; the additional purpose does not change the existing licence conditions. The Secretary of State will be able to add or modify licence conditions only following a statutory consultation.

This additional purpose will allow the Secretary of State to hold providers to account when they are not meeting their legal obligations; for example, when they are not following procurement rules. As with other conditions in the licence, it means that we can use guidance to influence provider behaviour in these areas. The change is necessary and forms an important part of the Secretary of State’s powers to intervene where providers are not meeting expectations.

Clause 46 clarifies the methods by which the Secretary of State can serve certain notices relating to changes in the regulation of healthcare services. It brings existing requirements up to date with modern methods of communication, reducing administrative burden.

As the Committee already discussed when considering the abolition of NHS England, the Bill will transfer functions relating to the provider licence and the payment scheme from NHS England to the Secretary of State. When changes are proposed to these documents, NHS England must consult those affected and must notify all relevant organisations of the consultation. Currently, that notice cannot be delivered by email without the agreement of the organisation receiving it—without that agreement, it must be posted.

That process is out of step with the modern, digital-first approach set out in the 10-year health plan. Technology has evolved since those requirements were set, and we no longer communicate predominately through the postal system. The changes in the clause allow for rapid communication to ensure that the notice reaches the appropriate person promptly.

The clause brings the method by which the Secretary of State can deliver notices up to date with modern methods of communication to ensure that everyone affected has the chance to participate in the consultation in a timely way. I am sure all hon. Members agree that that is necessary, so I commend clauses 45 and 46 to the Committee.

[Dr Johnson]

Clause 45 makes technical changes to the licence conditions, allowing the Secretary of State to use those conditions as a tool to ensure compliance with legal requirements beyond those in the Health and Social Care Act 2012. That power is somewhat open-ended, which reduces certainty for providers, particularly independent ones, as they will not be able to easily anticipate what additional legal duties might be folded into the licence. The Minister said that there would be a consultation, but does she have any more details on how long the consultation process will be, or on how much notice of changes providers can expect? Like other clauses in the Bill, despite the Government’s discussion of devolution, the clause introduces another centralising power.

Clause 46 is about the specifics of to whom legal documents can be served and through what mechanism. I understand the Minister’s argument on the need for modernisation, but everyone will have had emails that were bounced by spam filters or the like. How will she ensure that the emails are not just sent but received, so that there is a fair playing field for everyone?

--- Later in debate ---

[Karin Smyth]

I agree with the hon. Member for Farnham and Bordon that, through this amendment, the hon. Member for Winchester has given us an opportunity to think. I am grateful to him for this chance to talk about carers and this important issue. I am a carer of an older person, and for those of us who are carers, it is helpful to have some discussion about this area. Carers play a vital role and we are committed to ensuring that they have the support they need. We are of course very grateful for all the work that they do.

The Bill already includes a power that permits regulations to make patient information available to people other than patients on the patient’s behalf. As the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, said, that can include carers, and it is our intention to do so. We want to ensure that carers who act on behalf of the people they care for get the full benefit from the single patient record.

NHS proxy access already allows for people other than patients—which includes carers, parents or care home staff—to manage the health and care of someone they care for. Setting up proxy access requires the consent and involvement of the individual and the person they care for. We will set out in regulations how proxy access will work for the single patient record, as in the existing NHS position.

The single patient record will be developed on two priority care pathways in maternity and frailty, which will initially be delivered through local arrangements. Some clinicians and patients will be able to view and manage additional elements of care, such as proxy access for carers, earlier than others. For those reasons, I ask the hon. Member for Winchester to withdraw his amendment.

We have had some helpful comments about some other concerns.

[Dr Johnson]

Will the Minister confirm whether the intention of the Government is to separate parts of the record out so that people can give consent for part of the record to be shared, but not the complete record, where they have reasons to want extra privacy?

[Karin Smyth]

The hon. Lady knows that we are talking about an enabling power in the Bill. All the details will be brought forward in regulations, through discussions and consultation. We will discuss that more broadly as we talk about the wider clause.

One of the key issues I have been asked about is protecting vulnerable people. Patients will access a single patient record through the NHS app, and NHS England has published guidance on clinical safety, safeguarding and the NHS app, which provides advice on minimising the risk to those where there may be challenges or potential risks. We will adopt a similar approach to the single patient record. Clinicians will be able to redact information that is too sensitive to share, and we will agree a protocol with professional bodies on how that will be applied. I am sure that we will discuss that in more detail, because it is an important area to get right.

Health Bill (Ninth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

I will start where I left off. Clause 34 addresses the gap by making it clear where responsibility sits, so that there is no doubt about who must produce the final accounts and ensure that they are completed properly, and about how those accounts should be audited. We think this is a proportionate provision to ensure continuity and clarity on how NHS money has been managed during organisational transition. I commend the clauses to the Committee.

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

Clause 31 introduces schedule 4, which essentially makes series of amendments to other Acts. It amends the Public Finance and Accountability (Scotland) Act 2000 to remove a cross-reference to other categories, and it amends the Audit and Accountability (Northern Ireland) Order 2003 and the Public Audit (Wales) Act 2004 for similar purposes. It also amends the National Health Service Act 2006 by deleting section 62 and schedule 10, relating to the audit of accounts of NHS foundation trusts, to end the old audit scheme.

Schedule 4 amends section 3 of the Local Audit and Accountability Act 2014 so that foundation trusts are now included in the list of bodies that must keep accounts in the standard way, it amends section 4 to specify which documents count as accounts of foundation trusts for the purpose of auditing, and it amends sections 8 and 10 so that the auditor appointment procedure and the auditor panel’s role now cover foundation trusts.

In addition, schedule 4 rewrites section 13 of the 2014 Act so that if a trust fails to appoint a local auditor, it is the Secretary of State’s job to step in. Previously, that was NHS England’s job; clearly, that needs to change, because NHS England is being abolished. The schedule also amends section 21 so that the auditors’ general duties now apply to foundation trusts too, and it amends section 30, relating to unlawful expenditure and activity, and section 32B, relating to the independence requirement, to remove a now-redundant item from the list.

Schedule 4 also amends schedule 2 to the 2014 Act to formally add foundation trusts to the official list of audited bodies; schedule 5 so that the rules on who can be a local auditor now cover foundation trusts too; schedule 6 to remove an outdated segment from the audit practice code rules; schedule 7 to tidy the reporting rules and extend them to foundation trusts; schedule 9 to realign data matching rules that apply to foundation trusts in the new system; and schedule 11, relating to the disclosure of information, to remove a reference to NHS England, which is no longer necessary because NHS England is being abolished. In general, clause 31 aligns the audit process for accounts of foundation trusts with those of standard trusts and integrated care boards.

Clause 32 removes the need for NHS England to maintain a register of foundation trusts and the fees associated with maintaining it. Section 39 of the NHS Act 2006 requires NHS England to maintain a current register of NHS foundation trusts and specifies what must be in that register. Section 50 states that an NHS foundation trust must pay NHS England a fee that NHS England may determine in respect of exercising its functions under section 39, which relates to keeping the register, and section 39A, relating to a panel for advising governors. Clause 32 deletes sections 39 and 50. The explanatory notes say that the requirement to maintain a register does not need to be transferred to the Secretary of State when NHS England is abolished because, the Government argue, the information will already be available centrally, and there is no need for a fee to keep that in place. That seems sensible to me.

Clause 33 enables the Secretary of State to impose limits on a foundation trust’s annual capital or revenue expenditure. Section 42B of the 2006 Act allows NHS England to make an order imposing a limit on the capital expenditure of a foundation trust in a single year. Section 42C sets out that NHS England must publish guidance about the exercise of its power under section 42B, including about the circumstances in which it is likely to make an order and the method it will use to determine the capital expenditure limit. Clause 33 entirely replaces sections 42B and 42C with rewritten sections, with some notable changes. The wording is changed from “capital expenditure” to “expenditure”. The power is therefore widened from capital expenditure limits to limits on any expenditure—capital and revenue. The Secretary of State replaces NHS England as the entity with the power to impose limits, which makes sense, and the subsection requiring an order to specify the trust, the financial year and so on has been removed in full.

The change gives the Government financial control to stop overspending by NHS foundation trusts. I note that in financial year 2023-24, NHS trusts overspent by £1.2 billion, so presumably this is the Secretary of State getting a tighter grip on spending. In some respects that is sensible, but overspending is often due to staffing costs and day-to-day pressures, not capital expenditure, so there is an argument that the capital limits themselves are not sufficient to deal with the problem. Under the new governance model, the Secretary of State has oversight and responsibility for the health service, and financial control aligns with those changes. The new power could prevent one organisation’s failures from undermining the health service’s wider financial position or impacting other providers.

However, the purpose of foundation trusts is supposed to be that they have greater independence over spending, and the Government have stated that their aim is to create a more devolved and autonomous health system. How does broadening the Secretary of State’s ability to interfere in expenditure devolve power or make foundation trusts more independent? Imposing expenditure limits may control overspending on paper, but it does not address the reasons why it is happening, so limits could lead to a deterioration in the health services delivered by some trusts. What plans does the Minister have to deal with that?

Because the power moves from an arm’s length body to the Secretary of State, interventions could be politically motivated, rather than in the best interests of the NHS. How does the Minister consider that that will be managed?

The power for the Secretary of State to impose expenditure limits at any time during or before the financial year could create uncertainty among trust leadership and undermine long-term planning. If a trust is given a budget for the year, it knows what it has to work with, but if somebody says halfway through the year, “Actually, you are going to have to work with less money than that,” it is very difficult for the board to plan its expenditure, because it is always looking the other way. Why does the Secretary of State need that power? Can the Minister clarify that, if there is a change in the expenditure limit during the year, it will always be revised upwards, and never downwards?

--- Later in debate ---

[Karin Smyth]

During the process of producing our 10-year plan, we were clear that, as much as we will reward the best performing providers with new freedoms to innovate, we will not hesitate to act on poor performance, and this group of measures deal with just that: action in the event of a failing provider.

Clause 35 and schedule 5 insert new provisions into the NHS Act 2006 to enable the Secretary of State to, by order, convert a failing foundation trust to an NHS trust. This is intended to take place only in the most critical circumstances, and where it is in the public’s best interest for the Secretary of State to be able to direct the trust about how it should exercise its functions, to address safety or other issues at the trust. Foundation trust status should be a mark of good performance, and there must be a mechanism to remove it when performance is seriously deficient. This deauthorisation power will help to maintain the integrity of the reinvigorated foundation trust status and provide an additional incentive for challenged foundation trusts to improve.

The power to make a conversion order can be used where the foundation trust has failed to comply with a condition of its provider licence or with another legislative requirement. In deciding whether to make a conversion order, the Secretary of State must consider various factors, including the seriousness of the failure, the health and safety of patients, the quality of the provision by the trust of goods and services, the financial position of the trust, and the way the trust is being run.

The conversion power is also subject to two additional requirements. First, the Secretary of State must publish guidance about the matters they will consider in deciding whether to exercise the conversion power, including the factors I just outlined. They must consult on any such guidance before its publication. Secondly, where the Secretary of State proposes to use the power, they must first consult the foundation trust in question, any integrated care boards in the areas in which the trust operates, and any other person to whom the trust provides goods and services, and whom the Secretary of State considers it appropriate to consult.

Clause 35, together with schedule 5, also inserts new schedule 9A into the NHS Act 2006, which sets out the immediate consequences of a conversion order. Deauthorising a foundation trust has no impact on the property it holds, the contracts it has with commissioners and other groups, or the terms of employment of employees. These powers set clear organisational consequences for significant underperformance and allow the Secretary of State the freedom to take action to protect patients in extreme circumstances.

Clause 36 contains another critical power to allow action in the case of a failing foundation trust. It allows the Secretary of State to add conditions to an NHS foundation trust’s provider licence where they consider that the trust will breach its licence conditions due to issues with its governance. The clause is a consequence of abolishing NHS England and makes changes to the powers currently held by NHS England under section 111 of the Health and Social Care Act 2012, to confer them on the Secretary of State, with additional consequential changes reflecting the abolition of councils of governors.

The clause sets clear expectations for a foundation trust through the licence conditions and provides the Secretary of State with a transparent mechanism to take more urgent, targeted enforcement action to address failures of governance. Should the foundation trust breach any conditions imposed via section 111, the Secretary of State may require it to make changes to the executive directors of its board as necessary, including removing or suspending executive directors, replacing executive directors with interims, and preventing the trust from appointing specific individuals. If the foundation trust fails to take those actions, the Secretary of State may implement the changes.

To reassure the Committee, there are clear safeguards underpinning the clause, which can be used only where there is evidence that failures of governance in the foundation trust will cause it to breach the conditions of its licence. Further, acting under section 111 does not preclude the Secretary of State from using their other regulatory powers, including to require the foundation trust to take steps to address a breach of any condition of the licence, or to accept undertakings from the trust to address the breach.

Finally, the section 111 power was originally granted to Monitor in 2012 under transitional arrangements, as it was anticipated that the power could be withdrawn once governors had transitioned into their roles and could hold boards to account without outside intervention. Over 13 years on, that has proven not to be the case. With the abolition of the foundation trust councils of governors, it makes sense to repeal the provisions under sections 112 to 114 of the same Act that made it transitional.

Clause 37 makes changes to the special administration framework to ensure that it continues to function coherently after the abolition of NHS England. The clause makes focused, technical amendments to the Health and Social Care Act 2012 to amend the framework for establishing a mechanism for financial assistance in cases where a provider is subject to a health special administration order under chapter 5 of that Act. It also amends the Act to remove the duty to establish a mechanism for financial assistance to foundation trusts to which a trust special administrator has been appointed. The duty no longer needs to apply to foundation trusts, because the Secretary of State already has the power under provisions in the NHS Act 2006 to provide financial assistance to NHS foundation trusts if needed.

With the abolition of NHS England, the duty to establish a mechanism for financial assistance for independent providers will be retained and conferred on the Secretary of State. It is worth noting that the provisions related to financial assistance in special administration cases, and chapter 5 of the Health and Social Care Act 2012, which sets out the powers and processes for the making of health special administration orders, have not yet been commenced. However, the amendments made by the clause ensure that the special administration regime can operate smoothly if it is ever needed.

The clause does not create new financial support mechanisms, but ensures that existing ones can be used appropriately in the reformed system. In short, clause 37 ensures that the legal framework reflects the new institutional landscape while retaining the ability to act swiftly to safeguard continuity of services during special administration.

Clause 38 makes changes to the trust special administration framework to ensure that it continues to function coherently after the abolition of NHS England. This clause, together with schedule 6, make targeted changes to the trust special administration process set out in the NHS Act 2006 for NHS trusts and NHS foundation trusts as a consequence of the abolition of NHS England. It also aligns more closely the processes between NHS trusts and foundation trusts.

Trust special administration is, and will remain, a last resort mechanism used only in cases of serious failure. It is used to protect patients, stabilise services and put the organisation back on a sustainable footing. Where deemed necessary, a trust special administrator would be appointed to manage the trust and work with relevant key stakeholders to develop recommendations regarding the organisation and its services.

The amendments made by schedule 6 remove functions that currently sit with NHS England and confer the key decision-making functions on the Secretary of State, who will provide clearer lines of accountability and faster decision making when rapid intervention is required. The amendments also simplify the steps involved in the TSA process, with the aim of improving the speed of intervention and providing transparency. They align more closely the processes for trusts and foundation trusts, and set out a simpler process in relation to the administrator’s draft report, consultation and final report. They also require, as is the case now, that key documents and decisions are published and laid before Parliament. That will help ensure proper and meaningful scrutiny of the TSA process and outcomes. It also helps ensure that affected patients, staff and local partners have the opportunity to engage during the process, while maintaining the balance with the need to deliver timely intervention and secure continuity of safe services.

In addition, the amendments in schedule 6 make changes to the role of the Care Quality Commission in trust special administration. The CQC will be able to recommend that a trust special administrator should be appointed. The Secretary of State is also required to consult the CQC before making an order, ensuring that independent expertise on quality and safety informs decisions and that intelligence on service performance is co-ordinated.

The provisions in the Bill ensure that the process remains fit for purpose, proportionate, and aligned across NHS trusts and foundation trusts. They support faster, more coherent decision making in the most serious cases, with the aim of protecting patients and securing sustainable, high-quality services for the future. Taken together, the clauses provide the necessary tools for the Secretary of State to take proportionate, swift and decisive action in the event of provider failure. I therefore commend these clauses to the Committee.

[Dr Johnson]

Clause 35 essentially establishes the right of the Secretary of State to convert a foundation trust into an NHS trust in certain circumstances. Currently, section 25 of the NHS Act 2006 establishes trusts and introduces schedule 4 of the same Act, which makes provision about NHS trusts. Section 56AA sets out how additional requirements concerning acquisitions of a trust or foundation trust are to work. Clause 35 deletes section 25(2), which specifies that an order in this context is referred to as “an NHS trust order”, and amends subsection (3), so that no order under section 25—previously no “NHS trust order”—can be made until any consultation that has been prescribed is complete.

Clause 35 introduces proposed new section 57B into the 2006 Act, “Conversion of failing NHS foundation trust into NHS trust”, which provides the Secretary of State with the power to convert if the foundation trust breaches its licence or other legal duties. The trigger is broad and includes non-compliance with any statutory requirement. The proposed new section requires an order to specify when it takes effect and also requires the Secretary of State, when deciding to issue an order, to consider among other things

“the seriousness of the failure…the health and safety of patients…the quality of the provision by the trust of goods and services…the financial position of the trust, and…the way that the trust is being run.”

Before making an order, the Secretary of State will be required to consult the trust, any ICB where the trust has facilities and

“any other person to whom the trust provides goods or services…whom the Secretary of State considers it appropriate to consult.”

The proposed new section also provides the Secretary of State with the power, when the conversion order is made, to

“terminate the appointment of the chair or any executive or non-executive director”,

and to

“appoint a person to be the chair or an executive or non-executive director”.

It also time-limits the powers to intervene with management to one year after the order is made.

Clause 35 also introduces proposed new section 57C into the 2006 Act, “Guidance about conversion”, which requires the Secretary of State to publish guidance about matters to be considered when deciding to make an order and requires them to consult persons considered appropriate before publishing or revising guidance. The clause removes “NHS trust order” from section 276 of the 2006 Act, “Index of defined expressions”, and updates schedule 4, so that an NHS trust may be established by an ordinary order under section 25 or a conversion order under proposed new section 57B.

Schedule 5 to the Bill inserts proposed new schedule 9A to the 2006 Act, “Conversion of failing NHS foundation trusts”, which provides that, on conversion, the foundation trust’s chair and directors become the initial chair and directors of the new NHS trust, unless they are removed by the Secretary of State under the procedures we have just talked about. The proposed new schedule initially keeps the board the same size, until new arrangements are made. It provides that the foundation trust’s public dividend capital carries over to the NHS trust and that the conversion does not affect continuity of the body —it will remain the same organisation, just with NHS trust status.

The proposed new schedule provides that the trust’s property and liabilities, including criminal liabilities, continue unaffected. It also provides that existing contracts continue and that the trust remains party to them. It clarifies that those contracts do not automatically become NHS contracts under section 9(1) of the 2006 Act, provides that the trust keeps any corporate memberships that it held before the conversion, and clarifies that the continuity provisions do not affect the Secretary of State’s wider powers to make directions.

The Secretary of State will have a direct power to act where the foundation trust has failed—for instance, where there have been patient safety lapses—and there are clear benefits to that. There are also transparency requirements built in: the Secretary of State must publish guidance and consult before issuing guidance or undertaking conversion, and the power to change the management is limited to a year.

However, the last Labour Government said that independence was central to the success of foundation trusts. In 2005, the then Secretary of State, Patricia Hewitt, said:

“We know that independence from central Government control and greater freedoms are giving NHS foundation trusts the opportunity to innovate new approaches to healthcare and healthcare services, for the benefit of NHS patients.”—[Official Report, 7 November 2005; Vol. 439, c. 5WS.]

The challenge with innovations is that, even with the very best intentions and the very best advice, some will work and some will not. If any failure at all is a reason for trusts to be taken over, will that cause them to be shy about innovating, for fear of their independence being undermined as a result? There is a balance to strike, so I wonder whether the Minister will comment on that.

The change also makes it easy for the Secretary of State to convert a foundation trust for political reasons—for instance, because of pressure from local Members of Parliament. That is a positive in some ways and a negative in others. Again, it could have a chilling effect on the very autonomy and innovation that Ministers want to see, so the question is how they think they will balance that.

--- Later in debate ---

[Karin Smyth]

We know that robust finances are an essential part of the health service. The financial accounts related to the NHS are of keen interest to His Majesty’s Treasury and indeed to Parliament. The Government are especially mindful of the keen interest of the Public Accounts Committee in this area. Under current arrangements, NHS England prepares a set of financial accounts for all NHS trusts and foundation trusts, and that is audited by the National Audit Office. That is the point at which the National Audit Office conducts its oversight of NHS providers, with that feeding into the National Audit Office’s assurance over the Department of Health and Social Care group.

The financial accounts for integrated care boards are currently included in the NHS England group accounts, which are presented separately and audited by the National Audit Office. With the abolition of NHS England, the Government intend to reduce central administration costs, so financial reporting needs to be proportionate while balancing stakeholders’ keen interest in financial information related specifically to the NHS. Clause 40 therefore replaces the current consolidated accounts of NHS providers with a single set of consolidated accounts for the NHS covering its trusts, foundation trusts and integrated care boards. That consolidated account will continue to be audited by the National Audit Office.

We believe that bringing the accounts together in this way will assist the public, Parliament and the National Audit Office in scrutinising NHS expenditure. Although it is not covered by the clause, it is important for the Committee to be aware that there will be no change to the current requirement for the Department to publish a Department of Health and Social Care group annual report and accounts that will consolidate the NHS accounts with the core Department and other group bodies—for example, its arm’s length bodies.

However, the Government recognise that only reporting figures for the NHS in the overall Department group would reduce transparency compared with the current structure of NHS financial accounts. The clause therefore seeks to prioritise high quality audited financial accounts information being made available while balancing against administrative costs, both of which are important to the Government.

Clause 41 amends the Secretary of State’s existing power to create a scheme allowing NHS bodies to pool funds to cover property losses and legal claims arising from their healthcare activities. They ensure that when liabilities arise, whether from damage to property, negligence or other claims, there is a clear and consistent mechanism through which those liabilities can be managed and resolved. In doing so, they protect the financial stability of the NHS. The clause updates the legislation for the new landscape by removing NHS England from the arrangements and ensuring that responsibility for administrating the schemes rests appropriately with the Secretary of State.

Although the clause is targeted and technical, its effect is essential in that it ensures continuity and legal clarity and continued effective operation of arrangements that underpin confidence and functionality across the health service. Clause 42 is a necessary technical and structural change that supports the new statutory framework following the abolition of NHS England. It removes provisions in the NHS Act 2006 and the Health and Care Act 2022 that relate specifically to NHS England’s funding and financial responsibilities, which will no longer be required once NHS England ceases to exist. The clause avoids duplication and confusion and ensures that financial accountability is clearly defined in the post NHS England system. Under the reformed framework, the Department is responsible for the overall funding of the NHS and for national financial assurance, while integrated care boards and providers continue to operate within defined statutory financial duties and controls.

Clause 42 plays an important housekeeping role, providing legal clarity and underpinning a more transparent and coherent financial framework that is fit for the NHS future operating model. I therefore commend the clause to the Committee.

[Dr Johnson]

Clause 40 prepares for the preparation of the annual accounts of NHS trusts and integrated care boards. Existing legislation in section 65Z4 of the NHS Act 2006, “Consolidated accounts for NHS trusts and NHS foundation trusts”, requires NHS England to prepare a set of accounts every financial year and consolidate the accounts of all the trusts and NHS foundation trusts. The Secretary of State can give directions about the content for methods and principles, and the accounts must be accompanied by reports or other information as directed by the Secretary of State. A copy may be sent by NHS England to the Secretary of State and the Comptroller and Auditor General. The latter must then examine and certify those accounts before sending a copy to the Secretary of State and NHS England, and NHS England must then lay a copy of the consolidated accounts and the Comptroller and Auditor General’s report before Parliament. That is how it works at the moment.

Clause 40 rewrites section 65Z4 and the duty to prepare the consolidated accounts every financial year moves to the Secretary of State, and the list of what gets consolidated now includes the ICB accounts. The power to give directions to NHS England about accounts is removed, which is fair enough because there would be no need for it, as the Secretary of State is now preparing them and NHS England will cease to exist. The requirement for the accounts to be accompanied by such reports or other information as the Secretary of State may direct has been removed. The accounts go straight to the Comptroller and Auditor General, who reports back only to the Secretary of State. At the end, the Secretary of State lays the accounts before Parliament. The changes are necessary owing to the abolition of NHS England.

I want to ask about the consolidation, including the ICB accounts, which was not there before, and what impact that will have. Will the accounts be sufficiently detailed so that it is possible to disaggregate that information if people are interested in doing so?

Clause 41 changes which NHS companies can be covered by the scheme that meets certain losses, legal claims and liabilities. Currently, section 71, “Schemes for meeting losses and liabilities etc of certain health service bodies”, of the NHS Act 2006 enables the Secretary of State to establish schemes to meet the losses of NHS England, ICBs, trusts, the National Institute for Health and Care Excellence, the CQC and several other bodies. The list of bodies includes

“(ha) a company formed under section 223 and wholly or partly owned by the Secretary of State or NHS England”.

In the new legislation, clause 41 rewrites paragraph (ha) so that it is

“a company formed under section 223 other than by an integrated care board by virtue of section 223A”.

That narrows the scope of the liability scheme by preventing ICB-created companies from automatically gaining protection, presumably to encourage ICBs to manage risk responsibly.

Health Bill (Eighth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

The clause updates the National Health Service Act 2006 to abolish the requirement for integrated care boards and their partner NHS trusts to prepare and publish a joint forward plan and a joint capital resource use plan. The 10-year health plan aims to simplify local healthcare planning, and the Bill delivers that objective by removing legal requirements for integrated care partnerships, integrated care strategies, joint forward plans and joint capital resource use plans. Planning will now begin with the joint strategic needs assessment, developed by health and wellbeing boards. The assessment will inform a new neighbourhood health plan, replacing the joint local health and wellbeing strategy. ICBs will produce population health improvement plans, aligning multiple joint strategic needs assessments, neighbourhood health plans and local priorities across their wider populations. As a result, the planning process will be streamlined and less bureaucratic, and will deliver healthcare for local people based on local planning and strategy. I commend the clause to the Committee.

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

As the Minister said, the clause removes the need for ICBs and their partner trusts to produce a joint forward plan. The existing legislation requires ICBs and their partner trusts to prepare a plan setting out how they propose to exercise their functions over five years, which is reviewed and/or revised each financial year.

Joint forward plans address objectives in the Government mandate regarding the ambitions in the NHS long-term plan and planning guidance. Section 14Z52 of the 2006 Act sets out that an ICB and its partner trusts have to prepare such a plan before the start of each financial year and specifies what the plan must give regard to, including the ICB’s discharge of its duties—general duties and financial duties—under other sections of the Act. The plan must also cover steps that will be taken to implement the local health and wellbeing strategy, the particular needs of young people, and the particular needs of victims of abuse. ICBs and their partner trusts must publish the plan and give it to a set of specified authorities, and NHS England may give directions for that. Section 14Z54 sets out that an ICB and its partner trusts must consult people when developing such plans and that health and wellbeing boards must be involved. Section 14Z55 sets out that the relevant health and wellbeing board may give an opinion, and that when it does so, it must provide it to the ICB and its partner trusts.

Section 14Z56 sets out that an ICB and its partner trusts must prepare a joint capital resource use plan before the start of each financial year, and that the period may be determined by direction from the Secretary of State. Section 14Z57 sets out that an ICB and its partner trusts may revise the joint capital resource use plan, but if it is revised significantly, it must be published and given to the list of specified authorities.

Section 14Z58 sets out that an ICB must produce an annual report on how it has discharged its functions. It must explain how it has discharged its duties under other specified sections of the Act, review the extent to which it has exercised its functions in accordance with the forward plan and its capital resource use plan, review the extent to which it has exercised its functions consistently with NHS England’s views, and review steps it has taken to implement any joint local health and wellbeing strategy. The report must include details of expenditure and be given to NHS England by a specified date and then published.

In essence, the clause deletes sections 14Z52 to 14Z57. In some respects, it is legislative plumbing, to remove plans that are no longer necessary. The Government’s impact assessment notes that

“there is some duplication across planning documents. For example, the Joint Forward Plan covered the integration of services, which the Better Care Fund plan also considers, as does the Joint Local Health and Wellbeing Strategy.”

It goes on to note that duplication delivers an administrative burden, as staff

“complete parallel planning returns and fulfil competing data requests,”

so that is a positive aspect of the clause.

Will the Minister please address the following points? Section 14Z52 contains specific requirements to address the particular needs of young people and of victims of abuse. Where do they fall now? The NHS has a large maintenance backlog. What is the new mechanism for transparency of capital prioritisation decisions between the ICBs and the trusts? Can the Minister remind me and the Committee of other areas in which local democracy will be able to input into ICB planning once these planning documents are no longer required?

Under the Government’s strategic commissioning framework, ICBs have to develop population health improvement plans. Essex ICB published a document that is 148 pages long, with a particular focus on inequality. Is the Minister concerned about the length of some of the plans, the time it takes to produce them and the amount of bureaucracy involved, or does she think this is an improvement? What is the key objective in delivering these plans? Do the Government plan to introduce population health improvement plans through legislation? If they do not, Parliament will have scrutiny of the bureaucracy being removed but not of the bureaucracy that the Government replace it with. As the Minister once said:

“Local taxpayers deserve to know how their money is being spent.”—[Official Report, 13 June 2023; Vol. 734, c. 122WH.]

[Karin Smyth]

I thank the shadow Minister for her comments. I largely agree about legislative plumbing—that is a nice phrase. As she rightly highlights, and as is clear in the explanatory notes and so on, the duplication and administrative burden on all these bodies is considerable. On her question about objectives, we certainly want to streamline that so that ultimately, as well as organisations knowing the objectives they are pursuing, the local population—importantly to her concluding point—can readily see and address that, follow it through and hold people to account. I do think that 150-page documents are not always the easiest to see.

Young people will obviously be part of the joint strategic needs assessment, and ICBs will be mindful of the Government’s wider policy objectives, as we have discussed previously. With regard to maintenance and prioritisation of capital schemes, since coming into office we have already done a huge amount of work to streamline the relationship between NHS England and the Department of Health and Social Care—and, indeed, our friends over at His Majesty’s Treasury—in respect of the approvals process, making better use of capital and making that more transparent at local level so that individual organisations are involved in the prioritisation that comes forward to the ICBs.

Question put and agreed to.

Clause 22 accordingly ordered to stand part of the Bill.

Clause 23

Abolition of integrated care partnerships and strategies

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The clause abolishes the requirement for ICBs and their partner local authorities to form an integrated care partnership. It also abolishes the related requirement for that partnership to prepare and publish an integrated care strategy.

These abolitions address the policy objectives of the 10-year health plan by streamlining the number of plans that must be created by local health systems and supporting key local stakeholders to work together more flexibly and effectively. The changes recognise that in many areas, integrated care partnerships have not had a positive impact on local health outcomes and have come with significant opportunity costs. Alternative planning approaches proposed elsewhere in the Bill and more broadly will enable local health bodies to plan for their patients in a way that is tailored to their strengths. However, I can reassure the Committee that where existing arrangements are working well, nothing in the Bill will prevent local areas from coming together to consider how best to integrate services and plan their approach to tackling the challenges they face. I commend the clause to the Committee.

[Dr Johnson]

In essence, the clause abolishes integrated care partnerships and strategies, which are where ICBs come together with local authorities to discuss how they can make their services more integrated. We know that many of the challenges facing the NHS are caused by difficulties in social care provision and some of the difficulties in social care provision are caused by issues with health provision, and that if those commissioning services in those two areas work together, we can see an improvement in both.

The Local Government and Public Involvement in Health Act 2007 made changes to local government structures and enhanced public involvement in health services. Section 116 requires local authorities to produce joint strategic needs assessments for the local authority and its partner ICB. When preparing the assessment, the local authority and its partner ICB must

“co-operate with one another…have regard to any guidance issued by the Secretary of State…involve the Local Healthwatch organisation”,

and involve local people and the relevant district councils. I note that later in the Bill we will also come to the abolition of Healthwatch.

Section 116 of the 2007 Act has been modified by the Health and Social Care Act 2012 and the Health and Care Act 2022 to ensure that references match the current NHS structure. For instance, in 2008 there were primary care trusts, rather than ICBs. Section 116ZA of the 2007 Act requires ICBs and local authorities whose areas coincide or overlap to create integrated care partnerships, which consist of a member appointed by the ICB, one from each responsible local authority and any other members that they choose to add; to some extent, they can determine their own procedures.

Section 116ZB of the 2007 Act requires ICBs to prepare an integrated care strategy

“setting out how the assessed needs in relation to its area are to be met by the exercise of functions of…the integrated care board…NHS England, or…the responsible local authorities”.

When developing that integrated care strategy, the integrated care partnerships must have regard to NHS England’s mandate and any guidance issued by the Secretary of State. Clearly, that would now apply only to guidance issued by the Secretary of the State, because NHS England is also being abolished. An integrated care partnership must publish its integrated care strategy and give it to each local authority and partner ICB. Integrated care partnerships must reconsider and, where necessary, revise the strategy each time they receive a new needs assessment.

Clause 23 deletes section 116(5A) of the Local Government and Public Involvement in Health Act 2007. That subsection required the local authorities to give a copy of the needs assessments to the ICBs, which is of course no longer necessary because they are being abolished. Clause 23 also deletes sections 116ZA and 116ZB of the same Act, which established ICBs and defined integrated care strategies respectively.

As Conservatives, we believe that streamlining bureaucracy is sensible, and I am sure that this is a well-intentioned reform. However, a survey conducted by the NHS Alliance in November indicated that a quarter of integrated care system leaders are likely to keep the integrated care partnerships anyway on a non-statutory basis, and 40% plan to fold them into health and wellbeing boards and working partnerships with the authorities. It is not really a ringing endorsement of the policy if a sizeable number of people intend to keep it anyway.

Like many other elements of the Bill, these changes are uncosted—if we read the impact assessment, it says “N/A” for the cost. Clearly, there will be a cost incurred by the abolition of the process, but there will also be an opportunity cost to services if ICBs and commissioners are not working together in the provision of social care as effectively as they were before. That will cost people in social care, and it will cost people in healthcare.

As recognised by the impact assessment that the Government have produced themselves, there is a risk of reduced focus on the wider determinants of health at system level. Committee members on both sides of the House have already stressed the impact that other health determinants can have on the health service and social care, and we have previously considered amendments to that effect.

Overall, it is regrettable that local government does not have the direct feed into ICBs that the design of those integrated care partnerships provided. Whether or not I agree, I can follow the theory or principle behind making the area covered more local, in line with the strategic authority. However, if the Government wanted to do that, I do not understand why they did not decide the mayoral areas first. At the moment, we do not know where the mayors will be, and where they are now is not where the ICBs are. The Government have decided to cut ICB budgets and force mergers before they have decided where the mayoral authorities will be in some cases. Even where there are mayoral authorities already, the Government have not mandated that the ICBs be coherent with them, and, therefore, in many cases, they are not. We have a very confusing pattern emerging, which may require further reorganisation of ICBs to line them up, with a further cost down the line.

--- Later in debate ---

[Karin Smyth]

Clause 24 abolishes the requirement for health and wellbeing boards to prepare and publish a joint local health and wellbeing strategy. Instead ICBs, local authorities and their partners must work together through the health and wellbeing board to develop a neighbourhood health plan, in line with this Government’s commitment in the 10-year health plan. The neighbourhood health plan should be updated regularly to reflect the needs of the local population, unless all partners consider the existing plan is sufficient.

In developing their neighbourhood health plans, responsible local authorities and partner ICBs must involve the people who live or work in the area of the responsible local authority. The neighbourhood health plan will cover most of the topics previously considered by joint local health and wellbeing strategies, but will also encourage a deep focus on tackling the challenges facing individual neighbourhoods. That may mean applying different geographical focuses to different elements of the plan, to ensure that planners are addressing the real and different needs of the diverse communities they serve.

These plans will outline how the NHS, local government and local partners intend to improve the health of people in their locality and reduce health inequalities through a joined-up neighbourhood health approach. The plans will consider how local services can help realise national NHS priorities, further public service reforms, and improve performance against the adult social care outcomes framework and the local outcomes framework metrics. To support this work, the Government also intend to provide local areas with guidance and we will work with systems to ensure this addresses the needs of local planners and local communities.

[Dr Johnson]

Clause 24 puts neighbourhood health plans on a statutory basis. Currently, section 116A of the Local Government and Public Involvement in Health Act 2007 requires local authorities and partner ICBs to prepare a joint local health and wellbeing strategy once they have received their integrated care strategy. Essentially, that means that the ICBs and local authorities produce their overall strategy, then it devolves down, and then the joint health and wellbeing strategy looks at how it will be delivered. The local authority and its partners must give regard to the integrated care strategy, the NHS England mandate and any guidance issued by the Secretary of State. The strategy must be published and local people and the local Healthwatch must be involved in its development.

Section 116B of the 2007 Act places a duty on local authorities and partner ICBs to have regard to various strategies when exercising their function, specifically, a joint strategic needs assessment, an integrated care strategy and a joint local health and wellbeing strategy. NHS England also has regard to these when providing healthcare for a specific area.

Clause 24 changes the JLHWS to a neighbourhood health plan. In many ways, that aligns with the shift in the Government’s 10-year health plan from hospital to community. As they have described it, more care in the neighbourhood will allow hospitals to focus on the more specialist care that may be needed, so more people can be cared for closer to home, which seems a reasonable aim.

However, if local authorities and partner ICBs have to give regard to what the centre is doing when developing neighbourhood health plans, to what extent does the Minister envisage that being directed? Local authorities and partner ICBs giving regard to the centre could mean there being a very loose requirement from the centre to provide for the local population, and then they get on with it; it could also be very prescriptive—my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has talked about the pros and cons of having targets—with a whole litany of targets in the plans. Whether that squares with the Government’s claim to be devolving power, or whether it strikes as a centralising power, depends on how that is done and to what extent the Secretary of State plans to direct it. I would appreciate it if the Minister could talk about that.

As has been said, Sir Andrew Dilnot told the Committee that

“we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 84, Q131.]

The Government have asked Baroness Casey to review social care, but they have developed this measure in the meantime. Is that because they have been talking to her and know that it is the sort of thing that she will recommend—or are they putting the cart before the horse, as my hon. Friend the Member for Farnham and Bordon suggested?

Later in the Committee’s considerations, we will come to Healthwatch, its benefits and the concerns that I and, I am sure, many other Committee members have about its abolition. What mechanisms does the Minister envisage there being for local people—local patients—to contribute to the neighbourhood health plans? A local Healthwatch currently contributes to the equivalent, the joint local health and wellbeing strategy, as a way of ensuring that it captures patient and community voices. How will that be done otherwise?

Some 80% of the Government’s new neighbourhood health centres that will deliver these plans are expected to be funded through public-private partnerships. Does the Minister have any comments on that, particularly in the light of the expensive private finance initiative that the last Labour Government entered into and left us stuck with?

In March 2026, the Government produced a neighbourhood health framework policy paper, which identified the goal of reducing non-elective admissions for those with severe frailty. Given that goal, why are the Government not on track to deliver the fracture liaison service improvements that they promised?

The policy paper also commits to what it calls

“a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties”.

What is a “diversion rate”? It essentially requires more GP referrals to be rejected, so let us be clear about what that means. When someone, either hon. Members or constituents, goes to see their GP, they are referred to a consultant for care; I should declare an interest as a consultant in the NHS. The consultant will then review that referral and decide whether they think it is clinically appropriate to see the patient, whether a different specialty may be more appropriate, or whether they can give advice or make suggestions about treatment that could be given in primary care instead.

When a patient is given an appointment in secondary care, it essentially means that the GP has decided that they clinically need it, and the consultant has decided that they clinically need it too. If the Government want a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, are they suggesting that patients who the GP and consultant agree clinically need an appointment should not get one? If so, why?

--- Later in debate ---

[Karin Smyth]

Clause 25 makes focused but important changes to the accounting and audit arrangements for NHS trusts by amending schedule 4 to the National Health Service Act 2006. It does not put additional burdens on NHS trusts; instead, the aim of the clause is to align the requirements for trusts with the updated accounting arrangements for foundation trusts made elsewhere in the Bill. The changes are needed as a consequence of the abolition of NHS England and the removal of the requirement for foundation trusts to have councils of governors and members.

The amendments the clause makes replicate trusts’ existing duties to keep proper accounts and records about those accounts, and to prepare annual accounts for each financial year. The clause also replicates the Secretary of State’s current power to direct an NHS trust regarding the form of its annual accounts, but extends that power of direction so the Secretary of State may also direct a trust to prepare accounts for a specified period—for example, when part-period accounts are needed. That will help to ensure a consistent approach to financial reporting while retaining the flexibility to keep requirements up to date.

The clause also sets out and strengthens how the audit arrangements for NHS trusts should operate, mirroring the approach for foundation trusts and integrated care boards. It provides that NHS trust annual accounts are audited under the Local Audit and Accountability Act 2014, as is the case currently, but it also provides that part-period accounts may be audited in accordance with that Act where the Secretary of State so directs.

The clause also enables the Comptroller and Auditor General to examine the accounts and related auditor reports, as is currently the case. To reflect the fact that the Secretary of State will have oversight of providers once NHS England is abolished, it requires the accounts and audit reports to be sent to the Secretary of State.

Taken together, these measures support transparency, consistency and robust financial assurance. They will help to reduce unnecessary divergence in accounting requirements across different types of NHS provider, while maintaining clear oversight of public funds. That is consistent with the Bill’s broader intent to support effective governance and clear accountability for providers.

Clause 26 makes minor technical amendments to ensure that the statute book remains clear and coherent as the Bill aligns the approach to audit and accounts across NHS trusts and foundation trusts. It sits alongside the provisions in the Bill that update the arrangements for the audit of foundation trusts following the abolition of NHS England and the removal of the requirement for NHS foundation trusts to have councils of governors and members.

The clause does that by amending or removing outdated transitory provisions relating to the audit of NHS trust accounts in two places: the NHS Act 2006 and the Local Audit and Accountability Act 2014. Clause 26 therefore supports the effective implementation of the wider measures in this part of the Bill by ensuring that the legislation is up to date, accurate and internally consistent. I commend clauses 25 and 26 to the Committee.

[Dr Johnson]

As has been said, clause 25 specifies how NHS trusts should handle their accounting. Paragraph 11A of schedule 4 to the NHS Act 2006 sets out the current obligations, which are that the trust must keep proper accounts, that the Secretary of State may give directions about how the accounts are held, and that the accounts must be prepared annually, may be examined by the Comptroller and Auditor General, and must be submitted to NHS England.

Clause 25 replaces paragraph 11A entirely. Under the new provisions, the reporting goes to the Secretary of State, instead of NHS England—which seems sensible, because the Government are abolishing NHS England—and the Secretary of State may give directions about “methods and principles”, as well as the “form and content”. The Secretary of State may also give directions about specified periods in which accounts are to be prepared.

Will the Minister explain why those provisions are felt to be necessary? There will be suspicion among some more cynical people that the power to specify periods could be used to be more flattering for the Government, or that methods and principles could be used to change the perception of the position. Can the Minister give an example of where she thinks such periods would be useful, and also say why she thinks it is necessary to enable the Secretary of State to give directions about methods and principles, and form and content, in a way that is not done at the moment?

The exception for charitable trusts of which the NHS is a trustee is being removed. Will the Minister explain why she thinks that is important, and in what situation she thinks that power would be used? Finally, will she say whether the financial directors of NHS trusts have been consulted about these changes? If so, what was their feedback?

Clause 26 tidies up relevant provisions in two pieces of legislation, as the Minister has described.

[Karin Smyth]

If there are specific examples that are helpful, I will write to the hon. Lady—I am not entirely sure I got the point about charities, but we will pick that up in Hansard.

As I outlined in my opening remarks, these clauses are about standardising the key requirements across the NHS provider landscape in relation to annual and other accounts and records in relation to those, and audit and reporting requirements, including keeping those up to date and having a consistent approach across all NHS provider types. Of course, we worked closely with NHS England colleagues and directors of finance in seeking to bring forward those provisions.

Question put and agreed to.

Clause 25 accordingly ordered to stand part of the Bill.

Clause 26 ordered to stand part of the Bill.

Clause 27

Special Health Authorities: establishment and exercise of functions

--- Later in debate ---

[Karin Smyth]

Clauses 27 and 28 make amendments to the legal framework around special health authorities to give the Secretary of State the flexibility to best manage the reliable delivery of healthcare for patients and the public. As the Committee knows, special health authorities are independent bodies established by the Secretary of State, by order, to perform specific functions. They play a key national role in the health system, carrying out specific functions on behalf of the Secretary of State.

Clause 27 does two key things to the special health authority legal framework. First, it amends section 28 of the NHS Act 2006 to increase the scope of functions that a special health authority could be established to deliver. Currently, the Secretary of State can create a special health authority only for the purpose of exercising functions under the 2006 Act. The clause allows a special health authority to be established to exercise functions under any other Act as well.

Secondly, the clause amends section 29 of the 2006 Act, which currently enables regulations to provide for the functions of a special health authority to be carried out flexibly, by another special health authority or jointly with one or more other special health authorities. That applies only to functions that the Secretary of State has directed the special health authority to exercise under section 7 of the 2006 Act. The clause removes that limitation, so that those arrangements can be made for any functions of the special health authority, not just those that it is directed to carry out under section 7.

These changes are needed because the health and care system is underpinned by a range of statutory functions that do not sit exclusively within the 2006 Act. The Secretary of State needs to be able to establish special health authorities to carry out those wider functions, and to give those functions to existing special health authorities. The clause ensures that the Secretary of State has the modern, adaptable tools required to place specialist functions in the right national body, with the appropriate governance and accountability. Equally, special health authorities need to be able to work with other special health authorities across all their functions in a way that best serves the needs of the wider health and care system.

On occasion, it is necessary for Ministers to merge, alter or abolish special health authorities, either because of changing circumstances or to ensure the smooth and effective running of the system. Clause 28 provides the flexibility to transfer and redeploy staff. It allows regulations to be made to enable staff to be transferred to an integrated care board or another special health authority. These changes ensure that staff can be transferred where they may be needed most, allowing for flexibility to direct resources in the health system.

The clause also allows for arrangements to be made for a special health authority’s staff to be made available to another special health authority, a local authority, the Secretary of State or an integrated care board. That may be necessary during an emergency or to provide specialist support to help an organisation achieve a particular outcome. The clause also allows the Secretary of State to give directions to a special health authority to make staff available to another special health authority or integrated care board or the Secretary of State.

Clause 28 also amends the existing power to make regulations about the sharing of information with other bodies, to allow information to be shared with integrated care boards in addition to the Secretary of State and other special health authorities. That allows for information to be shared across the system so that national and local functions can be successfully fulfilled and supports a more joined-up health system.

Clauses 27 and 28 provide for future-facing updates that will support effective administration and ensure the more reliable delivery of healthcare for patients and the public. I commend them to the Committee.

[Dr Johnson]

Special health authorities are, in essence, specialist health authorities set up by the Secretary of State, usually to provide an England-wide service of some form. Examples include NHS Blood and Transplant, and the NHS Business Services Authority, which provides NHS pensions—I should declare that I have an NHS pension—admin for prescription exemptions and other such business-type functions. We also have NHS Resolution, which deals with clinical negligence claims, and the NHS Counter Fraud Authority.

In principle, special health authorities are useful in some cases, but they are effectively a form of quango. Can the Minister explain when she thinks the Government might want to set up a special health authority, rather than using a department within the DHSC to deliver the same thing? There are plenty of other nationally delivered services, and although the Government have suggested that some services, such as screening, will become localised as part of the Bill, some things will remain national. Can the Minister give some examples of what the new provision will be used for?

I can see there is provision for flexibility, but the special health authorities would require setting up, and there are set-up costs and costs associated with branding and those sorts of things. How does the Minister envisage those costs being provided for, and when will it be necessary for the Government to use them rather than just using the Department?

Special health authorities have been created, reconfigured and shelved many times. For example, the National Treatment Agency for Substance Misuse became part of Public Health England in 2013, and the NHS Institute for Innovation and Improvement was closed in the same year. The functions of the National Patient Safety Agency went to the NHS Commissioning Board Special Health Authority, later known as NHS England, in 2012 and then to NHS Improvement in 2016. Widening the scope could leave us with more quangos than are necessary.

Which specific functions do the Government plan to move into special health authorities under this widened power? Have the Government just decided that they need this power and are increasing the scope because they are abolishing NHS England without a proper plan? Is this power just to cover themselves in the event that, as they start to make a plan, they find out they need it?

Clause 28 enables the Secretary of State to make regulations for the transfer of staff from one special health authority to another, or to an ICB. Paragraph 3(8) of schedule 6 to the National Health Service Act 2006 states:

“Regulations may provide for the transfer of officers from one Special Health Authority to another”,

or to NHS England,

“and for arrangements under which the services of an officer…are placed at the disposal of another Special Health Authority”,

or NHS England, or a local authority. Paragraph 3(12)(a) states that the Secretary of State may give directions

“to place the services of any of its officers at the disposal of another Special Health Authority”,

or NHS England. Paragraph 13 states:

“Provision may be made by regulations with respect to the recording of information by a Special Health Authority, and the furnishing of information by a Special Health Authority to the Secretary of State, another Special Health Authority”,

or NHS England.

Clause 28 modifies that paragraph such that regulations can now provide for the transfer of an officer to an ICB—that is a new power—as well as a special health authority and a local health authority, but no longer to NHS England because NHS England is being abolished. Regulations can now provide for an officer’s services to be placed at the disposal of the ICB and the Secretary of State, which is a new power, as well as the special health authority or local authority, but no longer NHS England. The clause modifies paragraph 3(12)(a) of schedule 6, so that directions may be given about placing the services of officers at the disposal of the special health authority and, newly, the Secretary of State or an ICB, but not NHS England. As the Minister said, the clause also modifies paragraph 13 of schedule 6, so that a special health authority can be required by regulations to pass information to integrated care boards, which is a new power, but no longer to NHS England.

NHS England is to be abolished, so it is sensible to say that staff can no longer be placed there—that seems an entirely reasonable exercise—but the legislation providing for special health authorities essentially contains open-ended spending power. Remuneration of the special health authority chairman and staff can be determined by the Secretary of State, with the approval of the Treasury. Does the Minister foresee an upper limit to those sorts of salaries?

People will essentially be able to transfer from one special health authority to another, or to an ICB—or be placed at the disposal of another special health authority, an ICB, a local authority or the Secretary of State. Will the Minister talk about the location, pension and salary of those individuals? We heard yesterday that the future Prime Minister, the right hon. Member for Makerfield (Andy Burnham), may want to move a whole load of civil servants from London up to Manchester. That will clearly be within his gift if he becomes Prime Minister, but for individuals who work in one location to be asked to move to another is disruptive to their family and social lives, and involves significant relocation costs. If people are moved in the way that clause 28 describes, particularly by transfer, what choice will they have? What will happen to their pension, salary and other terms and conditions, and will they have a choice of location or not?

--- Later in debate ---

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I will move on, if I may. I think my response will the cover the issues raised in the debate.

On amendment 36 and new clause 59, I note the concern that the Secretary of State could act inappropriately when making appointments to the boards of ICBs and NHS trusts and foundation trusts. We discussed democratic accountability in a previous sitting, and at the end of the day it is up to the British public whom they elect to Parliament and as the governing party.

Transparency and democratic accountability are at the heart of our reforms. It would not be right for the civil service to be given sole legislative responsibility for appointments to NHS trusts, foundation trusts or integrated care boards. Ministers are democratically accountable to Parliament, and civil servants act on their behalf under the Carltona principle. Civil servants serve and advise the Government, and act on behalf of Ministers, but it is for Ministers to take decisions and to be held accountable to Parliament for the performance of the NHS. The civil service will run fair, open and equitable campaigns to fulfil these roles and will recommend appropriate candidates to Ministers.

Ministers are under a duty to comply with public law principles and to act reasonably, and will adhere to the Nolan principles, including objectivity, transparency and integrity, in discharging this function. The practical arrangements for appointments are being developed as part of the transition planning for the integration of NHS England’s functions into the Department, and will be based on these principles. It would therefore be inappropriate to exclude Ministers entirely from the appointments process. I urge hon. Members not to push the amendments to a vote.

[Dr Johnson]

Will the Minister give way?

Health Bill (Seventh sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 25th June 2026 Public Bill Committees

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

My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?

[The Minister for Secondary Care (Karin Smyth)]

Patients and the public have a critical role in shaping our health services. I am grateful to the hon. Member for Oxford West and Abingdon for tabling the amendment, as moved by the hon. Member for North Shropshire. I will discuss the amendment with the wider question of whether the clause should stand part of the Bill.

To be clear, the Government are committed to engaging with patients and the public about the services they use. Services shaped together with the people who rely on them are better services. We want to see deep and collaborative ways of working between patients, public and the NHS. Across the country, there are good examples of that from which we want to learn. That is why the clause requires the Secretary of State to involve patients and the public in the planning of commissioning arrangements, the development and consideration of proposals for service change, and decisions that may affect how services are delivered or the range of services available.

The clause is intended to encourage early engagement and meaningful involvement in service change, thereby helping to build legitimacy, trust and better-informed commissioning decisions. As a duty, it covers the entire end-to-end commissioning cycle. I have been a commissioner myself, so although I will not detain the Committee too much on that, it is indeed part of the job of a commissioner to do that at a very early stage.

I also draw attention to the fact that the clause places a statutory duty on the Secretary of State to make arrangements to ensure the involvement of individuals who use or may use health services, together with carers and representatives, where appropriate, in commissioning activity. That duty is purposely broad, covering both existing service users and those who may reasonably rely on services in future, and will support preventive approaches and enable the consideration of wider population health impacts.

We made the deliberate choice to include specific references to carers and representatives, recognising that some individuals may require support to participate effectively in engagement and decision-making processes. That is particularly important where barriers such as disability, communications needs, sometimes age, vulnerability or unequal access may otherwise limit participation. We are ensuring that involvement is inclusive and meaningful, which I think is what all hon. Members want to see.

Specifically on amendment 28, I gently caution against creating an implication of different approaches to patient involvement for different parts of the system, leading to a two-track approach and unnecessary confusion. Instead, we propose a Government commitment to ensure meaningful consultation. We support co-production and will continue to champion it, but we do not think it necessary to put it on the face of the Bill.

The Government support involving patients and the public at every stage, and we recognise that working closely with the people and communities affected by commissioning decisions brings valuable insight into service quality, accessibility, equity and effectiveness. We will use the duties and powers available to Ministers to ensure that that principle is embedded across the work of the NHS. I hope, therefore, that the hon. Member for North Shropshire has some reassurance and will withdraw her amendment. I commend the clause to the Committee.

--- Later in debate ---

[Gregory Stafford]

My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar.

I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved.

If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.

[Karin Smyth]

There are a number of amendments in the group. Amendment 35 was not moved but as the hon. Member for Farnham and Bordon spoke to it, I will comment on that amendment, which is in the name of my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). Community equipment and wheelchair services are really important to us and—to allay the concerns of the hon. Member for Farnham and Bordon—that is why the medium-term planning framework requires that, from this year, all ICBs and community health services must actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. I assure the Committee that we will hold the ICBs for their performance. The community health services situation report has a specific monitoring line, covering children and young people and covering adults, for the wheelchair, orthotics, prosthetics and equipment category. We intend to continue that work following NHS England’s abolition. Consistent national standards will help us to identify the best and the weakest-performing areas, to identify what improvements need to be made and to tackle the longest waits.

Amendment 52 was tabled by the hon. Member for Sleaford and North Hykeham. We are committed to ensuring that all patients receive the NHS care they need in a timely manner, and I recognise the importance that Committee members have placed on that matter. The NHS constitution sets out that patients should start consultant-led treatment within 18 weeks of referral, and it is imperative that the system continues to work towards returning to and then upholding that standard.

I listened with great care to the comments from Members on the Opposition Benches, but I was here—as were you, Dr Huq—during the last couple of Parliaments; I was here as waiting lists rose and rose after 2012, under the previous Government’s stewardship, until they reached 4 million people, all waiting an inordinate amount of time. That Government had no kind of approach to reducing the numbers; they were quite content to have 4 million people on waiting lists, and to never bring forward measures to change that. They were quite content not to challenge NHS England or trust boards about why people across the country in all our constituencies were languishing on those lists. We are determined to resolve that situation.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I will move on. It is absolutely right that integrated care boards, as local commissioners, retain the ability to manage their services and waiting lists effectively, given the shocking numbers that they have inherited. This is complicated, difficult work: commissioners have to balance demand, capacity and clinical need, and a prohibition such as the one set out in the amendment would threaten to remove legitimate flexibilities that are required at the local level to ensure that services are delivered safely and efficiently.

We are clear that systems should not be setting minimum wait times that exceed the 18-week constitutional standard, but hon. Members will appreciate that not all elements of waiting are inappropriate. In many cases, they reflect clinical pathways, sequencing of care or the need to prioritise the most urgent patients. It is imperative that clinical judgment and urgency remain the key drivers of prioritisation, which is something the amendment threatens to remove.

Turning to amendment 52, I recognise that Members across the House are committed to ensuring that all patients receive the NHS care they need in a timely manner. Validation is a routine and long-standing part of waiting list management by providers. It ensures that patient records are accurate, that patients are on the best pathway to meet their needs and that they still need their appointments. Routinely validated waiting lists will support a return to the 18-week NHS constitutional standard.

Reasons for removal as a result of validation include a patient no longer needing their appointment or there being a duplicate appointment. The previous Government left behind some systems and trusts in such a poor condition that they give out duplicate appointments, and we need to resolve that as part of our work. Other reasons for removal include a patient’s record not being properly updated following treatment or a clinical decision—another sign of the inefficiency that the previous Government left behind.

[Karin Smyth]

Once again, my hon. Friend is absolutely right. He is expert on this issue and has outlined to us some excellent clinical examples. I look forward to debating the single patient record further in Committee.

Importantly, any patient removed from a waiting list should be notified alongside their GP. Data on the total number of removals from waiting lists is published by NHS England. That data includes, but cannot separately identify, patient pathways removed as a result of validation. The Department remains committed to the transparent publication of official waiting list statistics following the abolition of NHS England, although there are no plans to publish more detailed breakdowns. NHS staff are delivering record levels of elective activity, which has enabled us to meet our interim target of 65% of patients being seen within 18 weeks.

[Dr Johnson]

If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?

--- Later in debate ---

[Dr Johnson]

The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?

[Karin Smyth]

As an MP in Bristol, which is not quite on the border, but is pretty close, I absolutely understand. We have relationships with our Welsh colleagues and I have been involved in debates on this matter. The clause ensures that, with the abolition of NHS England, regard is had to to arrangements with our colleagues across the border. We all understand that devolution means that different arrangements will be made in the constituent parts of the United Kingdom. It is not for the UK Government to determine what those are, because they are devolved. However, I assure members of the Committee that across the piece in the Department, and indeed across the Government, regular meetings and conversations on these and other matters with regard to the devolved functions are a regular part of the work that we do.

Question put and agreed to.

Clause 17 accordingly ordered to stand part of the Bill.

Clause 18

Transfer schemes in connection with integrated care boards

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The clause gives the Secretary of State the powers to make transfer schemes where an ICB is being abolished or established, or where the area covered by an ICB is being amended. A transfer scheme ensures that all the staff, property rights, responsibilities and liabilities, other than criminal liabilities, of the ICB being abolished are transferred to another ICB. That ensures that the ICB taking over has the appropriate information and resources to continue to arrange healthcare services for their population. In the past, that has been used to support the restructuring of ICBs to achieve geographical boundary alignment with strategic authorities, as set out in the 10-year health plan. The power also allows transfers to the Secretary of State and, when a new ICB is established, allows the transfer of staff from an NHS trust or foundation trust or from a special health authority.

Following the abolition of NHS England, we expect that Ministers will continue to need to be able to make transfers between ICBs. The clause allows that as needed. I therefore commend the clause to the Committee.

[Dr Johnson]

I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?

[Karin Smyth]

It is precautionary to give the power in the event—future-proofing the Bill.

Question put and agreed to.

Clause 18 accordingly ordered to stand part of the Bill.

Clause 19

Integrated care boards: power to provide assistance

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

The clause relates to the power for integrated care boards to provide assistance and support in relation to the health service. It replaces section 14Z48 and, in part, section 12ZA of the National Health Service Act 2006 with a clearer and more flexible power. At present, the various ICB assistance powers are narrower and more confusing. Section 12ZA provides for certain forms of practical assistance in connection with ICBs’ commissioning functions, while section 14Z48 provides a more limited power to make grants or loans. Other specific assistance powers sit elsewhere in the legislation, including in sections 96, 112, 124 and 147, which allow assistance and support for primary medical services, dental, ophthalmic and pharmaceutical services.

Clause 19 replaces all those separate powers with a general power for ICBs to provide assistance or support. The clause will make it clearer when an ICB may support providers, prospective providers or other activity connected with the health service. It will allow an ICB to provide assistance or support to a person who is providing or proposing to provide services as part of the health service. It will also enable an ICB to support a person who is carrying out or proposing to carry out activities that the ICB considers to be conducive to the health service. The assistance may include financial assistance, making available the services of ICB staff, or making available any other ICB resources. The clause also allows assistance to be provided on agreed terms, including terms about payments by or to the integrated care board.

The clause supports ICBs in their role as strategic commissioners. ICBs need to be able to support the development, improvement and resilience of services for their populations. They need to be able to cultivate their provider sector to meet the needs of the people they are responsible for, and they need to be able to do so in innovative and flexible ways. The clause gives them a clearer statutory basis for doing so. This is only an enabling power; it does not require an integrated care board to provide assistance and it does not create any entitlement for a person to receive assistance, nor does it disapply the ordinary legal and financial controls that apply to integrated care boards, or any other element of the usual way in which NHS bodies are overseen and regulated.

The clause should be read alongside clause 9, which creates a broadly analogous assistance power for the Secretary of State. In combination, the clauses support the move to a simpler, more flexible statutory framework that enables everybody, from the centre to ICBs, to discharge their responsibilities in ways that can be adapted to the complexity and multiplicity of circumstances they will inevitably encounter. I commend clause 19 to the Committee.

[Dr Johnson]

The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?

[Karin Smyth]

I thank the shadow Minister for her questions. ICBs are part of the accountability outcomes framework, so they will be monitored in the usual way, and any expenditure by the ICB—and, indeed, by the Department—is recorded in the departmental accounts.

Question put and agreed to.

Clause 19 accordingly ordered to stand part of the Bill.

Clause 20

Performance assessments of integrated care boards

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Karin Smyth]

I recognise the right hon. Gentleman’s expertise as a former Minister in this role. I do not want to mislead him, so I will come back to him in writing on both those points, if that is acceptable. He tempts me to be more prescriptive than I think we intend to be at this point, but I will ensure that he gets a proper answer to both questions. I commend the clause to the Committee.

[Dr Johnson]

As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed.

I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them?

Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?

[Karin Smyth]

Of course ICBs will know how they are going to be assessed; that will be in guidance in the usual way. In the last two years, in planning terms, we have brought forward all that work for the system—including on the finances—in order that the system works more efficiently, and we will continue to seek to do that.

The hon. Member, as she has several times in the Committee, returned to the question of variation. When there is devolution and local systems are different, there will be a degree of variation, as I have said. In performance management terms, where there is unwarranted variation, we will seek justification and understanding of that. Sometimes, there is variation for geographical reasons. There may also be historical structural reasons in a local system, or temporary reasons why performance is variable. We would look at that as part of that general work.

Question put and agreed to.

Clause 20 accordingly ordered to stand part of the Bill.

Clause 21

Membership of integrated care boards

[Dr Johnson]

I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert—

“(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include—

(a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A);

(b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A);

(c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and

(d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any).

(2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations.

(3) The constitution must set out the process for making nominations under sub-paragraph (2).

(4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.”

This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.

Health Bill (Sixth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 25th June 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

Clause 12 inserts new section 3B into the National Health Service Act 2006, re-establishing the responsibility of the Secretary of State to commission services. Although we intend ICBs to commission the vast majority of services, as we discussed this morning, we will use this regulation-making power to set out the small number of specialised services that the Secretary of State will be responsible for. That may include, for example, proton beam therapy, alongside a small number of other specialist services not currently suitable for ICB commissioning, such as gender dysphoria services and clinical genomics. By their nature, those are services to which national commissioning is appropriate because, for example, they have fewer patients or providers, greater or changeable costs, or they require specialist clinical expertise and input. Having a regulation-making power allows us to future-proof the system and update the regulations when new services or treatments emerge, or when services become cheaper or mainstream and therefore sit better with ICBs.

I now turn to amendment 57, which was tabled in the name of the hon. Member for Sleaford and North Hykeham. I recognise that any change to the way these services are commissioned matters enormously to the patients who depend on them. The hon. Lady used the word “worried”, and I understand that. Any change must be made with the greatest of care. However, the amendment would require the Secretary of State, before any regulations are made that alter the range of nationally commissioned services and regardless of the scale of the change, to publish a transition plan covering seven prescribed matters, to consult five prescribed categories of persons for a minimum of 12 weeks, to publish a response to that consultation and then to wait a minimum of 60 days before the regulations can be made.

As I have said, I understand and share the concern about continuity of care and the careful allocation of responsibility that lies behind it, but the proposals in amendment 57 are not the right way to address that concern. It proposes a fixed sequence of steps with minimum time periods that would apply to every change without exception. Taken together, the prescribed steps would add the better part of half a year to any change, including changes that are minor or technical, or that, for reasons of clinical safety, need to be expedited. That would create delays for patients and uncertainty for the wider system over where commissioning responsibility sits.

I would like to offer assurance on some of the concerns raised today. I commend my hon. Friend the Member for Blaydon and Consett, who has spoken to me regularly about her concerns, for the work that she does in this area. I also commend the Lib Dem spokesperson, the hon. Member for North Shropshire, for her work on spinal cord injuries. I have met the chair of the APPG on spinal cord injury to discuss this topic. I would like to thank Bristol Councillor Kelvin Blake, who has a spinal cord injury and who for many years has impressed on me the difficulties faced by people with spinal cord injuries who are wheelchair dependent. I commend the work of people with these conditions who, as the hon. Member for Sleaford and North Hykeham said, struggle through a system that they should not have to struggle through. We want to make sure that these changes are assured, and I commit to working with hon. Members to do that as the Bill goes through.

I can assure the Committee that any significant change to nationally commissioned services will be accompanied by proportionate and appropriate engagement with patients, clinicians and the bodies affected. Change will always proceed according to appropriate transition arrangements. Each service, as hon. Members know, has very different patient needs and commissioning requirements, and demands different skills to commission effectively. The framework the Government are proposing will enable the Department to manage these processes flexibly and proportionately.

The hon. Member for Sleaford and North Hykeham asked about arrangements for new organisations. In a changing organisation where people are coming forward for redundancy and in a new organisation that is taking shape, it is important that the executive looks at all redundancy requests and changing needs with regard for critical business infrastructure and the retention of skills. That is what we are currently doing.

The hon. Lady also asked about funding. The Bill allows the Secretary of State to set out which ICB pays for whom, and there are clear rules for people in prisons and those not registered with a GP currently under the guidance of court, which is called “Who Pays?” There are also long-standing processes for ICBs to pay each other as needed. The hon. Lady also asked about high security mental health services; I can assure her that we have no plans to ask the private sector to provide services. The power to direct has been updated to ensure that directions would bite on non-NHS providers if that changes in future.

Clause 13, which is part of this group, is a technical clause that permits the Secretary of State or an integrated care board to confer on a person discretion in relation to anything that is to be provided under the commissioning arrangement. In practice, this means that they could undertake some activities traditionally carried out by a commissioner, such as reviewing how services are provided for a population and designing the way that those services will be delivered within the parameters set by the commissioner. These activities would be clearly set out and measured under the contract, and the commissioner would retain overall responsibility for the delivery of their functions. Currently, integrated care boards are already permitted to do this, and with the transfer of NHS England’s commissioning powers to the Secretary of State, we propose a similar approach for services that are commissioned nationally.

I hope that I have been able to reassure the hon. Member for Sleaford and North Hykeham, and that she will withdraw her amendment. I commend clauses 12 and 13 to the Committee.

[Dr Johnson]

Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another.

Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote.

Question put, That the amendment be made.

Health Bill (Fifth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Karin Smyth]

Clause 8 will give the Secretary of State the power to direct integrated care boards to exercise his or her functions. This power, similar to that currently employed by NHS England, will promote subsidiarity by enabling such functions to be delivered at the lowest appropriate level. The clause builds on the existing section 7B of the National Health Service Act 2006, which allows the Secretary of State to direct ICBs but only in respect of public health functions.

With our plans to abolish NHS England, the Secretary of State will again have broad powers and responsibility relating to the health service, and so this power encompasses a wider range of functions. Unlike the delegated frameworks set out under sections 65Z5 and 75 of the 2006 Act, which are entered into voluntarily, any integrated care board directed under this power would be obliged to carry out the stated functions.

I reassure the Committee that, while the ICB will be legally responsible for how it discharges a function, overall accountability will remain with the Secretary of State. Furthermore, the Secretary of State might also use directions to place restrictions on the onward delegation of any functions, preventing delegation where it may be inappropriate. Finally, any directions must be published, ensuring transparency and allowing proper accountability.

This measure will empower the Secretary of State to assign functions to ICBs where most appropriate. It aligns with and facilitates our broader direction of travel towards flexibly planned and delivered local services. I therefore commend the clause to the Committee.

[Dr Johnson]

Clause 8 is essentially about the control that the Secretary of State has over ICBs. When we discussed the clause abolishing NHS England, we talked a lot about the balance between democratic accountability on the one hand and independence from political interference on the other.

The Government suggest that the Bill is a decentralising Bill. What this clause does is essentially to recentralise by default. As the Minister has just said, the Secretary of State can change what the ICB is doing if they think that it is inappropriate. What does “inappropriate” mean exactly, and how will that power be used? It may be used very infrequently—perhaps the current and previous Secretaries of State think that the power would be used infrequently—but equally it could be used in response to considerable pressure from MPs, lobbyists and campaign groups. Instead of issuing directions sparingly, we may end up in a position where the Secretary of State is issuing day-to-day instructions.

The Government want ICBs to take greater responsibility for commissioning decisions, but then they want to be able to undermine them by direction from the Health Secretary. The Health Secretary will never have as good a grasp of the situation in the local geographic area as local leaders, but he has the power to tell them what to do and issue blanket instructions with different characteristics. That will be inherently inefficient. ICB leaders will be under pressure, knowing that if they make a particular decision they can be removed or be told to do something different. They have the job and they have the power, but they haven’t really—all at the same time.

There is also the plan, as the Minister outlined, to make directions something that the Government publish. The clause says that directions must be published by the Secretary of State, but only

“as soon as reasonably practicable”.

The intention behind requiring the prompt publication of directions is to reduce the surface area for back-room pressures, but the lack of a clear timeframe makes it rather a weak measure.

We currently have a Government who seem open to greater use of the private sector, whether in financing projects or in delivering out-patient care. Well, our Prime Minister resigned yesterday, and there is no guarantee that the Government of the right hon. Member for Makerfield (Andy Burnham) will take the same approach. Will the Minister confirm whether the powers in clause 8 could be used by a Health Secretary to instruct ICBs to stop using a specific type of provider?

I would not dispute the idea that the Secretary of State needs to be able to exercise some control over the health service now that NHS England is being abolished, but the clause seems contrary to the Government’s stated vision for health management. I am not sure whether it is in the best interests of patients.

--- Later in debate ---

[Karin Smyth]

I recognise that this is a subject of some debate; we may discuss it further when we come to the part of the Bill on ICBs. The abolition of NHS England and transferring all its functions to one body has a consequence, which is that the Secretary of State retains that accountability and power. We are keen to have that power clear but flexible in order to empower local systems. That remains the intent.

The power is necessary for the Secretary of State to update national commissioning standards, for example. The ICBs will have wider roles as strategic commissioners. We expect them to take on formal responsibility for a number of services delegated by NHS England. That allows us to issue a common set of commissioning standards, on the point made by the hon. Member for Farnham and Bordon about variability in different places. There need to be common standards across the piece: eligibility criteria, the treatments the provider should use, and national reporting requirements. ICBs having those standards means that there will be a reduction in unwarranted variation in some of these events.

The shadow Minister raised the timetable. The Opposition will recognise that there needs to be flexibility for the Secretary of State and Ministers to respond to unforeseen or changing events. That is why it is purposely broad, because the range of events that can impact the NHS is clearly very broad. We cannot predict the future.

The hon. Member for Farnham and Bordon said that the Bill needs to deal with all these problems. The Bill needs to give enough flexibility to the system and devolve as much power to the system. The Bill needs to make sure that the powers are in the right place, but it is for the local systems to respond to their local needs within that framework. They will be held accountable, for example through the NHS oversight framework and through ICBs’ normal accountability frameworks.

[Dr Johnson]

The Minister is talking about flexibility. I understand that if a Minister is responding to an unforeseen circumstance, he or she may be very busy, but where a direction has been made, it should not take very long for a member of staff to publish it, because it will already have been written and sent. I understand that a Minister might take a day or so to sign it off because they are so busy, but it should not take months. The addition of a deadline is therefore not an unreasonable request.

[Karin Smyth]

With due respect to the hon. Lady, it is not a matter of the Minister being busy, whether that is me or anybody else. It is about the operational running of a £200 billion organisation with 1.5 million staff treating millions of people every day. I am sure we all remember from our own experience incidents and unforeseen events that have happened in the local system, and sometimes very tragic events that have required the Secretary of State to take action. We are trying not to increase the number of reports and documentation and to rid the system of bureaucracy by putting something out in that timeline.

[Dr Johnson]

Will the Minister give way on that point?

[Karin Smyth]

No, I have finished.

Question put and agreed to.

Clause 8 accordingly ordered to stand part of the Bill.

Clause 9

Secretary of State’s power to provide assistance

Question proposed, That the clause stand part of the Bill.

[Karin Smyth]

Clause 9, which will insert new section 12DA into the National Health Service Act 2006, will give the Secretary of State a clear statutory duty to provide financial, staffing or other practical assistance in connection with the health service. The power may be used to support persons providing, or proposing to provide, services as part of the health service or which are beneficial to the interests of the health service. It may also be used to support public authorities where the assistance relates to education or training for people employed, or considering becoming employed, in activities connected with the provision of health services. The assistance may include financial assistance, the services of civil servants or other resources of the Secretary of State, and it may be provided on agreed terms, including terms about payments by or to the Secretary of State.

The clause will support the wider purpose of the Bill by enabling a small centre to act in a supportive and enabling way towards the wider system. Where appropriate, the Secretary of State will be able to provide assistance directly to those delivering or supporting health service activity. The clause is needed because the existing statutory framework does not include a clear power that enables the Secretary of State to provide practical support across the full range of health service activity. Relevant support may be financial, practical, staffing-related or connected with education and training.

Without this clear power, there is a genuine risk of confusion about the basis on which such support may be offered, particularly where the Secretary of State is acting to facilitate the delivery of services by others. The power is permissive and facilitative: it does not require the Secretary of State to provide assistance, and it does not require any person or body to accept it. The power is also limited by its connection to the health service and matters relevant to education, training or activities considered beneficial to the health service. Its exercise remains subject to ordinary public law principles and public financial controls. For those reasons, I commend the clause to the Committee.

[Dr Johnson]

In a system as large as the NHS, covering an area as diverse as England, it is necessary that the Government be able to deal with unexpected situations. The pandemic may be half a decade behind us already, but the Committee will remember that the previous Government had to act quickly and part with a lot of money in a short time. In such instances, it is essential that Ministers have the power to provide financial assistance. It is not only about crises, however; ordinarily, there are occasions when a Government will want to roll out a new prevention programme or address deficiencies in care in particular areas. I know that health policy is always evolving, and the case for flexibility is clear. The Health Secretary may need to be able to provide financial assistance in pursuit of supporting the health service.

I am sure that hon. Members are familiar with the existing legislation. Section 12D of the National Health Service Act 2006 gives the Secretary of State, NHS England, an ICB or the local authority the ability to make direct financial payments as an assistance to persons or bodies. Clause 9 would new section 12DA of the Act, under which the Secretary of State would be empowered to provide assistance to any person or body carrying out, or proposing to carry out, activities that they deem beneficial to the service.

This is where semantics are important. The existing legislation allows the Secretary of State to make payments, but clause 9 is different: it would allow the Secretary of State to provide financial assistance and to make available persons employed by the civil service or any other resources that the Secretary of State has. This is a remarkably open-ended power that would allow the Secretary of State to spend taxpayers’ money while bypassing standard scrutiny. When NHS England spends money, there is transparency: the public can see how much has been spent on different types of care, ranging from hospitals to public health programmes. The public can see how much money has gone into trusts, into the independent sector and into procurement.

Transparency builds trust in the system and disincentivises wasteful spending. Where will parliamentarians or the public be able to see the financial expense of civil servants, or literally any other resource that the Secretary of State may offer in support? For the first time, the Health Secretary will have the power to insert politically directed civil servants into elements of the health service that are not under public ownership.

As clause 9 is drafted, the Secretary of State could provide civil service labour to private or mutual health providers that work within the NHS. Will the Minister elaborate on how that would be used, and how it would be beneficial to the taxpayer and the health service? The number of civil servants taking home more than six figures has increased under this Government. Their time should be focused on delivering public services, not propping up providers, especially ones that are private businesses.

It is also unclear where the legal liability lies under such arrangements. If something goes wrong and the human resources provided by the Secretary of State are responsible, is the Secretary of State responsible or the entity into which those staff have been inserted? Can the Minister clarify that?

It may be politically beneficial in the short term to provide state support, but it can be costly to the public purse and damaging to markets in the long term. By allowing the Health Secretary to issue assistance in the form of free civil servant labour, clause 9 effectively creates a new type of off-the-books subsidy. How can Members of the House or NHS providers tell whether assistance is operational support or a de facto subsidy? It could undermine the idea of a level playing field for firms contracted to deliver NHS services.

There is also the question of when assistance crosses from operational support into running a provider or firm. We do not necessarily want to be in a position where the Bill is used to bail out failing private firms with NHS contracts. I return to the phrase

“any other resources of the Secretary of State”.

It is difficult to understand why the legislation was written in this way, allowing financial assistance, the provision of labour, and then the use of absolutely any other resource at the Health Secretary’s disposal. As with several other provisions in the Bill, it seems another sign that the legislation was rushed. Instead of circumscribing power tightly where it is needed, the Bill gives huge sweeping powers while claiming that it decentralises.

The Minister has described clause 9 as a discretionary power intended to support the effective functioning of the health service and its workforce. Although that may be what she sought to achieve, that is not the reality. The clause paves the way for arbitrary and unaccountable deployments of state resources, and that should concern all hon. Members.

--- Later in debate ---

[Karin Smyth]

In concluding the debate on this part of the Bill, the Opposition have helpfully made most of my arguments for me. The hon. Member for Sleaford and North Hykeham opened with reference to the pandemic and the unusual circumstances in which we have found ourselves. It is obviously important that this Government learn the lessons from that pandemic in the round, that we are prepared and that, as NHS England is abolished, those powers come back to the Secretary of State so that we can respond to any eventuality that comes before us.

As the hon. Member for Farnham and Bordon said, there are existing standards and rules of procurement. Any spending that happens through the Department and the NHS will be publicly recorded and published in the Department of Health’s consolidated accounts. Those come before Parliament, so there is direct transparency through the parliamentary process in the usual way and, as we all know and as the hon. Member for Farnham and Bordon said, Treasury rules apply.

The point about the use of civil servants has been made. Again, it is really important that we recognise that we are bringing together NHS England, NHS staff and civil servants in the Department. It is right that the Secretary of State, in whatever eventuality comes before him or her, is able to deploy the right person for the right job, be they a civil servant or someone currently under NHS staff terms and conditions, to support that work going forward. The clause is necessarily flexible and broad to provide for those eventualities, and to enable the necessary assistance to be deployed. I commend clause 9 to the Committee.

Question put and agreed to.

Clause 9 ordered to stand part of the Bill.

Clause 10

Secretary of State’s duty as respects variation in provision of health services

[Dr Johnson]

I beg to move amendment 53, in clause 10, page 6, line 21, leave out from “interests” to end of line and insert “of patients”.

This amendment would only allow the Secretary of State to vary the balance between the public and private sectors in the NHS where it is in the interests of patients to do so.

--- Later in debate ---

[Karin Smyth]

I will respond to that question before picking up the other comments. If I do not address all the Committee’s comments, I will come back to Members.

Everyone would expect this, but let me be clear: this Government are absolutely committed to a free-at-the-point-of-use, taxpayer-funded service. We also think that unless it is reformed and changed, it is an existential problem for the British public, who will not continue to support the service. As Members know, one Parliament can never bind another one, so I cannot predict what a future Government will do. There is talk from some of our Reform colleagues about an insurance-based system. There are people who were in the Conservative party but have moved over who think that, so obviously I cannot—

[Dr Johnson]

Will the Minister give way on that point?

[Karin Smyth]

I will make some points, and then I will be happy take the hon. Lady’s intervention if I do not address what she was going to say.

The hon. Member for North Shropshire outlined some of the history. This clause seeks to strike a balance. The governing principle behind it is that the decisions of the Secretary of State must not vary the proportion of providers by the type of legal entity that they are. Decisions must be taken according to what serves the health service and the people who depend on it. The clause permits, by way of exception, the balance between sectors to be varied purposefully, but only where doing so would be in the interests of the health service. That would, for example, prevent the Secretary of State from deliberately choosing to grow the proportion of NHS services delivered by private providers for solely ideological reasons.

I understand the concern that drives the amendment. It is that the exception might be relied on to support the convenience of those already providing the service, without taking into account what is best for patients, as the hon. Member for Sleaford and North Hykeham said. That is not the Government’s position, and the clause does not lead to that outcome. The test that it creates is whether the interests of the health services are served.

As the hon. Member for Sleaford and North Hykeham also said, the definition of the health service—as defined under section 1 of the National Health Service Act 2006—is not separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness. A decision to rely on the exception must be justified by reference to that duty; one taken merely because it was easier or more convenient for existing providers or any other group, with no such justification, would be unlawful. The protection that she seeks is, in substance, already secured by the clause.

The amendment would also create another difficulty. Section 1 of the 2006 Act reaches the entire population and includes the prevention of illness before anyone becomes a patient at all. The “interests of patients” reaches only those already receiving care, which is a narrower test than I think the hon. Lady intended, and would allow a Secretary of State who was so minded to provide a landscape that ignores vital preventive health and wellbeing concerns. I hope that she will take from my remarks an assurance that the clause already meets her concerns.

The hon. Lady also highlighted the example of PFI—a subject of much discussion over many years—and of being unable to change her whiteboard. That is absolutely one of the lessons that needs to be learned from the way in which some past PFIs were procured and dealt with. For example, as a new Government, we outlined proposals for a new model of public-private partnerships for neighbourhood health centres, among other things. The previous Government could also have learned the lessons and done something about that, but they chose instead to completely halt the building of any kind of facilities. That is one reason why we are in such a shocking state at the moment. The new proposal outlines, as I think the Opposition know, an 80:20 funding route, exactly to make the point about which is the most efficient way forward. That will absolutely drive measures for growth and create more jobs in the sector.

--- Later in debate ---

[Karin Smyth]

I refer the hon. Gentleman back to my comments. The health service is defined under section 1 of the NHS Act 2006 as not being separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness—so, yes.

At this juncture, I will explain a number of other features of the clause. In particular, I draw the Committee’s attention to the fact that it builds on section 12E of the 2006 Act to cover the Secretary of State’s health functions, powers and duties. It recognises that, with the abolition of NHS England, the Secretary of State has a far more substantial role to play—as a commissioner of services, for example—than previously. I also put on the record that whenever the Secretary of State takes a decision in this space, the general NHS procurement requirements and other statutory duties will continue to apply.

Finally, the NHS relies on privately owned providers, as well as charities and community organisations, to provide a range of important NHS-funded services across the country. As such, it is important to ensure that, where there is a mixed-market provision between public and private for providers of a particular service, the Government’s powers are not used to distort the provision and potentially discourage important investment from outside the NHS. Conversely, they should not be used purposefully to favour independent providers over NHS providers for reasons unrelated to the quality or efficiency of NHS-funded healthcare.

[Dr Johnson]

If I heard the Minister right, she said that the clause did not provide for changes on the basis of ideology. However, it says that changes are not to be made

“unless the Secretary of State considers that to do so is in the interests of the health service.”

A Secretary of State whose ideology is that the private sector is bad, good or whatever else could well believe that it is in the interests of the health service to be private or not private. How does the clause prevent an ideologically driven Secretary of State from changing the health service on the basis simply of his ideology, rather than of patient or clinical need?

[Karin Smyth]

The hon. Lady tempts me to delve into the politics of future Secretaries of State. They will respond according to the manifesto on which they are elected by the British public. That is the point of a democratically accountable public service. I think that the clause strikes that balance, as I have said. For those reasons, I hope that the hon. Lady will withdraw her amendment. I commend the clause to the Committee.

Question put, That the amendment be made.

Health Bill (Fourth sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Gregory Stafford]

My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out—I will not say what that makes me.

What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham— I hope I am not misrepresenting her—is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of

“timely adoption and spread of clinically effective innovations”.

Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system.

By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for innovation to flourish, not one that shuts it down, as some Labour Members have suggested. Crucially, paragraph (d) of the amendment represents a significant and commendable commitment to fairness and inclusion by prioritising equal access to new technologies, medicines and models of care regardless of geography or socioeconomic background. It would help to tackle long-standing inequalities and move decisively towards ending the postcode lottery that we often see in care quality.

The focus of the amendment would ensure that innovation benefits all patients, not just those in the most advantaged areas. It would ensure that rural and coastal communities are aligned with the urban. As someone who represents a semi-rural seat, I see those inequalities in service delivery, quality of care and innovation. The large towns in my constituency receive far more money and get far better services than the surrounding villages.

I have many concerns about the clause as it currently stands, and I hope that the Minister will be able to clarify some of the Opposition’s questions. I entirely endorse amendment 58.

[Karin Smyth]

I am grateful to hon. Members for bringing this discussion to the Committee. We heard about the excitement in our constituencies around innovation—my hon. Friend the Member for Blaydon and Consett mentioned Newcastle University at the start and the hon. Member for Sleaford and North Hykeham mentioned her visit to Imperial College. Those visits are inspiring. Other universities and centres of excellence are available, but they made the case for why this is so important to the Government’s approach to innovation. I will talk about that and then turn to the amendment.

The Government are fully committed to innovation. It is absolutely central to our ambitious priorities to digitise health and care, support prevention and early diagnosis, and enable a shift to neighbourhood care, to growth in our economy, and to regaining our place in the world as a centre for innovation, which was lost under the Conservatives over those 14 years. That is why clause 6 places a clear duty on the Secretary of State to promote innovation in the provision of health services, including in how services are arranged and delivered.

The clause also incorporates the Secretary of State’s existing power to incentivise innovation and research through the payment of prizes, as we have discussed. That is a flexible tool that will allow him to stimulate breakthrough ideas and reward innovation across the life cycle, including an early-stage report.

On some issues that have been raised, the Conservative party knows that Ministers have to act reasonably as this transfers from NHS England, and we would obviously want to tailor a committee to the matter in question, including membership. The clause will allow that flexibility. The equivalent duty was on NHS England; I understand that it has not actually been used over the past five years, but it was previously suggested as a way of promoting innovation.

In practical terms, the Secretary of State already supports innovation in a number of ways, for example through the work of the Health Innovation Network, supporting workforce developments in schemes such as the clinical entrepreneur programme and providing funding support for developing and evaluating promising innovations.

[Dr Johnson]

The Minister talked about the flexibility of the committee, and my hon. Friend the Member for Farnham and Bordon explained why it is helpful to have some direction. Could the Minister explain why there is no stipulation for the chief medical officer or the chief scientific officer to be part of the committee?

[Karin Smyth]

I am happy to come back to the hon. Lady if I am not correct in this, or if there is another reason, but in the existing duty and under NHS England, the committee’s membership needs to reflect the matter in the question. If there is anything to add to that, I will certainly come back to her. We are also committed to spending more on innovation, raising the NICE threshold to ensure that patients have access to more innovative medicines on the NHS. That is action, not just words.

The Government commend the intent behind the amendment tabled by the hon. Lady, and she spoke well about that. As a clinician, I recognise her support for innovation, but we recognise that barriers remain to the systematic spread of innovation. That is a long-term problem that existed under previous Governments as well, and we seek to rectify it. The ministerial foreword to the “Life Science Sector Plan” published last year says:

“We are clear-eyed about the challenges. For too long, the journey from discovery to delivery has been too slow, too fragmented, and too often held back by outdated systems.”

That is why we need to remove barriers at every stage of the journey; however, the amendment is the wrong way to do that.

The experience of supporting innovation in the NHS suggests that we need flexibility in our approach to tackle emerging barriers as they arise. Specifying several areas of focus in the Bill would limit that flexibility; those are better set out in published strategies and guidance, which is what we are doing. The amendment could also cause unintended consequences. It would create a one-size-fits-all approach, requiring all of England to have equivalent access to innovations. While tackling unwarranted variation is of course vital, we should continue our focus on providing access to innovation that best meets local needs.

Instead of over-defining what we mean by innovation in legislation, we are taking practical measures to drive it on the ground. We are already building the 10-year health plan and the life sciences sector plan to deliver an ambitious set of actions, which address the areas raised by the amendment including procurement, aligned regulation and the alignment of our NHS innovation policy with sector growth policy. That echoes our approach elsewhere in the Bill of devolving power to local levels and giving more opportunity to systems and organisations to innovate, and more agency to use their resources to do so.

The NHS has a strong record of developing and adopting new treatments, technologies and models of care. The clause will build on that record, signalling the Secretary of State’s clear commitment to promoting innovation, and it will do so in a flexible way that will allow us to respond to challenges as they emerge. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her amendment, and I commend the clause the Committee.

Question put, That the amendment be made.

Health Bill (Third sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Thursday 18th June 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

Clause 1 formally abolishes NHS England as a statutory body, which is one of the key aims of the Bill. The current structure, with its two centres, has led to layers of unnecessary bureaucracy, duplication and unclear lines of accountability, and has come with significant cost, with the centre growing significantly in size since 2013. Through the Bill, we are simplifying the organisational landscape of the NHS and removing unnecessary complexity and overlapping roles among NHS England and the Department of Health and Social Care. The reform will enable leaders and staff to focus on delivering care, rather than on navigating bureaucratic hurdles. Importantly, it will also restore Ministers’ central role in national oversight and setting strategy, which the public rightly expect as part of a democratic system. The creation of an arm’s length body of this size was a mistake, and we seek to rectify it.

Clause 2 is integral to the orderly abolition of NHS England. It empowers the Secretary of State to establish transfer schemes, which will provide a structured and transparent means of moving property, rights and liabilities from NHS England to the Department of Health and Social Care, the integrated care boards and other relevant bodies. This robust legal mechanism is required to ensure a responsible transfer of NHS England’s assets and staff. It ensures that all necessary legal powers and permissions for the transfer are in place, preventing uncertainty or loose ends for staff, patients, service users and partner organisations as NHS England is abolished. The clause allows provisions to be made similar to those under TUPE to ensure the protection of employment rights for staff who are transferred from NHS England. In addition, the clause allows for the shared ownership or use of property, ensuring that assets can be distributed and used in a way that supports service continuity for patients and the broader health system.

Clause 3, at its core, provides a power for His Majesty’s Treasury to ensure through regulations that transfers from NHSE to the DHSC, ICBs and other bodies are delivered smoothly and on a tax-neutral basis. In particular, it allows HM Treasury to make adjustments to how existing tax legislation applies to transfers of NHS England’s property, staff and liabilities in a scheme made under clause 2. That will ensure that no tax charges arise, and that neither NHS England nor the transferee organisations end up with a different tax position due to the organisational changes. Importantly, the scope of the power is tightly constrained: it applies only to specified existing taxes and only for the purpose of ensuring tax neutrality in relation to transfers made under clause 2. Without the power, there would be a risk that transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 3 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal costs.

Without the changes made by clauses 1 to 3 we will not be able to meet the ambitions set out in the 10-year health plan. The abolition of NHS England, delivered in an orderly, proportionate and considered way that safeguards the interests of staff and taxpayers, is a necessary precondition for an NHS that is more effective for patients, delivers better outcomes across the country and achieves the ambitions that the public expect of us. I therefore commend the clauses to the Committee.

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

It is a pleasure to serve under your chairmanship, Sir Jeremy. First, I declare a number of interests. I am a consultant paediatrician working in the NHS, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health. Like the Minister for Secondary Care, I got into politics after working in the health service. I am sure she agrees that what you see when working in the health service stays with you when working in the House, and that it benefits the House to have people who have done all different jobs working here.

The NHS constitution says that health services should

“improve, prevent, diagnose and treat both physical and mental health problems with equal regard”,

yet in my work as a doctor—and I worked across several hospitals during my training—the gap between the vision of what should be delivered and the reality of what is being delivered has become apparent to me. The answer frequently given seems to be top-down reorganisation. As I will talk about in a minute, such top-down reorganisation has been done so many times but does not seem necessarily to have delivered in practice what it promised. Indeed, to an extent, we seem to be changing things from how they were to how they are to how they were, backwards and forwards. This Government have decided, in pursuit of better outcomes and cost savings, once again to reorganise the health service, and they seek to do so with this Bill and particularly clause 1.

Clause 1 formally abolishes NHS England. The clause may have very few words, but they represent one of the biggest changes to our health service in decades. Abolishing NHS England is not just a decision about organisational structure or trimming bureaucracy, but a break with the direction of travel the health service has been on since its inception.

Prior to the creation of the NHS in 1948, health services were fragmented: some people used contributory workplace schemes, people who could afford it paid out of pocket, and everyone else relied on very limited state and voluntary provision or went without. In the aftermath of the second world war, the national health service created a state monopoly provider. The Minister of Health had a duty to provide a comprehensive health service free for all at the point of use and a bureaucracy was created to manage it.

There was a tripartite split between hospital services, local authority services and independent practitioner services. The hospitals provided secondary care for those with serious disease and those requiring emergency response. The NHS also took over many cottage hospitals in rural areas that had previously been run by GPs, and larger hospitals that used to be run by local authorities and the voluntary sector. At that time, hospital staff were managed by hospital management committees appointed by regional hospital boards. Those boards implemented Government policies and oversaw the budget. Meanwhile, teaching hospitals kept more independence, directed by their own boards of governors.

Councils, operating as local health authorities, had a duty to provide several personal health services including health centres, maternity care, home nursing, immunisation and ambulance services—some of those are now provided by NHS England. They also had substantial powers to prevent illness and to care for the disabled. Independent practitioners—GPs, dentists, pharmacists and opticians— delivered services to local communities under contract from the health service. Now they deliver under contract from NHS England and the ICBs.

The health service underwent significant reorganisation in 1974, not long before I was born. The main objective at that time was to create a unified, integrated system. Community health services previously operated by councils moved into NHS control. These functions were put under the control of new area health authorities, which took control of most NHS hospitals. Some larger area health authorities had their own distinct management teams, which managed services on the ground—we can look at the current process and ask how it is similar and how it is different. The majority of teaching hospitals lost independent governance, in the way that we, too, are seeing that go back and forth. Above the new area health authorities sat regional health authorities, which were responsible for planning and allocating financial resources. Their members were appointed by the Secretary of State.

In the 1980s, Ministers recognised that the system had become very bureaucratic—perhaps similarly to today—and in 1982, area health authorities and district management committees were scrapped in favour of new district health authorities, with the aim of reducing what was in effect a three-layer structure to two layers. The thinking was that the new district health authorities would be closer to local populations, but primary care was left mostly unchanged. Once again, there are parallels with what is happening now.

From its inception to the end of the 1980s, the NHS had gone through several waves of rationalisation, but the model remained that of a centrally planned public service. However, during that time, there was an intellectual change—the concept of choice. Previously, people had been happy just to get a health service, which they had not had access to before, but that changed and people wanted choice. We now see the benefits of giving patients choice, and we will hear about how the Government’s changes through the Bill will apparently improve patient choice.

Of course, individuals have different values and preferences and live their lives in different ways, which makes it impossible for there to be a single public interest for the Government to pursue. Against that backdrop, the new public management approach to Government administration emerged, advocating for the introduction of market mechanisms and performance metrics—we have heard about the targets that NHS England follows—in public institutions. In theory, if elements of the state could operate more like the private sector, perhaps Ministers could achieve both cost savings and better outcomes.

In 1991 the Government introduced market logic into the health service. They created an internal market by splitting the purchasers—mainly, at that time, the district health authorities—from the providers, which were the hospitals. The Secretary of State gained the power to create NHS trusts—hospitals with the freedom to acquire, hold and dispose of assets; make bids for capital directly to the NHS management executive, in the way they might for NHS England; borrow money within limits; develop their own management structure; and employ their own staff with their own terms of employment. Within three years, almost all providers had become trusts. GP fundholding was established, enabling larger practices to receive budgets to buy secondary care on behalf of their patients, but that was short lived and was shelved in 1999.

When new Labour came to power in the late ’90s, one might have thought that things might swing back the other way, but in some respects the trajectory was similar. Initially, the Labour Government talked critically about the internal market. In 1998 the then Health Secretary told Members that the Government were

“sweeping away the internal market”—[Official Report, 1 July 1998; Vol. 315, c. 314.]

and the NHS plan published in 2000 claimed that

“the internal market introduced competition but failed to bring improvements.”

However, the policy choices of that Government furthered, rather than dismantled, the marketised aspects of the health service. They were saying one thing but, to some extent, doing another. There are similarities with this Bill: we have talked about decentralising power but, as we heard in evidence on Tuesday, many people feel it is more of a centralising Bill than a decentralising Bill.

It was clear that the new public management approach had been adopted across the political divide. The NHS plan promised patients more choice about how to access the NHS—a good thing. It promised a system of inspection, accountability and far greater local autonomy. It said:

“For the first time the NHS and the private sector will work more closely together not just to build new hospitals but to provide NHS patients with the operations they need.”

When GP fundholding went, the Government introduced primary care groups, which meant that GPs, nurses and other staff came together to commission for local populations. Those groups then evolved into primary care trusts, which by 2002 were responsible for spending 80% of the annual NHS budget—a budget that is now distributed by NHS England.

Health Bill (Second sitting)

Debate between Caroline Johnson and Karin Smyth

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Dr Johnson]

Q Mr Blythe, what value does your council of governors add to your trust?

James Blythe: Councils of governors across the NHS have added significant value since they were instituted and brought into foundation trusts. The foundation trust councils of governors play two roles. The first relates to the appointment and holding to account of the non-executive directors on the board. The second relates to securing public and patient involvement and voice in the organisation and the management of our services.

Since councils of governors were instituted, we have developed increasingly sophisticated ways of getting public and patient voice into services. If you look at innovations such as maternity and neonatal voices partnerships, which really involve service users in how services are developed on the ground and are very close to the teams that are running them, that gives us different ways of involving patients and the public in services where possibly councils of governors have not been able to do in the past. Councils of governors have played a really important role in foundation trusts, but certainly in terms of that patient and public voice function, we have moved on as a system and developed more sophisticated ways of doing that.

[The Minister for Secondary Care (Karin Smyth)]

Q To pick up on Sir Ciarán’s comments about experiences being extremely rare, the changes in the Bill sit alongside changes to the national centre and clarity for ICBs, with very little change to providers. What would make the biggest difference to providers and commissioners to improve things?

Sir Ciarán Devane: The biggest difference should be that the local providers and ICBs are incentivised to get together to make collective commissioning decisions. That means that, whether you call it a neighbourhood, footprint or local authority area, they make those decisions based on population evidence, which is why the single patient record is important, and they have the autonomy to do that with a lighter-touch centre that is set in guidance saying, “Look, this is broadly what we’d like you to do.” That guidance should be developed in conjunction with the people who have to do the job on the ground. That is what it should be; if the Bill allows that, that is fantastic.

The second bit is that the mechanism—it is not necessarily a legislative thing—by which the NHS is managed day-to-day will still need to exist. Who is going to be keeping an eye on things 24/7, 365 days a year? What happens if there is a fire—maybe even a literal fire—in a hospital? How is the NHS going to be corralled and brought in to help out a trust where something like that happens? That management function—the day-to-day operational management—needs to remain strong enough in the target operating model, as it is called, in the Department. If it is not, that could prove very difficult. Not necessarily day to day or in the short term, but in the long term, that bit has to be got right. One of the big risks of the legislation—there is not a legislative solution to this risk—is how day-to-day management works. We all have views on the relative strengths of the regions, of NHS England and so on, but how is that going to work in the new world? If one loses “grip”—that word is used a lot—then the risk to service delivery is quite high, and the risk to financial control is even higher.

James Blythe: Put simply, as an NHS organisational leader I think there are always a lot of things from which you can take your guidance on what you should be prioritising and focusing on as an organisation. If the result of this legislation is that we as organisational leaders have a really tightly defined set of priorities to deliver, articulated as far as possible as outcomes for local people and our population as a whole in terms of waiting times, quality and improving population health, I think that will allow us locally to get on with the partnerships that we already have as a day-to-day part of running local public services. We can focus on that very small set of things and do them really well.

Over the last year, there has been a sense of increasing clarity about those priorities as NHS England and the Department of Health and Social Care have worked more closely together. The NHS has delivered on those priorities to a large degree, but it all comes down, as my colleague says, to how senior officials and Ministers operate the system, because there is to be significantly more freedom to set priorities, and to design and run the system that essentially delivers them for the NHS. How that is done, retaining clarity about the things that we want to have delivered through the system and empowering local systems to do them will be really important.

--- Later in debate ---

[Dr Johnson]

So you are losing a protection with the Bill.

Sally Burlington: Exactly.

[Karin Smyth]

Q Councillor Wright, the Bill will essentially abolish NHS England. Do you have any comments about how that works at the moment in terms of local government? How can we unlock some of the potential in the Bill, with the changes to NHS England, with regard to local government, particularly on health and wellbeing boards and the entire place agenda?

Councillor Wright: The main problem the abolition of NHS England has caused is upheaval and uncertainty with our health partners. Many of the health partners at our health and wellbeing board meetings or our place committee meetings are almost saying to us, “I don’t know if I will be here at the next meeting.” Such turmoil in the changeover creates instability from a lack of being able to plan what will happen next. That is one of the challenges that we feel. We are working with our health partners and getting assurances that there will be continuity, but it is quite hard when the person we are working with is changing.

We are really excited about neighbourhood health sitting under health and wellbeing boards. We love the idea of neighbourhood health looking at the wider determinants of health and having a very localised health response to the issues that that community needs to help it. One of our anxieties is that a lot of ICBs have become bigger and have less connection with the place. They are also shrinking; I think NHS England is losing 30%—

Maria Higson: Larger geography, fewer people!

Councillor Wright: Exactly. We have had a letter from our ICB giving us the heads-up that they might not be able to guarantee that they can send the right person to our health and wellbeing committees, which will obviously make it difficult to plan neighbourhood health.

The other challenge we find in neighbourhood health is that local authority boundaries might not necessarily match neighbourhood boundaries. I will give an example from Bracknell, where I live. Bracknell is very clearly a neighbourhood, but the south of the borough, which is within the Bracknell Forest council area, probably sits within Bracknell and Wokingham and a little bit within Reading. It will be hard to bring in true neighbourhoods with the current structure, but that is something we are working around, and we are hopeful that we will be able to sort it out.

--- Later in debate ---

[Dr Johnson]

Q As a Lincolnshire MP, I am delighted to know that that is operating, if not necessarily in my constituency, then certainly in the county. I have a question for Kath: how does the single patient record apply to maternity in terms of safeguarding and access to that sort of information? As an aside, this Bill allows the Secretary of State to set targets. How would you see that working in maternity care?

Kath Abrahams: On digital exclusion, the same risks apply, although there is a different age demographic. If you have somebody who has a particular disability, has English as a second language, or has difficulty reading, we need to ensure that alongside the single patient record we are not excluding people without meaning to. Having said that, there are real opportunities to reduce inequities as a result of this change, such as by ensuring that everyone’s information is there, and that people do not have to retell their story if they find it difficult to speak to their clinician.

What the single patient record will not do is solve all the problems found in the national maternity and neonatal investigation. An action plan will come out of that investigation, and it must be looked at really seriously. A single patient record does not replace compassionate care or somebody really being looked after well, but it can potentially provide a safer environment—I am very happy to go into detail on that.

The national maternity ambitions have expired, but we are pushing very hard for them to be restated. There is potentially an opportunity to use the data at a broader level to measure progress. If it was possible to use the single patient record to understand how things were going towards improvement, that could be very helpful.

[Karin Smyth]

Q I will follow on from Dr Johnson’s questions. You have all expressed support for the single patient record, which is great, but that is not universal. Obviously, the Bill has to be enacted for that measure to go forward. It would be helpful to hear about your current experiences in your different areas—older people, maternity and carers. Your examples gave a bit more detail on why not to have this, Ms Abrahams—let us not assume, because although the process of the Bill is to make this happen, we have heard some concerns today from people who do not want that. What is happening in your world that this will help with?

Kath Abrahams: Right now, the situation is really tricky and people are being failed in their pregnancy and maternity care. Women report constantly having to retell their story—highly sensitive or traumatic experiences of loss—and that repetition can happen across the early pregnancy unit and maternity services. There is a common misconception that the NHS is one system, so when they find that people in another bit of the system do not know something, that can be really frustrating and annoying, because they assume that it exists.

There is also a lack of continuity. A clinician can be completely unaware of a sensitive or traumatic experience that somebody has had, and there can also be genuine dangers in outcomes. We know from the reports into Morecambe Bay, Shrewsbury and Telford that the lack of joined-up sharing of information and good communication between different parts of the system has led to some really difficult outcomes, particularly if somebody also has gestational diabetes, for example, or another condition and they are taking a particular medication that could cause harm to an unborn baby.

There are lots of situations in which not having the complete history is preventing people from getting not only really good, compassionate care, but the safe care they need. If someone is in an emergency situation and they are bleeding out, or their baby is not moving as much as they should, there is not time to start from scratch; they might not be in a position to explain what is happening to them and what their history is. They might not even know all the relevant bits of their history. Having that complete record, if it was done really well, would give clinicians the information that would allow them to make really timely decisions. Maternity can often be high risk—I do not need to say that to you; you know that—but these are often fast-moving situations where time is absolutely of the essence.

Emily Holzhausen: To build on what I said earlier about the amount of co-ordination and admin that people do, I will just refer to some carers’ words. One said that if they had to phone, they would end up in a long waiting queue or having to travel to the GP in person. There are people juggling work and care, so this has real, everyday impacts on their lives and their time.

When I refer to errors, I mean things such as medication errors or diagnosis errors. When you care for someone with very complex conditions, you can have health appointments every week—sometimes twice a week—and it is so hard to stay on top of it. When I say it is so hard, and talk about unpaid carers, we know that caring is a social determinant of health: in itself it is a single factor for poorer health outcomes. We know that 600 people a day give up work to care.

We have done a report on the tipping point: what tips carers out of work? One such thing is social care; another is how they are treated in the health system. If we reduce the pressure on carers and put information at their fingertips to help them to manage care, we improve outcomes for everybody: the health and wellbeing of the carer and the safety of the person that they care for. People are trying to do their best in quite a difficult situation.

One of our members, Norman Phillips, has talked about that a lot. He was in contact with more than 24 professionals, knitting up care around his wife who had advanced multiple sclerosis and dementia. That is an incredible amount of co-ordination of care. You can see how a single patient record, as it is envisaged in the future, could really help to support people who provide care. It is critical, given that we have an ageing population, that we recognise and support families in what they do.

Paul Farmer: I would start by talking about people with long-term conditions. Let us bear in mind that by the time we are 65, 82% of us will have one long-term condition, and half of people aged 70-plus have more than one long-term condition. Most of those long-term conditions are diagnosed within primary care, but of course they have a huge impact on access to secondary care services. For a clinician not to be able to see that whole picture and for the individual to have to explain again and again their physical health issues, and potentially their comorbid mental health issues, creates a huge challenge for people in getting access to the right help and support in a timely manner.

I would build on that to think about two areas that particularly affect older people: frailty and dementia. In this context, we know that assessment for frailty can make a big difference to ensuring people receive the right kind of help and support. That should be done in primary care, but often, sadly, people with frailty will present in hospital with a range of conditions. Understanding the frailty assessment score and what help and support is needed is key. For people with dementia and their family carers, having access to the right information for the clinician and for the individual concerned can make a huge difference. A disjointed experience just exacerbates what can often be a very challenging time.

--- Later in debate ---

[Dr Johnson]

Q Does it surprise you that the Bill is being brought forward before it has been properly and completely designed? We have tabled some amendments to clause 47; I appreciate that you will not have had a chance to look at those yet, but we would be interested in your thoughts if you could provide them to the Committee afterwards.

We keep hearing that it is difficult for people to have to repeat their story. I understand that stories can be traumatic and repeating them can be unpleasant, particularly if it must be done many times, but is there sometimes a clinical value in asking people to go through their story? If so, what is it?

Dr Imam: My specialty is frailty, which is a medical condition characterised by a loss of independence. Although it is associated with ageing, it is not an inevitable part of ageing. The treatment that I deliver as a clinician is called a comprehensive geriatric assessment. It is evidence-based and we know that it improves patient outcomes and maintains independence. What it describes is a multidisciplinary team approach to a holistic assessment that focuses on what matters most to the patient.

One of the issues that we have right now, however, is that the NHS does not consistently identify people who are living with frailty right across the system from community to hospital. If we are identifying people and diagnosing them with a condition, you would expect treatment options to be offered, yet we do not consistently do that across the country. That is essentially driving ineffective and inefficient care. Sometimes, therefore, when a crisis sets in—we have seen this in other reports around corridor care—that can ensue in older people living with frailty.

In my day job, where I look after people in a busy A&E department, I see people who have may have had a fall or become confused, or where there has been a breakdown in their social situation. My practitioners and I are spending hours trying to piece together information from multiple different sources. Those could be paper-based, digital or telephone—we could be trying to phone people to get up-to-date information. As you can imagine, sometimes they do not pick up the phone, so we are sometimes working from incomplete information and things that are not up to date.

Once we have done that, we try to create a care plan for a patient that allows them to be looked after in the community. However, that care plan may not follow the patient, because everyone uses different electronic patient record systems. Some important partners in that care, like social care or ambulance services, cannot actually see the care plan that I have developed for my patient.

Unfortunately, if a patient with frailty then succumbs to a crisis of some kind, the default setting is, in many cases, to trigger an admission to hospital. If a patient does not need to be in a hospital environment and they are frail, they can end up becoming more frail and weak, and lose their independence. That means that they will need even more social care than would otherwise have been required.

Where the solution comes in is that a nationally rolled-out single patient record system could fundamentally reshape this form of care, because we would be moving it from the fragmented, reactive model that I just described to one that is proactive, co-ordinated and truly centred around a patient. Another thing about frailty is that there are so many different people involved in that person’s care, so we need to try to restore the continuity of care for that type of patient, which has become eroded over time. The SPR addresses that with a single up-to-date view of a patient. It enables earlier risk identification, faster clinical decision making and that whole-system integrated response I have been describing, which is lacking at the moment.

There is often duplication; one of the other issues is that assessing patients in this manner can take a long period of time—up to two and a half hours is often quoted by the British Geriatrics Society. You can imagine that if you had an electronic record that could be auto-populated or could rely on the most recent, up-to-date plan done by someone else, that would avoid reassessment as we would be working from contemporaneous information.

Over time, you can see how, for frailty and many other conditions, that could lead to a more preventive approach that is more community based, that reduces the need for admissions, and that provides a better overall experience for staff and patients. Importantly, there needs to be a shift towards neighbourhood working on frailty, and this allows the multidisciplinary team to work towards one plan. You have also heard today about patient voice and carer voice, and this type of care plan also gives them the opportunity to become partners in looking after themselves.

Dr Cocker: The brief answer to the original question would be that communicating and getting a history from a patient are the cornerstone of the patient-doctor relationship. I do not think that the SPR is ever intended to replace that. Where I see its value within maternity, although I am sure that this is the same across all specialties, is that it would form a reliable means of cross-referencing information and being able to get information that—as we have alluded to previously—is often held on many separate systems. As a clinician, you will often not have the ability or the credentials to access that.

For example, in maternity care at my trust we use a certain piece of software. If you do not work in maternity, although you might be able to get generic access to it, you might not be able to navigate that system. The idea of the SPR is that it would pull out those key bits regarding current concerns about the pregnancy or what follow up has been arranged—all those kinds of things. That would not rely on the ability to use lots of different systems; instead, the information would be available. If there is information that requires cross-referencing or checking, it would also give you the ability to do that rather than replacing the process of taking a history and working out what is wrong with someone.

Dr Byrne: It is a terrific question. Healthcare is a relationship; it is not simply a transaction of facts. At its best, it is a working relationship between a clinician and a patient, but that is also why it is so hard sometimes. Our stories are a combination of two things: the facts and the interpretation of those facts. We heard a moving example earlier of someone saying that they had had five miscarriages and those facts were then not known and how distressing it was that they were not. That is a good example of why getting the facts from conversation to conversation could be really helpful.

Our life story changes over time, however, as does the interpretation that comes up in a conversation. As a doctor in the moment with a patient, I am sometimes as interested in what they are choosing not to tell me at a particular time as what they are choosing to tell me. For all of us, the story changes and is fluid. I think that is a potentially helpful distinction to make.

[Karin Smyth]

Q My questions around the benefits that you might see have been really well answered, so I will not go back to that issue. Dr Cocker and Dr Imam, in your work on maternity and frailty, what early lessons have you picked up on how this might work for you?

Dr Cocker: Having seen the maternity-focused prototype that NHS England developed in the north-west, we learned that it is technically difficult because there are lots of systems. There needs to be a level of interoperability that allows you to pull the data or it is not going to be much use as a reliable system.

The other thing was about trying to ensure that we design those systems for the patients most in need. That might be social or medical need, and there are many different facets to that. That was one of the other challenges. A lot of the focus went into trying to determine a set of theoretical patients who were very high need, and ensuring that you have encompassed all those possible needs, so that if you design the systems for those in most need, they will cater for as many people as possible.

Dr Imam: To expand on Dr Cocker’s point about the identification of problems, people living with frailty often have multiple under-identified issues. In the prototype we have been shown, the SPR has the potential to analyse the wealth of data on a person and summarise it in a manner that makes sense to the clinician logged into the record. It can also piece together a timeline of what has been happening with a person.

As I said earlier, we often follow a manual process to try to understand what has been going on recently for a person. The SPR will not only enable the automation of that process, but give us the ability to know who the key individuals involved in that person’s care are, so when that person is in a crisis or emergency situation, we know exactly who to call and who the last person to touch the patient was.

There are other important functions. It is not only about sharing information across an entire pathway and having the whole-system approach that I described—from community to hospital, and vice versa. Importantly, many people living with frailty require multiple different referrals and the involvement of multiple different people in their care. The SPR will be able to streamline some of those processes and make recommendations for certain referrals that a clinician, who, under an earlier version, would have logged into the record, may not have otherwise thought about, so it may even improve outcomes for patients by providing solutions to improve their care that we would not have come up with otherwise.

--- Later in debate ---

[Dr Johnson]

Q We do not have a plan of where we are going, but you have been asked to go somewhere.

Jon Restell: Obviously, we have the 10-year health plan, which most people broadly see as a good vision for the service, but there are too many key design questions around the new department, the role of the department’s regions, what ICBs will be doing and what trusts will take on as part of this reorganisation. Behind it, there is a lot of capacity and resource organisational memory being taken out of the system.

We do not talk nearly enough about the work of the commissioning support units staff, who are providing internal consultancy and a huge range of business services to the health service, including overseeing child immunisation programmes in some cases. It is really unclear what the future of those functions is. We are taking out a lot of staff who have skills, expertise, organisational memory and commitment, but we do not quite know yet what the precise form of those organisations will be. It is a very difficult change to manage.

[Karin Smyth]

Q It is always good to have a doctor from the NHS supporting managers in the NHS, having been one. I declared my interest earlier that I am a member of Managers in Partnership.

We had a lot of change with the Health and Social Care Act 2012, and the Bill seeks to reverse that in terms of the architecture of the NHS. We absolutely appreciate as a Government that that is very difficult for staff working in it. I appreciate that the operating model and so on is coming forward, but could you say a bit about people’s feelings about the Bill? There will be more clarity to the centre and the role of providers is not changing, while the real change is around commissioning functions and, as you said, commissioning support organisations. We heard earlier that everything is being reorganised. That is not true, but there is a big change in the geography and the functions of ICBs and commissioners, and the Secretary of State’s role will clearly be different. What might people’s approach to that be?

Jon Restell: Clarity, definitely. No one wants to start with the system that came in in 2011 and 2012. Successive Governments started to correct it almost as soon as it was put in place. I think most people would welcome sorting out the clarity around commissioning there, but I do not think that is the same thing as cutting 50% of those organisations’ staff and running costs. You are clarifying the relationship between the centre and ICBs, commissioning and providers. You still need enough managers with enough skills working in the right system to deliver. That is the nub of what we are doing.

For us it is not really about how the Bill will eventually pan out; it is about the cut and how that is being administered by NHS England, the Department and ICBs. The whole system of management is under strain across the health service. You say that providers are not changing but they are also being asked to take out quite significant amounts of management resource. They are merging to form bigger, potentially more centralised units that may be less responsive and less innovative. I think that organisational form is really important, even if the headline of the Bill might tidy up and clarify those relationships, which would be welcome.

A point made by a lot of members, particularly those in ICBs, is that they do not think that the model design—where we started with ICBs, then went to regions and we are eventually going to get to the target operating model for the Department—is being done at a time where you can see the proper connections that need to be made between those organisations. When the system is up and running, how well will it work together to share information, share risk and so on? It feels like the Bill is very high level and the detailed design of the organisations is being undertaken in a completely fragmented way. People see that as potentially requiring the next round of reorganisation. You are a former NHS manager, Minister; you know how often reorganisation is reached for as the solution. I genuinely feel that people have got to the point where enough is enough. That kind of continual change will create more and more problems for doing the things that the public actually want to see: innovation, improvement in the quality of service and happier staff—all the things that managers should be focused on, not the merry-go-round of organisational change.

--- Later in debate ---

[Dr Johnson]

Q We have heard evidence today that the Bill weakens links between local authority working and the ICB. Does that help social care, or could that actually make it worse?

Sir Andrew Dilnot: I would not claim to be expert here, but I have read the Bill and the briefings. The role of local authorities in social care is a very interesting one. If we were to stand way back and honestly answer the question, “Why is social care managed by local authorities at the moment?”, we would say, “Because it was forgotten in 1948, when the rest of the modern welfare state was created.” At that stage, social care was a pretty small activity, and it was just left with local authorities. What has happened since then is that it has grown and grown, and it is now putting enormous strain on at least many local authorities.

I think we should draw a clear distinction in something that is definitely appropriate—that is, care being provided within a local context. The kind of care that is appropriate in Camden will be different to the type of care that is appropriate in the highlands of Scotland. Local delivery seems relevant, but whether local financing makes sense in 2026 is a very big question. That is the context.

On its own, it is hard to see the potential reduction in the role of local authorities in ICBs making things better. It will not necessarily make things significantly worse, but I do not think it will help local authorities and the NHS in trying to integrate these two essentially non-integrated functions.

[Karin Smyth]

Q As you say, the Bill does not deal with social care, but it is great to have your expertise here. Do you think the Bill should or could have included social care at this stage?

Sir Andrew Dilnot: The question of the fine details of how legislation should be passed is certainly outside my skillset, so I have to be agnostic about whether the Bill should have addressed the wider questions of social care. On the question of whether we could address social care or not, the answer is definitely yes. After all, several Governments over the last few years have promised to do so. The former Secretary of State for Health and Social Care, when he was the shadow Secretary of State during the election two years ago, promised that he would do it. Such measures have received Royal Assent twice, but they have still not taken place, even though they were promised by the then shadow Secretary of State for Health and Social Care, before he became the Secretary of State.

Yes, we definitely could do it. The amounts of money involved, while of course significant, are small relative to the aggregate costs of the NHS or the uplift in spending on the NHS that, with my full support, we have seen in the last couple of years. I think it is a genuine puzzle and a black mark for all of us, including me, that all these years have gone by and we have done nothing. We have a social care system that is supported by millions of wonderful informal carers and about 1.5 million formal carers, benefiting hundreds of thousands of people, but it is creaking under intolerable strain. It really makes no sense to me, and I really do not know why or how we have managed to go for so long without addressing it. We should do so, not only because it is the right thing to do, but because it is now so bad that it is doing direct, instrumental damage to the NHS.

Health Bill (First sitting)

Debate between Caroline Johnson and Karin Smyth

Tuesday 16th June 2026 Public Bill Committees

[Dr Johnson]

Q What about the risks of that—the conflict?

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

[Karin Smyth]

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

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

--- Later in debate ---

[Dr Johnson]

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

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

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

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

[Karin Smyth]

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

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

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

--- Later in debate ---

[Dr Johnson]

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

[Karin Smyth]

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

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

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

--- Later in debate ---

[Dr Johnson]

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

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

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

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

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

[Karin Smyth]

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

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

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

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

Compassionate Use Medicine Schemes: VAT

Debate between Caroline Johnson and Karin Smyth

Thursday 11th June 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the effect of VAT on the availability of medicines through compassionate use schemes.

[The Minister for Secondary Care (Karin Smyth)]

It is very important for patients to have access to innovative medicines as quickly as possible, especially where there is unmet clinical need or no alternative treatment. We are working to streamline the decisions of the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency so that NHS patients benefit from the latest medicines as soon as they are proven to be safe and effective.

Early access and compassionate use programmes can play an important role in enabling patient access to medicines ahead of routine commissioning decisions. However, we should be clear that these programmes are commercial decisions taken by pharmaceutical companies: companies choose whether and how to provide medicines free of charge to patients and the NHS before the medicines go through licensing, post-trial access or a funding decision.

The tax system is, as Members know, a matter for the Chancellor, so I will not get into details about that at the Dispatch Box, but under long-standing VAT rules, supplies of goods free of charge can still be treated as taxable “deemed supplies” where input tax has been recovered. That means that VAT can apply even where no payment is made, reflecting established principles of the tax system. We recognise the concerns raised by industry and others about the potential impact of this treatment on the provision of free-of-charge medicines. We are working closely with the Treasury and His Majesty’s Revenue and Customs to explore options to address these issues, as witnessed by my hon. Friend the Exchequer Secretary to the Treasury, who is here with me on the Front Bench. We will carefully consider the legal, fiscal and operational implications of any potential changes. Until then, we will continue to engage constructively with industry, the NHS and all our partners to make sure that British patients, who we have in our thoughts at all times, have access to innovative medicines.

[Dr Johnson]

I declare an interest as a consultant paediatrician. One of the worst moments as a paediatrician is when all treatments have failed and there is no suitable clinical trial. At that point, in those dark moments, compassionate use schemes can be a glimmer of hope, and new unlicensed medicines with clinical potential have been provided free to the patient, and free to the NHS. Last year, however, the Government started charging VAT on the deemed value of those drugs, meaning that companies had to pay tax to give the drugs away. When hearing that “every meeting” with Labour MPs was about

“who can we tax in order to pay benefits to others?”

few would have imagined that that would include potentially lifesaving, charitably given drugs for sick adults and dying children.

Following lobbying by my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez), the Government have paused enforcement while they review the situation, but they have said that liabilities remain, and they are taking too long. Bayer has now withdrawn from the scheme, and others could follow. Patients are at risk. Does the Minister recognise that that makes trials in the UK less attractive, and that HMRC’s pause is not enough? How much money do the Government expect to raise with this VAT? How did the Government find time to reduce VAT on fairground rides at Alton Towers, but not to sort out this problem? How many patients have missed out so far? Does the Minister recognise that this delay could cost lives, and who was the Minister who signed this off? Was it the Health Secretary when he was a Minister in the Treasury?

I understand that the Government say this situation is not new, and that it may apply to a law dating back over 30 years. I gently point out, however, that the application is new, and that the levers to change it—and change it quickly—lie in this Government’s hands. Patients need them to act swiftly.

[Karin Smyth]

I pay tribute to the hon. Lady’s service as a clinician, and she is right to say that, at times, for patients facing such situations, compassionate use schemes are a glimmer of hope, but I think the rest of her comments were ill deserved. I understand the desire of the Opposition to attack a new Secretary of State because he was in the Treasury, but I will move on to the actual issues, because patients care about this. The rules had been in place for a long time when this Government took office, and we have not changed them. We have inherited this system, and we are looking at how we can improve it.

The previous Government could have abolished VAT on such medicines, but they chose not to do so. What is more, since we have been in office, we have struck a deal with the USA that not only guarantees 0% on pharmaceutical tariffs, but changes the old formula that we use for medicines. For the first time in 20 years, the Government are spending more to ensure that our patients are first in the queue for innovative medicines. The previous Government could also have raised the threshold, but they chose not to do so. Now, for example, patients facing Duchenne muscular dystrophy, children as young as 12 who need a brain cancer drug, or those who have a type of rare and aggressive stomach cancer, are being treated.

We recognise the importance of the UK remaining a leading location for life sciences, investment and innovation. That is precisely why we are engaging with industry and partners across the Government to understand and address concerns, including the issue of VAT payable on donated medicines. In considering a way forward, it is important to safeguard the robust and fair system by which routine access to medicines commissioned by the NHS is determined. A range of options are being considered. No decisions have been made at this stage, and I will not pre-empt any.

Women’s Health Strategy

Debate between Caroline Johnson and Karin Smyth

Thursday 16th April 2026 Commons Chamber

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

I am glad to see that the much-delayed women’s health strategy is finally here, and I thank the Minister for her work on that and for advance sight of her statement. I am particularly pleased that Ministers have pledged to prioritise medical health conditions such as endometriosis and to continue the roll-out of the HPV testing that we piloted.

Today it is one year since the For Women Scotland judgment in the Supreme Court confirmed that sex is biological sex. At the time the Secretary of State told the public:

“We will be issuing guidance in the coming weeks before the summer”.

To be fair to him, he did not say which summer. This week, a Minister told the House that the guidance on single-sex spaces could not be published under purdah rules until after the local elections. Will the Minister explain why it is okay to announce policy on other aspects of women’s health but not on single-sex provision in the NHS?

I find it remarkable that the Minister has the audacity to talk about women harmed by pelvic mesh when, after almost two years in office, the Government have still not responded to the Hughes report. When do they intend to do so?

I was disappointed not to find a commitment in the strategy to the lobular breast cancer moon shot project. Will the Minister give us a timeline for what I understand is a commitment to that project by the Government?

The Minister talked about waiting lists. While it is welcome that gynaecology waiting lists have fallen in the past year by 1.9%, for those requiring some sort of procedure or admission, waiting lists are 4.5% higher than they were a year ago. One way to make waiting lists shorter is to not start counting until someone has been waiting for a few days already—more targets can certainly be hit that way—so will the Minister clear something up for me? The Government have decided to prevent GPs from directly referring patients to consultants, insisting that they request advice from consultant-led teams instead. If the consultant then decides to offer an appointment, the clock starts, but that will be a few days after the original request is received, making the waiting time a few days shorter. This is where it gets really confusing: the Minister for Care said that the rules are going to change so that the clock will start when the advice request is received, so that patient waiting times are accurately reflected, but the Minister for Secondary Care has said that that will only happen from October.

Who is right? Do the Government intend to try and fiddle the figures by making people’s waits look shorter between now and the autumn? Given that we have heard different answers from two different Ministers, do they not know what is going on? Or can they confirm that with their new process and with immediate effect waiting times will be calculated from the moment that the advice and guidance request is received, in the same way as happens with referrals now?

The first chapter of the strategy is about acting on women’s voices and listening to women, which of course is welcome, but the Government plan to abolish Healthwatch in favour of listening to organisations. Why are the views of organisations that may or may not accurately represent the voices of women more generally being prioritised, and the voices of women themselves being somewhat deprioritised?

In the strategy, the Government commit to increasing capacity for surgical—in other words, later—abortions. They commit to making the morning after pill available free from pharmacies; they have made the oral contraceptive pill available from pharmacies too, and they have said that they will improve workforce capacity to provide long-acting reversible contraception. At a time when sexually transmitted infections are on the rise, with potential significant short-term and long-term consequences for women, there is no mention of condoms in the strategy. Given that some men can be reluctant to use condoms and there is discussion of eliminating misogyny throughout the document, will the Minister explain the choice not to include those too?

Another issue I want to raise is that of fracture liaison services. On entering Government, the Secretary of State said that one of his first jobs would be to establish universal fracture liaison services by 2030, yet that is moving at such a slow pace that he will not meet his target. Will the Minister set out how many of the dual-energy X-ray absorptiometry—DEXA—scanners are new, how many are replacements and how many will be used to set up new fracture liaison services?

There are many more questions that I can ask, but I understand that I have run out of time. In summary, while there are a few good points, it has taken a long time to produce a strategy that is rather disappointing. Women deserve much better.

[Karin Smyth]

It is hard to know where to start. I heard the word “welcome” somewhere in the hon. Lady’s remarks, so thanks for that.

In launching what we call a “renewed strategy” we have given credit to the previous strategy, which we welcomed when we were in opposition. However, on issues where there could be cross-party agreement, from going to war to the women’s health strategy, the Conservatives’ modus operandi is now to give nothing for us to work on together on behalf of the people who we represent. It is disappointing that they choose to start on a negative and really they could have done better.

In opposition, we welcomed the initiative to have a women’s health strategy and we supported that work going forward, which has led to the publication of this renewed strategy, because the diagnosis of many of the issues was right. However, as I have made clear, we are upending the system because for decades the health service was built around the work and health needs of men and the predominance of men working in the system, despite the fact that 77% of our nursing staff are women. We are upending that to put women’s voices and choices front and centre, including control of the budget and through NHS Online. Those are the game changers.

The Conservatives do not recognise the total game-changing nature of NHS Online in facilitating services for women wherever they live across the country, whether they live near highly specialised centres, such as those that I am privileged to have in my city of Bristol, in the coastal and rural communities represented by Members from across the House, or near tertiary centres. Any woman, from any part of our country, can access NHS Online and have that specialist service. We are trialling that with gynaecology. They will then get support from our rapidly expanding community diagnostic centres, about whose expansion we made an announcement this week, in order to get quicker diagnosis and the support that they need, closer to home in their neighbourhood health services.

I am happy to respond to the other issues that the hon. Lady raises, including the For Women Scotland judgment, and to set out the work that we have had to do to clear up the mess that the Conservatives left. Everything that happened to women under that system happened on the watch of the Conservative Government, from self ID to the issues at the Tavistock and everything else. There was a lack of rules, a lack of governance and a lack of clarity, and they did not take control. That is the mess that we inherited from the Conservative Government.

The Minister for Women and Equalities, my right hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), is doing an excellent job: she is made of steel and good experience, and she has had to navigate a difficult landscape. The Conservatives understand the rules of purdah like the rest of us, so let us not pretend that they do not. My right hon. Friend will be laying that guidance as soon as she can after the election.

I will go on to talk about the DEXA scanners that we are investing in and fracture liaison services bringing people together, which were promises in our manifesto. This strategy is about specialists coming together and working together in fracture liaison services and women’s health hubs. Those have led the way among clinicians about how we can work better for women. That is why we are building on and expanding them, and it is disappointing that the Conservatives do not want to work with us on that.

Oral Answers to Questions

Debate between Caroline Johnson and Karin Smyth

Tuesday 13th January 2026 Commons Chamber

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

The Secretary of State has previously said that he accepts all the recommendations in the Cass review. One such recommendation is that the Secretary of State mandate the release of data for the data linkage study. Can the Minister tell us what specific steps have been taken to mandate the release of that data?

[Karin Smyth]

We absolutely stand by that work, and we are working with NHS England to make sure it is mandated to do exactly that.

Oral Answers to Questions

Debate between Caroline Johnson and Karin Smyth

Tuesday 21st October 2025 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

We have.

[Karin Smyth]

As my right hon. Friend has just said, we have delivered on that commitment. The hon. Member talks about the reorganisation being a distraction. If her party had focused taxpayers’ money on patient services rather than ballooning bureaucracy, with costs increasing both among providers and through ICBs, we would not have inherited the mess that we did, and would be able to roll out programmes more effectively. We have committed to doing that.

[Dr Caroline Johnson]

I thank the hon. Lady for her answer, but I would like her to check and perhaps update the guidance for GPs and the websites that continue to say that it is only available to 80-year-olds who turned 80 after 1 September 2024, which is not all people over the age of 80.

Reorganisation is affecting delivery elsewhere, too. The Secretary of State also promised that the continued roll-out of fracture liaison services would be one of his first priorities. How many new fracture liaison services have opened since the general election?

[Karin Smyth]

On the hon. Lady’s first point, this Government, unlike the previous Government, do believe in experts, and we follow the clinical advice that we are given. On her second point, as she is so keen on reading our manifesto commitments, the commitment was to do that by 2030. It is currently 2025. Our reforms to ICBs and providers, bringing NHS England inside the Department of Health and Social Care to make it more democratically accountable for taxpayers, will reverse the shocking increase in funding that the previous Government put into a leaky bucket. We are fixing the foundations of the NHS. We are targeting resources at people in line with our 10-year plan.

NHS and Care Volunteer Responders Service

Debate between Caroline Johnson and Karin Smyth

Monday 19th May 2025 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement regarding the volunteer and care service.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for giving me the opportunity to speak about this topic and highlight the important role that volunteering plays in our health and social care system. The NHS has always benefited from the generous contribution made by volunteers, who play a vital role in supporting our patients, staff and services. We are grateful to the thousands of volunteers who donate their time to support the NHS in a wide variety of roles, from helping patients to leave hospital faster and settle in at home, to supporting emergency cardiac incidents and providing companionship to patients during end-of-life care.

The national NHS and care volunteer responders programme was first established as part of the covid response, and then adapted to respond to other organisational pressures. However, a model that worked well in that national crisis is no longer the most cost effective way of facilitating the important contribution of our much valued volunteers, so NHS England has recently taken the decision to close the current programme. Instead, a new central recruitment portal for NHS volunteers will be fully launched this year, providing opportunities for the current pool of volunteer responders to continue to play their part. Volunteers will have had that information emailed to them recently.

NHS England will also work with NHS providers that draw on the support of the volunteer responders programme to ensure that they are helped in developing other volunteering interventions that meet their service needs.

The roles of 50,000 additional volunteers who are recruited and supported by NHS trusts directly will be unaffected by the closure of this programme. That is in addition to many more thousands of volunteers who support the NHS either directly or indirectly via other local and national voluntary sector organisations.

Successive volunteering programmes in the NHS are primarily run locally by individual trusts and integrated care systems identifying the best opportunities for volunteering interventions that meet their specific service needs. That means local NHS action to build relationships with voluntary sector organisations and co-developing volunteering programmes and pathways that support patients, staff and NHS services. There will continue to be opportunities to strengthen and encourage innovation in NHS volunteering at national level. The Government recognise the need for sufficient and agile volunteering capacity and capability of support in particular scenarios, such as pandemics and flu seasons, when the health and care sector is particularly stretched.

[Dr Johnson]

Thank you, Mr Speaker, for granting this urgent question. At the start of the covid pandemic, NHS volunteer responders were set up to support vulnerable people. Following its success, the previous Government expanded the scheme into adult social care, forming a joint NHS and care volunteers programme. That service has mobilised more than 750,000 ordinary citizens who have completed more than 2.7 million tasks and shifts, including more than 1.1 million telephone support calls, 1 million community response tasks and almost 400,000 steward shifts. I saw at first hand as a volunteer and doctor during the pandemic that NHS and social care teams benefit from volunteer support, and I put on record my thanks to all those who give up their time to support those around them.

Out of nowhere, the Labour Government have decided to cancel this service at the end of the month. No tasks allocated after 31 May will be completed, seemingly leaving patients in the lurch. Has the Minister thought about the real-world implications of the additional pressure placed on NHS local authorities, the loss of institutional knowledge and the impact on vulnerable patients? What alternative measures are being put in place to support the people who were supported by volunteers? The Minister said that something would be put in place later this year, but when? Why leave a gap? The telephone helpline is open only until 31 May, so what happens if people need support after that?

Will the Minister explain why the decision was taken so suddenly and which Minister signed it off? The volunteer website says that the decision was taken due to financial pressures, so can the Minister tell us how much the scheme costs? What is that cost as a proportion of the total NHS budget?

The Public Accounts Committee report published last week on the reorganisation of NHS England was damning. The Secretary of State said he would

“devolve more resources and responsibility to the frontline, to deliver…a better service for patients.”—[Official Report, 13 May 2025; Vol. 763, c. 1286.]

However, cancelling the volunteer programme takes services away from the frontline. This seems to be yet another example of Labour rushing into decisions without thinking them through properly, and yet another promise broken by this Government at the expense of the most vulnerable people.

[Karin Smyth]

The hon. Lady is right to highlight the tremendous effort that went into establishing the programme very quickly at a time of great crisis, and to thank the hundreds of thousands of volunteers across the country who took part and stepped up. It was a huge effort to get the scheme running and we were all very grateful for it. Everyone learned a great deal from that; as I outlined in my initial response, we will be taking forward those lessons as we look at the role of volunteering in the future.

The hon. Lady says that the changes have come out of nowhere; they have not. We are looking critically across the piece as we fix the foundations of our NHS and ensure that it is fit for the future. We are looking at the most cost-effective means of delivering the same outcome, which is why we will be moving to a centralised portal for part of this work. We have emailed people about that; some people may not have scrolled to the bottom of that email, where there is an option to push a button to register their details, so that they will be updated as new systems come online and we can make sure that we do not lose that great volunteering spirit. That is about digital techniques for the future, using the most cost-effective means and developing clear outcomes.

--- Later in debate ---

[Karin Smyth]

I thank my hon. Friend for what he has said, and I thank the Butterfly Volunteers. Supporting people at that really important end of life stage is hard and critical work, and I commend them for it. The local link is also critical: we need to ensure that people can be directed from the national system to local systems, through NHS England and perhaps—if it is appropriate, Mr Speaker—through the House. It is in the interests of local Members of Parliament for us to ensure that what we have learnt from the national scheme is continued into the local scheme, and, as my hon. Friend says, we need the local co-ordination and infrastructure about which we have heard this afternoon.

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

On a point of order, Mr Speaker. Notwithstanding the response to the urgent question that you were kind enough to grant, we still have no idea how long the gap in the service will last, or what will happen to the most vulnerable people who are using it. What other parliamentary mechanisms could I use to secure the answers to these questions?

Draft Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations

Debate between Caroline Johnson and Karin Smyth

Monday 12th May 2025 General Committees

[Karin Smyth]

I thank the hon. Members for Sleaford and North Hykeham and for Chichester for their comments, which I will try to address.

As I think everyone agrees, the MHRA provides essential services that play a crucial public health role, and it is important that it recovers its costs, which is what these fee increases are set to do. The main benefit of the draft regulations will be that patients and innovators have the faster and better-delivered service that has been committed to. I meet the MHRA regularly, and I will be meeting with the new chief executive and chair later this week to make sure that the improvement that we have seen recently continues. I know that the whole House is interested in that, because, like all regulators, the MHRA is a huge contributor to the growth that we want to see as part of our growth agenda. I expect patients and the industry to see the impact.

Recovering the fees is crucial. It is also right that the regulated bear the cost of regulation, rather than it falling to UK taxpayers to subsidise it. By supporting the draft regulations, we will ensure that the MHRA continues to contribute to the Government’s health mission, balancing the responsibilities to maintain product safety and to champion innovation. It has made progress in responding to the recommendations set out in Baroness Cumberlege’s independent medicines and medical devices safety review. It has listened carefully to the people who gave evidence and to the findings of the independent review team, which are a matter of concern to many Members and constituents across the country, as the Liberal Democrat spokesperson, the hon. Member for Chichester, quite rightly highlighted.

The MHRA is committed to bringing about the changes that have been identified and to achieving ambition to be a regulator that absolutely delivers for UK patients, as well as delivering at speed to give confidence to the industry. We absolutely do not want to deter innovation; that is why in the draft regulations we are making some changes to support SMEs, which may find regulation more burdensome. We will keep that under review.

We expect the organisation to look closely at staff costs and make sure, like all organisations, that it produces the efficiencies needed to deliver a good service.

[Dr Johnson]

Before the Minister concludes, could she answer my questions on national insurance and on below-inflation pay rises? If not, will she commit to answering my remaining questions by letter?

[Karin Smyth]

I am happy to answer any questions, but as far as I am aware, they are NHS-employed staff, so they will be dealt with in the usual way. I am happy to write to the shadow Minister with any specifics if that is helpful.

In conclusion, the draft regulations are important to ensure that the MHRA has the resources that it needs to continue delivering reliable services and its public health role. I commend them to the Committee.

Question put and agreed to.

Hospice Funding

Debate between Caroline Johnson and Karin Smyth

Thursday 19th December 2024 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on hospice funding.

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for asking that important question. This Government want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. We will shift care out of hospitals into the community to ensure that patients and their families receive personalised care in the most appropriate settings. Palliative end of life care services, including hospices, will have a big role to play in that shift. Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies both within and between integrated care board areas.

On children and young people’s hospice funding, the Minister for Care met representatives from NHS England and Together for Short Lives and one of the chairs of the all-party parliamentary group for children who need palliative care to discuss children’s palliative and end of life care, and that funding stream was discussed at length at that meeting.

This Government recognise the range of cost pressures that the hospice sector has been facing over a number of years, so today I am delighted to announce the biggest investment in hospices and end of life care in a generation. We are supporting the hospice sector with a £100 million boost for adult and children’s hospices, to ensure that those hospices have the best physical environment for care, and with £26 million in revenue to support children and young people’s hospices. The funding will support hospices and deliver much needed funding for improvements, including refurbishment, overhaul of IT systems and improved security for patients and visitors. It will help hospices in this year and next year in providing the best end of life care for patients and their families in a supportive and dignified physical environment.

Hospices for children and young people will receive that further £26 million in funding for 2025-26 through what was, until recently, known as the children’s hospice grant. We will set out the details of the funding allocation and dissemination in the new year.

We completely understand the pressures that people are under. To govern is to choose, and the Chancellor chose to support health and social care in the Budget. The alternative is not to fund. The sector has suffered from 14 years of underfunding, and we are righting that historic wrong. This Government are committed to ensuring that every person has access to high-quality palliative and end of life care as part of our plan for change. We are taking immediate action to make our healthcare fit for the future. I am sure that the hon. Member for Sleaford and North Hykeham and everyone in the House will welcome this announcement. I thank her for giving me the opportunity to give the House an early Christmas present.

--- Later in debate ---

[Dr Caroline Johnson]

After the confusion of yesterday, I welcome the fact that further details on hospice funding have been announced, albeit by our dragging them out of the Government on the very last day of Parliament before the recess.

On 30 October, the Chancellor decided to break her election promise by increasing employers national insurance contributions and reducing the threshold at which employer contributions are payable. It was later confirmed that hospices would not be exempt from the increase in costs. Now the Government have announced new funding for the sector, which they have the audacity to call

“the biggest investment in a generation”.

Let us be clear about what is going on: the Government are taking millions of pounds off hospices and palliative care charities, and then think those hospices and palliative care charities should be grateful when the Government give them some of that back. That is socialism at its finest.

We will look more closely at the funding announced today, but despite many questions from right hon. and hon. Members, to date the Government have refused to give any clear answers on how much their tax rises will cost hospices. I will try again: will the Minister please tell us how much the Government estimate they will raise from taxing hospices more? Was an impact assessment ever produced on how hospices will be hit, and how that will affect the care that they provide? Do the Government expect the funding that they have announced today to cover the additional costs in their entirety?

At the heart of this discussion are charities that provide compassionate care to terminally ill people in their final days, weeks and months. While hospices were left without information, Hospice UK reported that 300 beds have already closed, with many more closures to come. Does the Minister accept any responsibility for that? Ultimately, it is patients who will pay the price.

While we welcome this update for hospices, when will the Health Secretary come forward with more details on the many other health providers who have been hit by Labour’s tax increases, including GPs, community pharmacies and dentists? Will they be expected to be similarly grateful for getting back some of the money that the Government have taken from them?

[Karin Smyth]

To govern is, indeed, to choose. The Conservative party chose neither this sector nor any other health sector and it refused to govern. Within five months, we have not only increased the funding to the health sector to stabilise it but made today’s announcement.

Beneath all that, there might have been a welcome for the announcement—I am not entirely sure—whereas the sector is pleased to have the money. The chief executive of Hospice UK said:

“This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need”.

The chief executive of Haven House children’s hospice said that it is

“very positive to hear about the government’s plan to invest significantly in the wider hospice sector; we hope that there will be as much flexibility as possible to determine locally how this new money is spent.”

This is an important issue for many hon. Members, and we look forward to working with the sector in the new year on the specifics of the announcement.