Underperforming NHS Trusts: Government Oversight

Debate between Caroline Voaden and Helen Morgan

Wednesday 14th October 2026 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate my hon. Friend the Member for Chelmsford (Marie Goldman) on securing this important debate.

Tackling underperforming NHS trusts is essential if we are serious about taking the necessary strides forward for patient safety and experience—as well as for the wellbeing of NHS workers, who are suffering anxiety and burnout at an unprecedented and frankly unacceptable scale. The Liberal Democrats have put forward our robust plan to end corridor care and transform patient safety, with essential measures needed to fix our NHS and relieve the pressure at both the front door and the back door of the service.

Years of Conservative mismanagement and neglect of the NHS have left many trusts on their knees, with huge challenges from which to recover. The onus is now on the new Labour Government, with their intensive recovery programme, to finally create the right conditions for failing trusts to succeed where their predecessors have failed.

[Caroline Voaden (South Devon) (LD)]

My hon. Friend talks about the challenges that NHS trusts face. My local hospital, Torbay hospital, has an ageing tower block that has now received a fire enforcement notice, which could affect up to a quarter of the beds in the hospital. Panic is spreading today in the local community about what this means for future treatment. Does she agree that when things become as urgent as that, with a quarter of the beds in the hospital potentially having to be closed by the fire brigade, the Government desperately need to bring forward the new hospital programme funding, so that repair and remedial work can begin immediately to restore this part of the hospital?

[Helen Morgan]

I do agree, and I echo my hon. Friend’s call. The estate that people work in is part of the fundamental problem that we are trying to tackle across the NHS.

I hope all the Members here who have made excellent speeches highlighting shocking failures in their own trusts can take heart from the fact that it is possible to tackle the issues in underperforming trusts. In my time as the MP for North Shropshire, I have seen meaningful changes for my constituents. From 2018 to 2023, Shrewsbury and Telford hospital trust was obviously underperforming, with CQC inspections consistently rating it as inadequate. That included inadequate levels of safety and services—reflected in the horrifying stories received at the time in my inbox and those of the other Shropshire MPs, and on doorsteps—and a churn in the management team that led to constant uncertainty about what was going to happen there. The human consequence of those stories was devastating.

When I was first elected, the overwhelming issue was the abysmal ambulance waiting times, related to poor handover times, as the hon. Member for Stoke-on-Trent South (Dr Gardner) highlighted. I will never forget the letter I received from a headteacher: after a pupil dislocated his knee playing football, he and the teachers waited so long for an ambulance in the dark and cold on a winter night that he was at risk of developing hypothermia by the time the ambulance arrived. We heard countless devastating stories, including ones where the ambulance had taken so long to arrive that it was too late, and the outcome was fatal.

Following a targeted campaign, which included me joining the West Midlands ambulance service team for an eye-opening shift, wait times have significantly improved, and we see far fewer of these cases in our inboxes. But challenges remain, not least in corridor care in the accident and emergency department, which has at times been rated one of the worst in the country.

A constituent told me of the shocking experience of her aunt Cath during this period, who was admitted to Royal Shrewsbury hospital following a serious stroke. One night, Cath fell out of her hospital bed and broke her hip after staff had failed to put up the necessary guardrails. She spent nearly half an hour trying to attract the attention of staff on the ward with the alert bell, but they were so overworked that they did not respond, and in the end she was forced to dial 999 from the floor of the ward. She was left in the ridiculous position of explaining to the call centre staff that she was actually on the floor of a ward in Royal Shrewsbury hospital before the staff reached her. That cannot be right. We heard of many heartbreaking situations where cancer patients’ scans could not take place because waiting lists had meant that they were booked in the wrong order and of fatally long waits for diagnosis in some cases, with the trust failing to hit key targets across the board.

Finally, the 2022 Ockenden report shook my community with its devastating finding of over 200 preventable deaths of babies and unimaginable harm done to families. Campaigning and voicing justified anger, which everyone has done today, and working with Ministers on the failings can bring about change. That was essential in Shropshire, and though things are not perfect, it is encouraging to see the improvements that have been made so far. It has been a really difficult environment for staff to work in. I pay tribute to them and the new leadership team for all the hard work that they have put into turning this extremely difficult situation around. The trust’s CQC rating has recently been upgraded, although it still requires improvement, with emergency department waiting times and understaffing as key focuses. However, there is much to be pleased with. Reviews have noted a positive culture, and the trust has recently been shortlisted for several awards for its performance improvements.

We must celebrate the many trusts in the UK that provide high levels of care and innovation, and support those making significant improvements. For underperforming trusts, it is our duty to our patients and constituents to ensure that we campaign to bring them up to good standards, and I congratulate everyone here today on doing just that. However, if conditions for care are stretched and staff are expected to deliver the impossible with limited time and resources, it is patients who suffer. How can we transform patient safety? To start, we need to hold failing leaders to account, as I have discussed. Reports have pointed to a culture of unaccountability among NHS leaders, which has accompanied recent scandals and undermines public confidence. Failing trusts need to be held to account, and our amendments to the Health Bill would help do that by retaining the necessary structures for accountability.

First, we must retain the independent patient voice, Healthwatch, which was established in the wake of the Mid Staffordshire scandal. Although still in its infancy, HSSIB, the Health Services Safety Investigations Body, should also be retained because it promises to improve the patient safety environment. Our amendments would also introduce duties and a standardised framework for the reporting of suspected health system failings and medical malpractice by coroners, medical examiners and members of ICB and NHS trust boards.

Whistleblowing routes to the CQC, the Department of Health and Social Care, HSSIB and the police would be accompanied by statutory protections. We would also place a corresponding duty on senior leadership to escalate any concerns they have about safety or malpractice to the relevant boards. My colleagues in the other place will be re-tabling those amendments at the next stage of the Health Bill, and I urge the Government to accept them.

Rural Upper-tier Local Authorities

Debate between Caroline Voaden and Helen Morgan

Wednesday 2nd September 2026 Westminster Hall

[Caroline Voaden (South Devon) (LD)]

It is a pleasure to serve with you in the Chair, Ms Barker. I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this important debate.

Before moving to rural South Devon in 2007, I had spent all my life living in and around major cities: Edinburgh, Sheffield and then London. After nearly 20 years living in the rural south-west, I can honestly say that I had previously not understood rural life because I had not lived it. I have since come to realise that the rural-urban divide is possibly one of the deepest divides in our country and one that is too often overlooked, especially by Governments made up of city and urban MPs who simply do not understand the reality of rural communities and fail to see the deprivation that lurks behind the hedgerows.

Those communities are often forgotten when spending decisions are taken despite a set of circumstances that mean we desperately need the Government’s financial backing. Incomes are lower due to the older average age, jobs are often seasonal and low-waged, people in rural areas travel almost twice as far as those in urban areas, and there is often no public transport. Healthcare is a challenge because community services have been cut, hospitals are miles away and hospital transport has all but disappeared. High-speed internet is crucial when services are scarce, yet broadband connectivity lags far behind urban areas. Banks, pubs and post offices are closing, hollowing out communities and increasing rural isolation. As the hon. Members for Camborne and Redruth (Perran Moon), for St Austell and Newquay (Noah Law) and for Truro and Falmouth (Jayne Kirkham)—all of them from Cornwall—have said, the high number of second homes, high house prices and low wages massively exacerbates the housing affordability crisis. In Devon, the full-time salary to house price ratio is 10.6:1—well above England’s average of 8.7:1.

Despite all that, funding is persistently driven into urban areas while rural communities are left behind. The previous Conservative Government forced councils to do more with less. Their policy to force local authorities to use their reserves to subsidise their revenue expenditure was deeply wrong and, as a result, six rural upper-tier local authorities are on the brink of issuing section 114 notices, which would effectively declare them bankrupt.

The current Government have committed to providing multi-year funding settlements for local authorities, which we welcome, but for rural communities the 2026-27 to 2028-29 settlement falls well short. The withdrawal of the rural services delivery grant was a huge blow to councils in Devon, costing about £14 million, and no rural councils benefited from the replacement funding or recovery grant.

The new formulas mean that local authorities in cities will have higher spending power than in previous years while rural shire districts will have less to spend. Under the local government finance settlement for this year, urban councils will receive 32% more per head in Government-funded spending than rural councils. Devon county council will receive £1,056 in core spending power per head compared to Hackney council’s £1,645 or Liverpool city council’s £1,598. It does not cost 50% more to provide services in Hackney or Liverpool than in Devon. In fact, I would argue it potentially costs less because of the rurality.

Furthermore, the Government’s 2026-29 local government finance settlement does not include any explicit support for rural upper-tier authorities. The new formula has included remoteness only as an uplift in the formula for adult social care. As my hon. Friend the Member for Horsham (John Milne) said, a rural child is not easier to service than a rural adult. It is utterly shocking that the Government do not believe that remoteness is relevant to the delivery of any other service, such as school transport or waste collection.

It goes way beyond the additional time it takes to travel. Rural councils have several other considerations that urban councils simply do not have to contend with, including requiring more service centres due to the spread-out population and more professionals to cover visits across a huge rural area. They receive fewer responses to contract tenders, perhaps only getting one from the incumbent provider, which leads to a market with increased prices for services.

There are physical constraints such as needing smaller refuse vehicles, especially on the narrow lanes near where I live in Devon. Those vehicles have to return to base to be emptied more often, and rural areas also need multiple depots for equipment and vehicles. Thus, they need more equipment to service the streets and more drivers.

Pockets of deprivation, often hidden by prettiness, are particularly hard hit. Social mobility for young people living in deprived rural areas is one of the lowest in the country. None of this is considered in the new funding formula outside of adult social care. I urge the Minister to review that.

Quite simply, the new system of allocation does not recognise that the sparse and isolated nature of rural areas drives higher costs for the delivery of essential services, creates challenges in recruitment of staff for key services and requires local authorities to provide a greater public subsidy for the provision of public transport. This is very much in keeping with a Labour Government that have persistently failed to acknowledge that every service is harder to deliver across rural areas.

Let me use Devon to illustrate why this service delivery is so tough. Rural Devon is a drive of over 100 miles from north to south. It would take me 10 hours to walk across just my constituency, which is a fraction of the county, and nowhere near the biggest. I am not sure how Manchesterism will translate to rural areas, but we cannot apply the same principles to a city of 3 million people and villages with just 10 houses and expect to see the same results.

The trajectory for rural councils over the next three years is deeply concerning. The very limited increase in Government funding will require service reductions or significant increases in council tax or business rate income to maintain core spending power. As has been said, rural residents will pay 17% more in council tax per head compared to urban residents this year, yet Government funding will be directed towards urban authorities.

The Government are relying on a regressive council tax to fund services in rural areas that it was never meant to. As a result of this funding settlement, by 2028-29 urban councils will have seen a 20% increase in Government-funded spending power, compared to only 2% for rural councils. How can that be fair? These are not just numbers on a spreadsheet; we are talking about people’s lives. From the growing number of children with SEND who cannot access the support they need to the closing of vital community spaces like libraries and leisure centres, this lack of funding has a real impact on people.

We are concerned by the Government’s decision to allocate additional funding within the local government finance settlement on a need and demand basis. It will jeopardise the sustainability of rural local councils. The Liberal Democrats oppose the three-year local government finance settlement, which does not go far enough in providing a truly fair funding settlement to all local authorities across the board. We urge the Government to provide rural councils with a funding settlement that reflects the true impact of rurality and sparsity of the areas they serve through the application of the fair funding formula.

The ability to provide services to people in my constituency and across rural Devon will only be made worse by the proposal for four unitary authorities recently chosen by the Government for the local government reorganisation in Devon. I urge the Minister to bear with me on this. That proposal from Labour-run Plymouth and Exeter will see those two cities massively expanded, to the great delight of their Labour MPs, and a new urban growth area based around Torbay, leaving a fourth authority—the bits that were left behind when the urban areas were gouged out—stretching 70 miles from Ilfracombe in the north to Salcombe in the south, but 100 miles by road. That authority will have to maintain a road network not dissimilar to the whole of Luxembourg’s with no major town to offer opportunities for growth and regeneration and the most deprived area of Devon to support.

[Helen Morgan]

The point of combined authorities is to derive economies of scale from placing urban and rural areas together. Some of those economies of scale can be driven by the density in the urban area. Does my hon. Friend agree that it makes no sense to split up the urban and rural areas in the way she describes?

[Caroline Voaden]

I absolutely agree. It makes no sense to any of us in Devon. I have spent the entire summer listening to constituents who are deeply distressed about what has happened, which leaves them in a rump rural local authority with no option for economic growth or regeneration.