Health Bill

Danny Beales Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for his work on the all-party parliamentary group; he is a real champion of this cause. AJM Healthcare, the contractor in my constituency, has a similar level of failure. People are left for months—sometimes six months—without a wheelchair, bed-bound and unable to get out of the house. Does he agree that ICBs seem completely at sea on this issue, and are totally unaccountable? Does he agree that we need much tougher measures, such as those he suggests, to hold them to account?

[Daniel Francis]

I completely agree with my hon. Friend. As I will come on to, there is an inconsistent set of data across the country. This inconsistency is not just between ICBs but, in the case of my constituency and that of my hon. Friend the Member for Eltham and Chislehurst (Clive Efford), between neighbouring London boroughs, which may have the same ICB but different frameworks.

I also welcome the support for the amendment from the Children’s Commissioner, who has said:

“Across the country, children wait far too long for the right equipment that is essential for daily life. In recent research on children experiencing delayed discharge from hospital, the office was told that delays in getting equipment, and having equipment serviced, had led to children being stuck in hospital, away from family, friends and school.”

This postcode lottery is not just cross-country—I know of a number of ICBs in which there are significant issues—but within ICBs. In my part of south-east London, one patient can be discharged, while another, in the same hospital with the same condition, living on the opposite side of the road, cannot be discharged. That difference arises because a borough boundary runs down the road. There are different contractual arrangements between different London boroughs in the same ICB. I know at first hand that pupils in the same school class, and in the same ICB, can have completely different service standards for their wheelchairs because one lives in one London borough while another lives in the neighbouring borough.

I will speak briefly to new clause 85, tabled by my hon. Friend the Member for Thurrock (Jen Craft). Like me, she is the parent of a disabled child. We have fought these issues for many years, both as parents and on behalf of our constituents. In my case, I know that when Ofsted found that there were systemic failings in our SEND provision, we could hold our local authority to account, but we could not properly hold our ICB to account. The judgment was issued against the council, not the ICB.

--- Later in debate ---

[Layla Moran]

I am grateful to the hon. Member for his intervention, and for the work of that Committee. We are doing work together right now on children’s mental health, so I am sure we will continue to pursue this theme.

The point is that the impact was not just on that child; it was also on the mother, who could not work, and there was also the distress of having to battle the system. The mental health of both parents was affected. It does not need to be this way, and I genuinely believe that accountability is part of the answer. As such, my plea to the Government is simply to say that it is past time that the “H” part of EHCPs is put on a statutory footing, and I urge the House to support new clause 85.

[Danny Beales]

There is much to support in the Bill, and I support its ambition to enable many of the provisions of the welcome 10-year plan for the NHS. The plan is the right one; the three shifts are correct, and we have to fundamentally reform the health system if we are to meet the modern health and care challenges that we all see in our constituencies. To some extent those challenges are not new, and neither are these ambitions—we have seen similar initiatives before—but the systems, the structures, the bureaucracy and the siloed budgets push against change in the health sector. They have been a hinderance, reinforcing silos and making the same investment choices. They have prevented digitalisation, kept care in acute settings and stopped joined-up working. This Bill could and should be a key lever in overcoming those challenges, which we need to do if we are to achieve those ambitions.

I very much support the digital single patient record, which is a key ambition in the shift from analogue to digital health. We have all heard from patients who have to tell their story over and over again at every single health appointment—between care and health, between community and secondary care—so a genuine single patient record has the potential to be transformational. We have, however, heard from pharmacies and community mental health services that if this is to work, they have to have a seat at the table. While this Bill enables the architecture, I hope that the delivery will ensure that the whole of the health and care system is part of the decision-making process when the single patient record is designed. That is crucial.

Turning to the abolition of NHS England, the idea of streamlining bureaucracy at the centre is a good one, and delivering power—including decision-making power—budgets and resources locally is also admirable. Success, however, will mean the right decisions being taken at the right scale.

[Ben Coleman (Chelsea and Fulham) (Lab)]

One of my concerns about the abolition of NHS England is that highly specialised services for treating the rarest and most complex conditions—of which there are only 79 in the country—currently sit directly with NHS England. It is not clear whether those services will continue to be commissioned centrally. Does my hon. Friend think it would be helpful if the Minister could clarify that?

[Danny Beales]

I thank my hon. Friend for that contribution. Having worked in neonatal care services and areas of specialised services in the NHS for 10 years, I understand that one of the benefits of NHS England was that it brought together highly specialised services, ensured consistent service specifications and uplifted the quality and availability of care across the country. I hope that when we make decisions about which specialised services will be devolved to ICBs, consideration will be given to that point. Equally, we have heard from national population health programmes such as the Diabetes Prevention Programme, which has been a huge success. As we make the final decisions about the level at which decisions are made, we cannot lose the benefits of public health initiatives at scale, such as vaccinations and prevention programmes. I would welcome the Minister’s thoughts and reflections on that.

Integrated working is also important—as I say, we have to blend budgets and bring together decision makers across current silo divides. In that spirit, I very much welcome the change made by Government amendment 60 to give local authorities a seat back at the table. We need a bigger voice for public health and social care in health decision making, not less, so I thank the Minister and the Government for listening to the Health and Social Care Committee and moving on that. In the view of the NHS Alliance, this is not enough; it would like to see a reciprocal duty to collaborate, which is an interesting suggestion. However, the Government’s amendment is an important start.

[Anna Dixon (Shipley) (Lab)]

I congratulate my hon. Friend and others on the Select Committee who did the work on strengthening local authority representation on integrated care boards. Does he agree with the sentiments of my new clause 106, which says that we need a stronger duty to co-operate, both within the NHS and between the NHS and local authorities?

[Danny Beales]

My hon. Friend might have read my speech, because I was about to turn to her amendment’s proposal of a report on integrating health and social care. It is an interesting idea that has a great deal of merit, and I hope that the Minister, in her response, will outline the Government’s approach to enabling more progress on integrating health and social care, particularly with the ongoing Casey review.

Inequalities have already been mentioned in the debate. Obviously, one of the Government’s key ambitions is growth in every postcode; another is good health in every postcode. Time and again we see disproportionality and inequalities that are seemingly hardwired into our health system. To change that, we are going to have to do something differently, and I welcome new clauses 90 and 91, tabled by my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). Unfortunately, those amendments have not been selected for debate, but they definitely reinforce the Government’s 10-year plan commitment to halve the gap in healthy life expectancy between the richest regions and the poorest, and to raise the healthiest generation of children ever. Unfortunately, we have moved away from those goals over the past 10 years, and we will have to do something differently if we are to bridge that gap. In my own constituency, from north to south, there is a huge divide in the quality of health and outcomes based on postcode. That must change.

Although the Government are not minded to accept those amendments, I know that the Minister is passionate about inequalities and that the Bill requires neighbourhood health plans to be developed. That will be an important new measure when responding to neighbourhood health needs, and in preparing those plans,

“the responsible local authority and…partner integrated care boards must have regard to any guidance issued by the Secretary of State.”

I hope that the Minister will explore using this guidance to ensure that as they are developed, neighbourhood health plans specifically address inequalities between neighbourhoods.

Finally, I turn to the SEND system, which is another major challenge with which the Government are rightly grappling. I thank my hon. Friend the Member for Thurrock (Jen Craft), a fellow member of the Health and Social Care Committee, for new clause 85, which would address the chasm between the education system and the health system. While this is fundamentally a health Bill, it is right to ask what more the health system could and should be doing. As the Chair of the Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has rightly said already, the “H” is far from present in EHCPs. Decision makers are not required to come round the table, and the specialists are not provided. I have been to specialist schools in my constituency where there is no nursing provision, so people miss school days, and where there is no specialist transport, so people cannot even get to school, because bus drivers do not have the proper health knowledge. We need to have an education and health response. I therefore hope that the Minister will address in her closing remarks how, if this Bill is not the right mechanism, future SEND reforms may pick this issue up and how the Department of Health and Social Care will contribute.

There is a great deal to support in this Bill. It is a major step forward, particularly for digital healthcare, giving people control of their records and joined-up care. I hope that the Government will continue to drive forward reform of our health system.