Health Bill (Fifteenth sitting)

Edward Argar Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Sojan Joseph]

My hon. Friend makes a sensible comment. I work closely with her on mental health, and she is absolutely right. Some of the policies the Government have introduced, such as giving children early access to mental health provision, will be absolutely vital to prevent them from becoming unwell later on. The Government are also rolling out a new mental health strategy focused on prevention, which will be important. We need to be more lean and productive, rather than creating more managers and committees.

[Edward Argar (Melton and Syston) (Con)]

The hon. Gentleman will probably be aware of the King’s Fund report from late last year, which covers the years 2010 to 2025. It highlighted that the growth rate was only 5% for managers during those 15 years, but 94% for children’s nurses and 55% for doctors, and other groups had similar increases. We are seeing investment and workforce increases in the right areas.

It is right that we acknowledge, as I suspect the hon. Gentleman will, that the one group where we have not seen that same growth is community health visitors and community health workers. Alongside the massive investment and increase in doctors in the past 15 years, that group, and the role it plays, deserves focus from whichever party is in government.

[Sojan Joseph]

I agree. We need more band 5 nurses or healthcare assistants who can check blood pressure or blood sugar in patients’ homes. When someone rings their GP surgery, they should be able to meet a nurse or a healthcare worker to carry out some basic checks, rather than being delayed from seeing somebody until, a few weeks, months or a year later, they end up in A&E. That is where the focus should be.

I do not support the new clauses, and I urge the Committee to think about some of the other new clauses that propose creating more directors or committees. We need to focus on making our health system more productive.

Health Bill (Fourteenth sitting)

Edward Argar Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

I hope that the Minister understands the intention of this new clause, the urgency with which we think corridor care needs to be addressed, and the importance of putting it on the same footing as referrals for cancer treatment and elective care waits. Corridor care waits kill, and it is time that we got rid of them.

[Edward Argar (Melton and Syston) (Con)]

I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point.

Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition.

The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

On the publication of data on avoidable deaths, new clause 84 states

“where waits of more than 12 hours in accident and emergency departments was a contributory factor.”

Does the right hon. Member consider it likely that there is any great accuracy in the assessment of whether a death was avoidable?

[Edward Argar]

The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.

I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.

I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.

The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.

[Helen Morgan]

New clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.

[Edward Argar]

The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.

The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.

The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.

I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.

I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.

While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.

Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.

I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.

I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.

--- Later in debate ---

[Edward Argar]

Does my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.

[Dr Prinsley]

rose—

Health Bill (Thirteenth sitting)

Edward Argar Excerpts

Tuesday 7th July 2026 Public Bill Committees

The other issue that was raised by Opposition Members concerned the CQC looking into itself. I reassure the Committee that the CQC’s investigatory function will be empowered to do that if necessary. The investigations function within the CQC will have autonomy to launch investigations into any part of the health system, including other parts of the CQC if required, and make recommendations to any part of the system, just as HSSIB does now.

[Edward Argar (Melton and Syston) (Con)]

On that point, will the Minister briefly give way?

[Karin Smyth]

No.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

--- Later in debate ---

[Dave Robertson]

I am just about to conclude, so I will allow the hon. Lady to come back when she makes her speech shortly.

The final point I want to make is about local government. I hope the Secretary of State will issue guidance on how local government will commission adult social care services. I also hope we will get annual reporting from ICBs and local councils on how they are using the patient voice. I know that the Secretary of State will have the ability to intervene, and I would expect him to do so should those reports show that the patient voice is not being used, is not finding its way into the room or is not leading to the meaningful change that the Amos report suggests.

[Edward Argar]

I will confine my remarks to group 47, conscious that the next group will give us an opportunity to discuss local arrangements, so I will stick to the national ones.

We are all aware of the significant role that Healthwatch England plays, as well as its popularity and the trust that many people place in it. As a former Minister in the Department, I was on the receiving end, on occasion, of some sharp—or firm—suggestions from Healthwatch England, but that is what it was there for. It was there to be the grit in the oyster. It often made useful suggestions, and its independence meant that it could put reports not only to me but to the public—it published them. It could give them, for example, to my hon. Friends who served on the Health and Social Care Committee and, if it wished, go to the media to make sure that that voice was heard.

That is where, for me, the challenge with what is proposed comes in, because a new directorate in the Department, staffed by civil servants, will simply not be able to do that. We all know that those who work in a Department, however excellent they are, report upwards ultimately to the permanent secretary and to Ministers. They are answerable to the political leadership of the Department. Would they be able to decide that something was coming through regularly from patient feedback and publish it independently, without ministerial approval or that of the permanent secretary, or hand it to the media? Would that director be able to champion the patient voice by going on television, irrespective of any ministerial approval?

The reality is, of course, that they could not. It would all be kept in-house in the Department, part of a closed process that would not alter decision making in reality, because that is already happening in the Department. The Department should already be looking at reports from Healthwatch England as part of decision making by Ministers and senior officials. What this simply does is remove the independence. It weakens that voice by making it something that happens within the Department rather than in the public sphere because, quite rightly, those officials will not be able to have their own independent voice out there, irrespective of the leadership of the NHS or the Minister.

I genuinely worry that what we see here is the continuation of a theme that has run throughout other aspects of this legislation—a theme of centralisation, of removing independent external challenge and bringing it inside the system, be it the Department or the NHS. When that happens, my fear is that the people who will lose out will be the patients, whose voice will no longer carry as loudly.

[Dr Prinsley]

I rise to speak to new clause 74 on behalf of my hon. Friend the Member for Rugby (John Slinger), who is in the Gallery, and also to some extent on behalf of my predecessor, Jo Churchill, who was the Member of Parliament for Bury St Edmunds and Stowmarket before me, and was also a Health Minister. This is about Healthwatch and the patient voice. The amendment tabled by my hon. Friend the Member for Rugby suggests that the Secretary of State create an impact report within 12 months of the Bill passing through Parliament to assess what the impact of the amalgamation or integration of the functions of Healthwatch into the ICB would in fact be, and in particular look at the effectiveness of the complaints procedure and the way in which complaints were responded to.

The theme is also that which we spoke about this morning on whether an organisation can successfully interrogate itself. I believe that with the appropriate safeguards it probably could, but I do think that the suggestion that there ought to be a formal report on the impact within 12 months is something worth considering.

--- Later in debate ---

[Helen Morgan]

The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.

[Edward Argar]

Clause 65 and schedule 10 focus on local healthwatch arrangements. As I said when speaking to the previous group of amendments, Healthwatch is respected and trusted at a national level, and that is even more the case at a local level. I fear that the Government seek to remove something that works, that is effective and that ensures a strong patient voice in the system.

It simply does not work to have integrated care boards take on those responsibilities, as they will be marking their own homework rather than being the independent patient voice. It is a little like the discussion the Committee had during the previous grouping on HSSIB, in which it turned out that the CQC will be able to investigate itself, but the chief executive of the CQC would decide whether any protected disclosures could be published during that investigation. That measure brings things entirely within the system and removes the independent voice, which is exactly what this clause also does.

The ICB is the voice of the NHS system, not the voice of the patient. We need the grit in the oyster that is provided by an independent voice talking to the ICB. Being in the room with an ICB will not mean that the patient voice is heard more loudly or clearly, or that it will be acted on—it is probably more likely to mean that it is not. As an example from my constituency, the ICB did conduct a consultation exercise on the proposed closure of St Mary’s birth centre in Melton Mowbray, the response to which was overwhelming: the patient voice said that they did not want that to happen. That response was fed into the ICB, but the ICB did what I fear it planned to do all along and closed the centre. Given that that voice in the room came from a consultation exercise led by the ICB, it seemingly did not make a jot of difference to the outcome or decision, or to whether the patient was heard.

On the impact of local authority scrutiny panels, the NHS ICB in Melton previously recognised the need for increased GP provision in the town due to the increasing size of the town and the long waiting times, but just recently decided to reverse that position and say that it did not see the need for that. Members of the scrutiny committee, across all parties, were absolutely clear that they disagreed with that decision, but did that get listened to or make a jot of difference to the ICB? No—the ICB did what it was going to do anyway and changed its mind.

My concern is that we will see less grit in the oyster and patient voice, and more managerialism in the NHS ICB system. We heard from the hon. Member for North Shropshire and the shadow Minister about the challenges there would be, even were that patient voice to happen. Given the Government’s 50% cuts to ICB budgets, which are already impacting frontline services, ICBs will not be able to take on additional responsibilities without the funding that they need. That is quite apart from the principle that they should not be marking their own homework. I fear that “system knows best” will become the default.

We have also heard about the geographical challenges. Given that mergers and acquisitions are getting even bigger, ICBs are moving further and further away from what was conceived: for them to have the same geographical footprint as the upper-tier local authority providing social care, to ensure that the two organisations spoke to each other and were better integrated. Removing the representative from the local authority that provides that healthcare from the board, even if they are replaced with a mayor, does not bring about the reconnection with social care provision that is so central. Removing the voice of general practice or primary care from the ICBs again moves that independent challenge away from the system.

I fear that this is a fragmentation of those links at a local level and the weakening, if not silencing, of a patient voice that can challenge publicly and ensure that what patients need to have said is genuinely said. Being in the room does not mean that that voice is heard or acted on, as shown from the examples I have spoken about: there is a consultation exercise, the view is reflected on, and the ICB does what it was going to do anyway and does not change its position. I have genuine concerns about the loss of an independent patient voice in a local context.

The Minister will correct me if I am wrong, but I think she made the point in her opening remarks that we have lacked not recommendations and suggestions for changes but action to fix the issue. But it is not for Healthwatch to take action to fix the issue; it is for the ICBs and the NHS to act on those recommendations. We are proposing to give the bits of the system that have failed to take action and fix the issue not just the responsibility that they already have but the responsibility for reflecting patient voice. The one bit that is working—where patients’ voices are heard—is the bit that we are getting rid of. We are not seeking to fix the bits that have real pressure and genuine levers to compel an ICB to act on those recommendations when they are made independently, rather than simply marking its own homework.

As with my reflections on clause 64, I genuinely fear that in this weakening of patient voice, particularly at a local level, the patient will be the loser because the system will continue to do what it wishes to do. It will do its consultations, and it may have a director of patient experience at an ICB level, but they will be working for the ICB; they will not be there as an independent voice to challenge the ICB—including publicly—on what it is doing.

I hope that the Minister reflects further on the real diminution, if not the neutering, of patient voice that comes with some of these arrangements. As always, I look forward to her reflections when she winds up.

[Gregory Stafford]

I want to address this clause because I believe that the Government are making a significant mistake by abolishing Healthwatch England, as they have just done with the group of amendments, and local healthwatch organisations. The Government have sought to reassure the Committee that the functions currently carried out by Healthwatch will continue; however, that is not the question before us. The question is whether those functions can continue with the same degree of independence, credibility and public confidence once they are absorbed into the organisations that they currently scrutinise.

Having listened carefully to the witnesses who appeared before the Committee, and having reflected on the debate on Second Reading, I do not believe that the Government have demonstrated that they care. Once again, the Government’s case rests largely on the recommendations of Dr Penny Dash. Dr Dash argued that patient engagement should sit much closer to those responsible for planning and delivering services, that providers and commissioners gather and respond to patient experience themselves, that integrated care boards already possess engagement functions capable of undertaking that work, and that the variation between local healthwatch organisations means that the current statutory model is no longer justified.

Those are interesting arguments, but they were examined by this Committee and, in my view, were not sustained by the evidence that we subsequently heard. Indeed, what struck me throughout the oral evidence sessions was not simply that witnesses disagreed with Dr Dash’s conclusions but that they challenged the central assumptions on which they depend. Dr Dash’s recommendations assume that independence is desirable but not essential. The overwhelming weight of evidence presented to this Committee suggests precisely the opposite.

That distinction matters, because this debate is not fundamentally about patient experience. No member of this Committee disputes that patients should influence the design and delivery of services; Healthwatch already exists to help to achieve precisely that. The issue before us is different: it is whether those speaking on behalf of patients should remain institutionally independent of the organisations whose decisions they are expected to scrutinise. Throughout our proceedings, I have become increasingly convinced that that is the question that Ministers have not answered adequately.

--- Later in debate ---

[Dr Johnson]

I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe.

New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.

[Edward Argar]

My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.

New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?

I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.

[Karin Smyth]

I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work.

I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience.

I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control.

We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins.

A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier.

Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually.

As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary.

Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.

I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose.

The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses.

Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.

Health Bill (Twelfth sitting)

Edward Argar Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Edward Argar (Melton and Syston) (Con)]

I am particularly keen to speak on clauses 59 to 63, because HSSIB was a key part of the Health and Care Act 2022, which I took through as a Minister. At that time, I was grateful for not only the fearless and tough questioning from the now Minister, who was on the Opposition Benches, but for her support. She said:

“HSSIB is a really important new body”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564.]

She also said that it is a

“new and important body, which we are all desperate to ensure works well.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 566.]

It is fair to say that it does work well, as my hon. Friend the Member for Farnham and Bordon set out clearly in his detailed remarks. The thread running through his remarks, which is particularly important in this context, was trust. People who have had something go wrong and have reported a problem need to trust that it will be looked at independently and dispassionately.

I fear that what is proposed here results from a deeply misguided decision, which has at the heart of its logic a fundamental flaw. As the hon. Member for North Shropshire set out, the decision fails to recognise that HSSIB’s role is fundamentally different from the role of CQC. It is an independent investigator; it is not a regulator or an enforcer, yet that somehow seems to be conflated in what the Government are trying to do here. They have simply failed to make a logical case for the change.

The hon. Member for Bury St Edmunds and Stowmarket, who I always listen to with great interest on these matters, highlighted that patient safety should be at the heart of this legislation. That is absolutely right, but patient safety goes hand in hand with the confidence of those working in the system to speak out and put forward evidence that will improve patient safety. It is not an either/or; one is complementary to the other. It is important that this safe space remains, because that provides the conditions in which patient safety can be improved.

In her evidence during the first session of this Committee, Dr Dash stated that she found more than 150 organisations operating in this space when she undertook her review. However, in Hansard, she went on to say:

“I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q2.]

Only six out of 150? That does not ring true. That is not a tidying-up of the landscape but a very narrow focus. When the Minister comes to her concluding remarks, can she answer who specifically determined those six organisations for Dr Dash and told her to look only at those, ignoring the other 144-plus organisations? We all know that what a review comes up with is, to a large degree, determined by the scope set for it. By picking a mere six out of 150-plus organisations, I fear there is a risk that the scope has effectively, to a degree, stacked the outcome of what would be looked at and what would be concluded.

Before addressing specific concerns about the approach being adopted with the abolition of HSSIB, I want to highlight a real challenge with—even if one accepted the premise, which I do not—where it is proposed the functions are transferred to, as my hon. Friend the Member for Farnham and Bordon set out.

Dr Dash said in her evidence that the CQC

“still has a way to go, and we all need to acknowledge that.”

She went on to say:

“I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 4, Q2.]

We are talking about moving an effective organisation into another organisation which, quite apart from whether the merger is appropriate given their different remits, is—by the review author’s own admission in evidence—basically not in a fit state to receive those new functions. I think that has been tacitly acknowledged by the Minister in saying it will only be done at an appropriate time, when the CQC is ready. Therefore, why make those changes at all? At the moment, it does not look like the CQC will be ready, at least in the near future, based on the evidence we have heard.

[Dr Johnson]

My right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.

[Edward Argar]

My hon. Friend the shadow Minister is right to highlight, for want of a better way of putting it, the cumulative challenges that will potentially be piled on the CQC, on top of the pre-existing challenges with how that organisation is functioning.

I read with great care the Adjournment debate that took place last night in the Chamber, which has been referred to by a number of hon. Members, in the name of my hon. Friend the Member for Harwich and North Essex, and I pay tribute to him for his work in this space. I worked closely with him in the context of the passage of the Health and Care Act 2022, and I know that the issue of patient safety is fundamental to what he seeks to improve and achieve in this House. I agree with him: I fear the Dash review simply fails to make the case for those changes. Also, as hon. Members have set out, it sadly appears to contain a number of errors and assumptions that are inaccurate, which I will turn to in a moment.

The fundamental challenge is to establish a way for people to feel confident and trusting in challenging a culture of denial and blame. We have seen this most recently in the context of maternity failings and scandals. The need for that safe space, and for an organisation able to challenge the institutions, is very clear, and I fear that this change actually weakens the ability to do that. Dr Dash’s review, I fear, fails to fully recognise just how important the safe space concept is—not just in how it is drafted and framed legally but, as my hon. Friend the Member for Farnham and Bordon said, in how it is perceived by those who need to use it. The CQC, of course, has a legal duty to act on information it receives, but that risks being conflated here.

I saw this illustrated last night, for example, in the Adjournment debate, in a comment made by the Minister’s colleague, the Under-Secretary of State for Health and Social Care, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), when she was responding to my hon. Friend the Member for Harwich and North Essex. She was talking about the criteria for disclosing protected information outside the investigative function. She said:

“Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail.”

This is the key point. She went on to say:

“As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space.”

And this is the crux of it:

“That person is likely to be the CQC’s chief executive officer.”—[Official Report, 6 July 2026; Vol. 789, c. 147.]

That is an inherent conflict. If the person who is the head of the regulatory body is making the decision on whether information should be disclosed by HSSIB in its folded-in form, that will do nothing to inspire confidence in disclosure and the safe space provisions. I fear that drives a coach and horses through some of the arguments being made that there are sufficient safeguards within this merger to ensure HSSIB can continue as it has done thus far.

The crux of some of Dr Dash’s arguments appears to be that there are, as the Minister also alluded to, too many recommendations being made and that it is a complex landscape. Yet HSSIB, as my hon. Friend the Member for Harwich and North Essex set out yesterday, has made 56. He went on to say that the 30 or so public inquiries and other investigations have delivered 1,400, so it simply does not follow that HSSIB is the problem in that complex landscape.

What was made very clear by, again, my hon. Friend the Member for Farnham and Bordon is that, of course, the concern is not the recommendations. It is not the organisation making the recommendations that is responsible for the fact that they are not implemented. It is the NHS itself, its inertia, its unwillingness and the Department’s unwillingness to take them forward in a coherent fashion—to drive the recommendations through and monitor whether they have been delivered on by the NHS.

[Dr Johnson]

On pages 8 and 9 of the Dash review, Dr Dash talks about this. She states:

“Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.”

She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.

--- Later in debate ---

[Edward Argar]

I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its

“scope of work beyond the original remit.”

It goes on to say:

“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”

I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.

Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:

“Most investigations into safety incidents should continue to be managed within provider organisations”.

That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.

[Helen Morgan]

I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?

[Edward Argar]

The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.

--- Later in debate ---

[Joe Robertson]

My hon. Friend leads me to a point I was going to make later, but I will make it now. He is absolutely right: the CQC has not had a lot of good press and does not instil a high degree of confidence in professionals and the public. That is a very real issue. The Minister and, I think, Dr Dash have said that the transfer of powers from HSSIB to the CQC will not happen until it is in a better place, and that is all very well, but these changes are intended to last for a long time—indefinitely, presumably. To merely wait until an organisation is in a better place to transfer those powers, and to expect that organisation to remain in a better place in perpetuity, is wishful thinking.

The CQC has had leadership issues. We all hope and I am sure that the leadership will be in a better place in the near future, but if an organisation can be in such a bad place because of a failure of leadership, those circumstances can return in the future. Of course, it might be leadership failings within the regulator that HSSIB is asked to investigate. Again, if its functions are delivered by a regulatory organisation with leadership failings, there will be no confidence whatever that a truly independent and meaningful investigation can take place.

Let us not forget that the public are somewhat jaded by investigations, inquiries and reports—justifiably so. They clearly have a valuable function, but their function is far more valuable if there is confidence in them. If a powerful organisation such as the CQC—the regulator—can effectively mark its own homework, that does nothing to help the reputation of investigations and inquiries with the public. I suspect that the problem with them in the public’s mind is that it always looks a little bit like the establishment is looking at itself and coming up with an argument it can then justify. There is a perception that that does not lead to meaningful change. With this Bill, we will create an environment where that perception is even stronger.

[Edward Argar]

My hon. Friend is rightly highlighting the importance of independence, and trust in the independence, of the organisations investigating failures and making recommendations. Does he agree that that is only half of it? Those organisations are not at fault when recommendations are not implemented, so the other half of this is that the NHS and the system need to act on those recommendations when they are made.

[Joe Robertson]

It is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it—an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.

Health Bill (Eleventh sitting)

Edward Argar Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Gregory Stafford]

For me, the key thing is that we must have equity of access to the single patient record. If somebody wishes to see their own medical record, they should be able to do so, whether they are digitally savvy or not. As far as I can tell, that is the intention behind the Liberal Democrat amendment.

However, the hon. Gentleman raises an interesting point. We are seeing this already, but the more we go down the digital route—because it is more efficient and straightforward, and takes out the unnecessary bureaucracy of having a human interaction to book an appointment or whatever—the more likely it is that this will become the portal for all interactions. I am not saying that that is the Government’s intention, but he raises a point, perhaps inadvertently, that we need to think about.

To conclude on amendment 70, before we proceed any further, the Government should be able to demonstrate that no patient will receive a worse service, face greater barriers to care or lose access to information simply because they are older, disabled or less digitally connected than others—that goes to the heart of fairness and equity of access in our NHS. I am absolutely certain that the Minister does not wish that to happen, but it would be interesting to hear how she will ensure that it does not happen.

Amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, would prevent the Secretary of State from making regulations to establish the single patient record unless a public awareness plan had first been published and laid before Parliament, and a minimum three-month public information campaign had been conducted before the system went live. That seems eminently sensible, and I hope it is something that would be not just welcomed by Ministers, but on their agenda already.

Patients clearly have a right to know what information is being held, who will have access to it, how it will be used, what safeguards are in place and what rights they have in relation to their own data before the system goes live. A three-month campaign to give them that opportunity would be appropriate, because the things that I have outlined are not technical details that need to be buried in some Government website or hidden in the small print of a privacy notice; they are fundamental questions that deserve proper public engagement.

I am especially supportive of amendment 49 because of the impact on older people, disabled people and those who are less digitally engaged. I do not think that most of my constituents spend their time reading NHS policy documents online—my notes say “most”, but I think none of them do, unless they are involved in the health world themselves—and they should not wake up one morning to discover that a major change to the management of their health information has already been implemented without their knowledge.

A public information campaign is not a bureaucratic hurdle; it is a democratic necessity. If Ministers are confident that the single patient record will improve care, strengthen efficiency and protect privacy, they should be eager to make that case to the public and should therefore welcome the scrutiny, transparency and informed debate that a three-month public information would bring.

[Edward Argar (Melton and Syston) (Con)]

I want to speak primarily to amendment 49, in the name of my hon. Friend the Member for Sleaford and North Hykeham, the shadow Minister, and to agree with what my hon. Friend the Member for Farnham and Bordon has just said. Sadly, there will be a large number of people who do not follow the debates in this House or this Committee in great detail, however fascinating they may be. That is perfectly understandable.

The single patient record has genuine potential. It has the potential to put all the different bits of data in one place, so that when, for example, someone is blue-lighted to hospital, their consultant or the doctors treating them in A&E can access the information they need about their medical history and any medications they are on, which could improve clinical outcomes for patients.

I can entirely see the potential of the single patient record, but I am also conscious of the genuine concern among those of our constituents who are aware of this about what it might mean in practical terms for them and their data—it is important to remember that it is their data. They will have concerns, as my hon. Friend the Member for Farnham and Bordon set out, about who can access it, what safeguards are in place, whether they can opt out, and a range of other legitimate questions about how it will work.

I have to say that amendment 49, tabled by my hon. Friend the Member for Sleaford and North Hykeham, is not unreasonable. It would give the Government an opportunity to reassure our constituents and bring them along on this journey, rather than leaving questions unanswered or just addressing them in a Q&A on a Government webpage. People have genuine questions, and in many cases I am confident that the Minister will be able to allay those concerns or put them to rest, but some campaign of that sort is needed.

Such campaigns happen regularly on a range of subjects. The Department of Health and Social Care spends a significant amount of money on public health and awareness campaigns, and His Majesty’s Revenue and Customs spends a large amount of money on reminding everyone to get their tax returns in on time, in the lead up to that, or to remind them of the penalties if they do not. Government do that day in, day out across a range of services and where major changes are being made.

The Government have a genuine opportunity to accept amendment 49, which will help them to bring the people we serve on this journey, and potentially help to realise the benefits and allay people’s concerns. I genuinely hope that the Minister will be able to accept the amendment or will commit to take it away, look at it, engage with my hon. Friend the shadow Minister and possibly bring back a Government amendment that does exactly this on Report.

[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.

--- Later in debate ---

[Sojan Joseph]

I agree that we are never going to have 100% proof. There will always be people accessing records. What I am talking about is the existing system, which does have provisions. What we need to strengthen is the training and the audit trail. All staff who do the training are aware that they are not supposed to check patients’ records unless it is relevant to them. Those who access records inappropriately should be identified and action should be taken.

Just because we are moving to a single patient record system, it does not mean that everybody is going to access everything they want. People working in the healthcare system are given access based on their role. Not everybody is able to access everything. Systems are in place, and we need to strengthen those systems and the training. We should not be scaremongering by saying that, because we are moving to a single patient record, everybody will be able to see their records.

[Edward Argar]

The hon. Member for Ashford made his point very clearly about what happens when something goes wrong and someone behaves inappropriately—the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, has highlighted some very concerning recent incidents—and was right to highlight the ability to follow an audit trail and take action. He is also right to highlight the importance of training.

However, taking action once inappropriate access is known, and then following the audit trail, deals essentially with the consequences rather than preventing it from happening in the first place. That is why amendment 48, and particularly proposed new section 250E(4B)(a) of the National Health Service Act 2006, is important. It describes the technical controls. That goes beyond the audit process and what happens after something has gone wrong. It is about what can be done to build safeguards into the system to make it much harder for anyone to circumvent their obligations, and to build those technical safeguards into the overall design of the single patient record. That is a reasonable ask, because such incidents, while hopefully rare, as the hon. Member for Ashford alluded to, do happen and understandably cause concern.

The challenge is that there is potentially a lot more information in one place, rather than being held in different pots, trusts or GP surgeries. For those inclined to break their legal obligations and behave outside the rules, the potential opportunity to access a wider range of information is more significant. The design of the record needs to have those technical safeguards strengthened and built in.

[Dr Johnson]

If we use the example of Southport, the people who could access those records worked in the Liverpool trust, because that is where the records were stored. With the single patient record, as planned, people would be able to access those records from across the country, if they had a clinical reason to do so. However, someone behaving badly could also potentially do so, even if they did not have a reason.

[Edward Argar]

That is the challenge. The Minister knows her brief very well—if I may say, I hope that whatever happens in a few weeks’ time, she retains it. She is that rare thing among Ministers in Government: someone who comes to their position with a hinterland of knowledge, experience and interest, which she has demonstrated through her period in office thus far. I hope that she retains her role, because continuity of Ministers in Government is a good thing.

Can the Minister reassure us on the shadow Minister’s point, which is one that I have been seeking to make? Can she reassure us that the system will include barriers to prevent whoever builds and operates it—whether a third party or someone internal—from having inappropriate access to the records? The data must be ringfenced and protected, so that it does not go out of the country and cannot be accessed by those who are technically running or providing the platform. Even within the social care system, there must be very clear and technical restrictions on who can access the records for legitimate purposes, as the hon. Member for Ashford has highlighted. I think that would just reassure people.

As I said in response to previous amendments, I think the potential of the single patient record to improve clinical outcomes in care is very significant, but we need to bring people with us. I suspect that if anyone can reassure us on those points, it is the Minister.

[Gregory Stafford]

As my right hon. Friend has just said, this is a unique system that will have unique benefits, but it will also have unique risks. Almost in answer to the point made by the hon. Member for Ashford, I do not think there is anything—[Interruption.]

Health Bill (Tenth sitting)

Edward Argar Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

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

The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply.

As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one.

My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do.

I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.

[Edward Argar (Melton and Syston) (Con)]

It is a pleasure, as always, to serve under your chairship, Ms Lewell.

I am grateful to the hon. Member for Winchester for his explanation of amendments 60 and 61. Like my hon. Friend the shadow Minister, I entirely understand what he is seeking to achieve, and also how important general practice is. Access to appointments with a general practitioner or at a practice is one of the most significant issues in Melton Mowbray. Despite the fantastic work that doctors are doing to try to manage that, the pressure continues to be intense, which on occasion is causing real anxiety for patients. Equally, I can see what the hon. Gentleman and the hon. Member for Epsom and Ewell (Helen Maguire) are trying to achieve by kick-starting a shift away from acute settings and towards front-loading—for want of a better way of putting it—people’s treatment in the NHS. As he said, Governments of many different complexions have tried to achieve that shift; what he is trying to do is give it a bit of oomph.

I can entirely see where the hon. Gentleman is coming from, but I do have some concerns, one of which was articulated well by my hon. Friend the shadow Minister, which is that the amendments are very much focused on inputs rather than outcomes. With the Health and Care Act 2022, we sought to shift the focus more towards outcomes, and I think the Minister is also seeking to move it towards outcomes rather than purely inputs—she will correct me if I am wrong—so I do worry about that.

Like my hon. Friend, I also have a slight concern about the effect of amendment 60 on the flexibility to address local circumstances and—for want of a better way of putting it—the discretion available to ICBs in determining the local health priorities. The Bill moves us away from the conception of ICBs in the 2022 Act, under which they were essentially mapped on to an upper-tier local authority geography, so that those delivering social care mapped directly on to the same geography and better integrated with it. With the removal of local authority reps and their potential replacement with representatives of a mayoral authority, and with ICBs covering much larger areas, we see a fracturing of the link with social care provision, and also perhaps a lot of local mapping and a local focus from the ICBs. None the less, my concern is that taking a prescriptive approach in primary legislation could further reduce ICBs’ ability to flex in order to address local needs. I can entirely see what the hon. Gentleman is getting at, and we all want to see primary care—general practice and dentistry—getting the funding it needs to address needs, but I am not convinced that the amendment will not have potential unintended consequences.

On amendment 61, I can again see what the hon. Gentleman and the hon. Member for Epsom and Ewell are trying to do: give the shift teeth and make sure that ICBs look at it. The risk is that if they fail to achieve it, they will face financial penalties, which risks compounding the financial challenges they face and potentially reducing the available funds for primary care, mental health and a range of other healthcare services in the vicinity. I get where the hon. Gentleman is coming from and I share the objective, but I have concerns about how it would work in practice and whether it would be overly prescriptive.

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

It is a pleasure to serve under your chairmanship, Ms Lewell.

My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Sleaford and North Hykeham have covered a lot of the points I wanted to make, so I will keep this relatively brief. Like them, I entirely sympathise with what the hon. Member for Winchester is trying to achieve with the two amendments. I think we would all want to see more investment in primary care. As my right hon. Friend—a former Health Minister—knows all too well, we need to see growth in primary care. The fact that there is not a single dentist’s practice in my constituency taking new NHS patients is a real concern, as are the waiting times for GPs in my constituency.

However, I do have some concerns. The first is that the standard, as the hon. Member for Winchester puts it, would be mandatorily enforced with a potential financial penalty. That takes away from what I think the Government are trying to achieve, which is local flexibility. As far as I can tell from the amendment, it makes no distinction between revenue spending and capital spending. I am still hopeful that my ICB is going to build a brand-new GP surgery and health hub in my constituency—it has been promising that for eight years and it is not here yet, so this may be hope over experience—and that would be a significant capital investment. Would the ICB be able to include that as spending on primary care services and get around the potential financial penalty?

I also worry about pitting one part of health spending against another. The hon. Member for Winchester said that the proposed standard would be similar to the mental health investment standard, but I believe that the Government—I am sure the Minister will correct me if I am wrong—have relatively recently changed the mental health standard to be in line with inflation rather than overall total spending. Therefore, if the amendment were to pass, primary care budgets would increase in line with total overall spending, whereas mental health budgets would increase in line with inflation. If those two things were out of sync, there would be a problem.

I totally accept what the hon. Member is trying to achieve. We all want to see more spent on primary care. The Government’s stated intention is to bring healthcare closer to home, and that can only be delivered, in my view, through primary care services. But there are some unintended consequences of the two amendments, which at least need more exploration before I could vote for them.

Health Bill (Ninth sitting)

Edward Argar Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

I have a question: the Secretary of State would consult with the CQC but the CQC would no longer be able to initiate the appointment of the TSA and approve the final report. That weakens the role of the regulator, yet in so many other ways the Government wish to strengthen the role of the CQC and give it more and more to do, so why have the Government made that decision? Will the Minister talk about that in her summing-up?

[Edward Argar (Melton and Syston) (Con)]

I will endeavour to be relatively brief in my reflections, and I will address, particularly, clauses 35 and 38. I can see a logic to what the Minister proposes in them. On clause 35, we know that foundation trusts face challenges. We saw that writ large with the scandal at Mid Staffs, and in my time as a Minister, several foundation trusts required intervention—maybe not on that scale—or required improvement. I pick on them just because they are in my head—I do not know the situation today. I am looking across at the hon. Member for Ashford, because going back some years to when I was a Minister, East Kent hospitals NHS foundation trust faced some considerable challenges. I am not necessarily saying that that meets the bar for intervention, but foundation trusts have challenges from time to time.

I should also declare an interest: I was born in the forerunner of the William Harvey hospital—the old Willesborough hospital—in the hon. Member’s constituency. I recognise that on occasions foundation trusts get into serious, or less serious but still challenging, circumstances. So I can see where the Minister is coming from, but I have a few questions for her.

First, we recognise that although foundation trusts can get into bother, so too can NHS trusts. NHS trusts can underperform, have safety issues or have financial or other performance issues. I am interested to hear the Minister’s reflections on why she believes that removing foundation status and the organisation becoming an NHS trust will necessarily solve those problems, when many NHS trusts can have equally significant challenges. I would welcome the Minister’s reflections on that.

In terms of whether a conversion was to take place—if the Secretary of State determined that that was expedient and it met the criteria—what would the timescales and process be if, further down the line, a foundation trust wished to reapply for its old status, having previously converted to an NHS trust? Would that be possible, and how would it work? I suspect that there would be a significant number of hurdles to get over to prove that it had achieved that status. I would welcome the Minister’s reflections on that point.

Finally, on clause 38, what the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, touched on gives me a little cause for concern. Essentially, this appears to be a further centralisation of powers in the Secretary of State’s hands, particularly with the changes to the role of the CQC. It effectively downgrades the CQC’s power as the independent regulator in these matters. Instead of the CQC being able to initiate the appointment of a TSA where, on safety grounds, they consider it to be necessary and the criteria met, that power will sit with the Secretary of State, who will be required to consult the CQC, but it will seemingly lose its ability to take that initiating step irrespective of what they have seen in any inspections. I would be grateful if the Minister addressed and potentially reassured me on those points.

[Karin Smyth]

As people who have been listening will know, this is a chunky set of clauses on some technical details. Let me broadly pick up some of the key points.

I want to be very clear about deauthorisation and our seeking to establish, essentially, a more dynamic model. As I said, the coalition Government repealed the legislation on deauthorisation in the 2012 Act. Although other regulatory levers exist to manage poor performance, we are using two core arguments. First, converting foundation trusts into NHS trusts will enable the Secretary of State, if needed, to intervene further through their power of direction over NHS trusts. The Secretary of State will therefore be able to focus on the patient and public interest over preservation of providers’ statutory freedoms in cases of serious failure. I hope that that addresses some of the points that have been raised. Secondly, having a more dynamic environment with the potential for deauthorisation in such cases, and the consequent loss of statutory autonomy, may act as an incentive for challenged foundation trusts to improve, and it would show that there are consequences.

As I think the hon. Member for Sleaford and North Hykeham knows, the usual processes exist for managing performance across various aspects of the provider. They will continue. This is for exceptional circumstances. As I said, this is about maintaining a more dynamic model than the one we have. The purpose behind her questions about continuous service—the purpose of having a range of failure powers—is to ensure continuity of care for patients and the public. The analogy with general practice does not hold; this is a very different set of circumstances. But, obviously, she raises an important point about public concern relating to the service’s provision, and I assure her on that. We need to make sure that we diagnose the situation, provide the trust with support and assess which toolbox is most applicable.

The CQC can recommend that a trust special administrator should be appointed where it is satisfied that there is a serious failure to provide services of a sufficient quality, and it must provide a report on the safety and quality of services following the appointment of an administrator. The Secretary of State must also consult the CQC before making an order to appoint a trust special administrator.

Question put and agreed to.

Clause 35 accordingly ordered to stand part of the Bill.

Schedule 5 agreed to.

Clauses 36 to 38 ordered to stand part of the Bill.

Schedule 6 agreed to.

Clause 39

Joint working and delegation arrangements

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Clause 42 changes parts of the NHS Act 2006 and the Health and Care Act 2022 concerning NHS England’s funding and financial responsibilities. Currently, the NHS Act 2006 contains sections relating to NHS England’s finances, including section 223B, “Funding of NHS England”; section 223C, “Financial duties of NHS England: expenditure”; section 223CA, “NHS England: banking facilities”; section 223D, “Financial duties of NHS England: controls on total resource use”; section 223E, “Financial duties of NHS England: additional controls on resource use”; and section 223F, “Power to establish contingency fund”. There are sections in the Health and Care Act 2022 concerning NHS England’s financial responsibilities and the expansion of its duties in respect of expenditure. Essentially, they are all deleted by clause 42.

[Edward Argar]

I will be relatively brief, turning just to clause 40. I hope the Minister may be able to clarify something for me. I take the opportunity to thank the Minister for the letter that I received this morning, which was a very prompt response to her promise to write to me last week.

In respect of clause 40 and subsequent clauses, I can see the logic of updating the legislation to reflect the abolition of NHS England and the changes that come with that. I can also see the logic of a consolidated set of accounts so that one can see the national, or overall, picture. In the interests of transparency, I would be grateful if the Minister could confirm that that will be in addition to, and in no way replace, every individual trust having to produce granular public accounts that anyone can inspect, so that we can see not only the overall operation and financial health of the system but that of each of its individual component parts sitting beneath.

[Gregory Stafford]

I wish to carry on the point that my right hon. Friend the Member for Melton and Syston has just raised. He rightly says that there is a transparency element to this, so that the public and any other interested party can look at the individual accounts of an ICB or a trust. Going further than that on the technical elements, my understanding is that NHS England’s own guidance notes suggest that consolidation does not just bring accounting under one set of accounts, one umbrella or one document. Within that accounting, however, adjustments and eliminations of transactions between NHS bodies can happen. Therefore, the aggregated figures do not necessarily reflect the financial reality of individual organisations.

I understand why that might be entirely appropriate from an accounting point of view, but it can make it harder for external observers to understand exactly where the pressures are coming from, where they are concentrated and, in a world where we want accountability, who should be held responsible for addressing them. That is all I need to say on that point.

Health Bill (Eighth sitting)

Edward Argar Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

I am concerned about this clause and the general move in the Bill to separate the two organisations. I hope the Minister will be able to describe to us how she will ensure that social care is not lost from ICB planning. Local authorities do not have a big enough say, and the decision to split Healthwatch’s local functions between ICBs and local authorities continues that theme. A lot of people who report concerns to Healthwatch are stuck in the hand-off between the NHS and social care provision from the local authority, and as the Bill envisages it, they will not even have one body to report those concerns back to. That separation of social care planning is a theme of the Bill.

[Edward Argar (Melton and Syston) (Con)]

Does the hon. Member share my concern that what often gets billed as simply streamlining or efficiencies is in fact slimming down, decoupling and weakening?

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[Karin Smyth]

There has been a wide-ranging discussion on this clause. I remind Members that the abolition of ICPs is about reducing that complex legal framework, allowing for local decisions and putting partnership work in place in the most effective way. That is what the measure seeks to do. I do not think anyone has disagreed with the notion that the landscape is complex, and that people are producing a lot of reports. In future, health and wellbeing boards will be the focal point for the collaboration between ICBs and local authorities. They are statutory committees that bring together the NHS, local government and relevant community partners; set the strategic direction for health and care services; and oversee joint working in their area, which we are of course committed to making work in local areas. I do not think many people will disagree with that; I hope that is clear.

There is also an enhanced role, not only for the health and wellbeing boards—as I said last week, I think they have been underutilised in most areas; again, I do not think people generally disagree with that point—but for health scrutiny. Again, across the country, that has not been pursued to the greatest extent to create links with elected councillors in local areas.

We are clear that the role of local authorities is crucial at a local level—as the name describes—and particularly in working on our commitment for neighbourhood partnerships and developing the neighbourhood plan; most of that was covered in our sittings last week. I accept that there are a number of concerns about how that will work in different geographies. I think the Opposition said last week that a survey suggested a quarter of areas will keep those partnerships, which is absolutely fine. That is up to them.

On the one hand, the Opposition say that there is centralisation and a power grab in this Bill; on the other, they complain—I should not say complain, because it is their right and their job to do so—about the move to devolution and the freedom to allow, or indeed encourage, local leaders to work together across authorities on behalf of the populations they serve, even where some of them are politically divided, because the populations they serve voted for different people. It is incumbent on all of us as individual elected politicians to work with people—whoever the population around us voted for. These provisions provide for that.

[Edward Argar]

Can the Minister set out how she envisages health scrutiny committees having genuine teeth? Our cross-party health scrutiny committee in Leicestershire universally condemned a decision by the ICB—totally disagreed with it—and the ICB basically said, “Thank you; noted,” and carried on anyway.

[Karin Smyth]

We all have examples of decisions that are made in our constituencies that we do not like. Again, that is part of the democratic process, but I go back to my earlier point: either there is a centralised unaccountable body like NHS England making decisions, or the Secretary of State devolves those responsibilities.

It is incumbent on people and elected leaders locally, and the ICB, which is not elected, to work with local leaders on these decisions. ICBs will be held accountable through mechanisms in the Department of Health and Social Care. There will be decisions that people do not like—that is a consequence of some of these things—but the clause simplifies the landscape.

Health Bill (Seventh sitting)

Edward Argar Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Dr Huq. I will speak briefly about clause 15 and amendment 28, tabled in the name of the hon. Member for Oxford West and Abingdon, the Chair of the Health and Social Care Committee, of which I am a member.

The amendment is clearly positively intended. We all want the co-production of services, and we have discussed it quite a lot on the Health and Social Care Committee. A number of amendments were tabled in the name of the hon. Member for Oxford West and Abingdon but were agreed on by the Select Committee. I think it is fair to say that there are a number of areas that the Committee could not agree on and that are obviously not in front of it, given its political make-up, but we all agreed on the ones she has tabled.

That being said, cross-party agreement often necessitates fairly non-partisan and perhaps non-specific wording, so while I agree with the intention behind the amendment, and while it is clearly important to have co-production when designing services, I am not entirely comfortable with the way the amendment has been drafted. This goes back to comments I made on the Liberal Democrat new clause 2 about how the requirement would operate in practice or how such an approach would be applied consistently across different commissioning functions. Although I am very keen on the principle, I am concerned about the intention.

[Edward Argar (Melton and Syston) (Con)]

I will not detain the Committee for long, and I will speak primarily to clause 15. I am broadly supportive of what the Minister seeks to achieve, as I understand it, with the clause. It is absolutely right that service users and communities are engaged by their integrated care boards—those commissioning services—in the design of services as well in individual care.

As I alluded to before we adjourned for lunch, however diligent an ICB may be in doing formal consultations or conducting surveys, it is all too easy for that to appear to the actual users of the service as a box-ticking exercise, with the board none the less determined to follow through with the strategic plan that it conceived and consulted on in the first place. We have seen that challenge on a number of occasions in my Melton and Syston constituency, with the recent closure of St Mary’s birth centre in Melton Mowbray. There was a consultation and engagement with the public, but we always feared that, ultimately, a decision to close was what the ICB wanted and, lo and behold, that is what happened. Similarly, the ICB decided to pull away from accepting the need for a second GP practice or enhanced GP services in Melton Mowbray. There was a consultation and discussion, but ultimately the conclusion that we feared at the outset of the process was indeed what was reached at the end of it.

The clause will not necessarily address all that, but it is a step forward in putting pressure on an ICB, or on those commissioning services, whoever they may be, to engage with local communities in a meaningful way.

[Gregory Stafford]

My right hon. Friend is making an absolutely correct point, which I made when we were talking about the Secretary of State’s ability to remove, by sacking or otherwise, the chief executives of ICBs. There is a tension between us as Members of Parliament trying to lobby the Secretary of State for changes in our constituencies when he currently has no power to actually make those changes. The clause will potentially give him the power to make those changes, but being able to sack a chief executive is probably a step too far. How does my right hon. Friend see the powers in the clause, which are probably correct, balancing with the local decision-making process and clinical expertise? There will clearly be a tension between the two.

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[Edward Argar]

My hon. Friend comes to this with significant knowledge from his work on the Health and Social Care Committee. He is absolutely right, but that is a tension and a balance that I fear runs as a thread throughout this legislation, between local decision making and tailoring and the genuine need for a Secretary of State to have effective powers. We lobby Secretaries of State; on occasion I have lobbied the Minister, and she has always been very responsive—she does not always agree with me, but she has always been very responsive to me. As Members of Parliament, we do that on behalf of our communities.

My argument is that ICBs need to be more responsive, even when they do consult, to make it clear that the decision is not predetermined by the board and that they are going through the process. In the context of this clause, that also needs to be true of the Secretary of State: it needs to be not simply a formulaic approach but a genuine engagement and consultation. My question for the Minister, in that context, is about how we make sure of what she is seeking to do in the clause. The Secretary of State or those undertaking commissioning on their behalf must pay heed to something, but how do we make sure that that consultation, engagement and feedback genuinely have some teeth in what emerges in the final decision?

[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?

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[Helen Morgan]

I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.

[Edward Argar]

The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.

I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.

[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?

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[Karin Smyth]

The clause transfers the requirement to conduct annual assessments of integrated care boards from NHS England to the Secretary of State and focuses the assessment on the statutory functions of the organisations. To do that, it removes a prescriptive list of duties to be assessed that was inserted by the Health and Care Act 2022.

ICBs are essential to delivering our health mission. They are responsible not only for arranging healthcare services, but for planning how those services will focus more on prevention, digital innovation and delivery in the community. It is therefore entirely appropriate that the Secretary of State should hold ICBs to account and undertake a meaningful assessment of their performance.

Currently, NHS England assesses the performance of ICBs annually, reviewing how well they have performed against a list of duties prescribed by the current legislation. The process for those assessments is set out in guidance each year and is driven by both publicly available performance data and local insight. The results are published online and form part of the ongoing performance conversation between NHS England and each ICB.

Although NHS England can choose to assess more than those statutory duties as part of that process, the duties form a static list of requirements that are already expected as part of the ICBs’ statutory functions. Having such a list may inadvertently skew attention away from other priorities in the 10-year health plan and our mission. As we reform the NHS, the ICB performance assessment will need to adapt to the evolving role of ICBs as strategic commissioners and reflect new models of commissioning. The list of duties will therefore become too prescriptive to provide the accountability intended. The clause allows a more nimble and flexible approach, ensuring meaningful assessment of ICB performance.

[Edward Argar]

The Minister has saved me from having to give a speech on this clause, so I will ask her a couple of questions instead. Does the Secretary of State intend to publish the list of criteria against which he will require assessment to take place, so that it is transparent what is being considered? Notwithstanding the Minister’s point about the 2022 legislation, the Secretary of State will define the list, so will he publish those criteria? Within what period following the end of the financial year will the Secretary of State commit that the results will be published?

[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.

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[Gregory Stafford]

My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point.

That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board.

That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham. Reducing the representation to a single mayoral representative is a problem. Reinstating and consolidating the full range of required members and thereby giving the breadth of representation within ICBs that we have all talked about, is essential. It would strengthen the legislative framework, ensuring decision making remains multidisciplinary and balanced and that it incorporates both the clinical expertise, which we are going to lose, and the local authority political input, rather than having a one-sized, over-politicised mayor in charge.

By maintaining that membership, the amendments would help safeguard overdominance by a single actor, support a much more informed and locally responsive decision-making process and, crucially, reinforce the collaborative foundation between health and social care that I thought was a given among all parties in this House. I urge the Minister to reconsider what she is proposing in this clause. She should, at least, give us some clarity on what will happen in the interim period or, at best, go back to the drawing board and ensure proper representation of the people who are actually delivering health and social care in our constituencies.

[Edward Argar]

I agree entirely with my hon. Friend the Member for Farnham and Bordon. At risk to my political career, such as it is, I also agree entirely with the hon. Member for Winchester, who made a very good point in drawing the Committee’s attention to something that should not need to be said, which is that the provision of healthcare and social care go hand in hand, and if either part of that equation does not function, the other part will not. He highlighted a good example, and I visited Winchester hospital when I was a Minister.

If we do not have a functioning social care system, or a social care system that is closely integrated in and working closely with the NHS, we see the knock-on effects pretty swiftly in terms of the large numbers of people medically fit for discharge who are unable to be discharged, which then impacts on the flow through an acute hospital setting. That is one of the big factors we see in A&E backing up, because people cannot be discharged, people cannot get into beds because the beds are full and then the ambulances are queuing up outside. The hon. Gentleman illustrated that point extremely well.

[Dr Chambers]

On the economics, it costs around £850 a night to keep someone in a hospital bed and a fraction of that for a social care package. This is an absolute false economy, even if we ignore patient experience and patient recovery.

[Edward Argar]

The hon. Gentleman is absolutely right from the financial perspective. As he mentioned, there is, of course, the human perspective and the impact on someone’s recovery and their health, as well as their psychological health, if they are in hospital when they simply want to get home, because they have no medical need to be in hospital.

My worry about clause 21 is that it essentially seeks to undermine the whole concept that ICBs rest upon. ICBs were conceived to bring together all the NHS services in a particular area, but also, as my hon. Friend the Member for Farnham and Bordon highlighted, to make sure that the NHS footprint mapped on to the geographical footprint of the upper-tier local authority delivering social care, so that the ICB is looking at the same geographical area for the two key parts of the system and they neatly map on to one another.

With changes, mergers and acquisitions—as well as a whole range of other changes—that link is already breaking and weakening, as ICBs start covering larger areas and look in different directions. As my hon. Friend the Member for Farnham and Bordon set out, and as I think the hon. Member for Winchester highlighted in an earlier sitting, because we do not know what local government reorganisation will look like in the years to come, we increasingly run the risk of creating something that again will not map on to a geographical footprint and may have to change.

In a number of areas—take my area, Leicestershire—we do not have a mayoral authority. At present, there is no plan or proposal before us for one. Yet the ICB is merged with Northamptonshire, which does not have one either. We will see a real gap in representation.

We are moving away from what we sought to do with ICBs. During the passage of the 2022 legislation, I always used the phrase—the Minister probably heard it until she wished to hear it no more—that we were seeking to be permissive, not prescriptive, where we could be. However, this was one area where it was not just us in the then Government who were trying to put a bit of a guardrail around the membership of ICBs. We were pushed by the now Government, then Opposition MPs, to go further in what we prescribed for the membership of an ICB.

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[Dr Prinsley]

I am listening carefully to what the right hon. Member has to say. I wonder whether he could present us with a concrete example of where precisely elected local government involvement in the commissioning of services in ICBs has been essential, because it seems to me that what an ICB needs is expertise in commissioning. We need people who know how to commission services. Although I understand the importance of representation, I think that what we really need is expertise in commissioning.

[Edward Argar]

I take the hon. Gentleman’s point to a degree, but I would refute a chunk of it. We need within the organisation people who have those technical skills and know how to commission, draw up a specification, put it out to tender, or work out what is needed and ensure that what is delivered reflects what was commissioned and that the performance is what is sought to meet the needs of the local area. At board level, we need representation from local authorities and others, because it sets the strategic direction.

The board members are not the people who are going to sit there and write the commissioning document. They will probably approve it, but they are not the experts who will be drafting it. We are talking about two different functions, and I argue that when a board-level decision is being made, we want those voices in the room to ensure that those different perspectives are reflected and there is that critical challenge to what is proposed by the executive directors. We essentially have non-executive directors who are there to challenge, to question—perhaps to agree, but perhaps to push back on things. That is how many boards operate.

In what is proposed, we lose some powerful voices from round the table. They may not carry the day, but those voices should be heard. Having sat where the Minister is sitting now, I appreciate that she may not be willing or in a position to accept the amendments, but I hope that she will take away and reflect further on the challenges of representation.

[Karin Smyth]

I absolutely recognise that this is an area of huge interest to hon. Members across the piece. I assure colleagues that officials and I have been working with representatives of the Local Government Association and mayors throughout the development of the Bill and the future architecture, and we will continue to do so. We will continue to have discussions and to make sure we get this right, because it is complex and complicated. Given that we are all politicians, we understand. Many of us have been councillors and local representatives, and have spent a lot of our time—sadly, for officials—knocking on doors, going out and persuading individuals to vote for these people. We understand that it is quite personal and we want to get it right.

If I may, I will not take any interventions so that I can address the amendments and our approach to ICB membership. As my hon. Friend the Member for Bury St Edmunds and Stowmarket said, ICBs are commissioners. This is a fundamental shift, which I will come on to, and it is different from the 2022 work. I now want to outline the board membership set out in clause 21, but I think we will be discussing this for some time.

Lord Darzi’s review found inconsistency in the roles being undertaken by ICBs and concluded that the health and care system would work better if each organisation had greater clarity and focus on its particular role. That is our starting point, and we set out to do that in the 10-year health plan. In future, all ICBs will discharge their common statutory duties through best-practice approaches, getting better at allocating their budgets to meet the population’s needs and securing the best outcomes. The new focus for ICBs is strategic commissioning. All ICBs will, in future, operate at a minimum efficient scale, with a population of around 1.5 million people covering multiple partner local authorities.

Effective partnership working is core to strategic commissioning and is aided, rather than diminished, by replacing ambiguity in roles with clarity and focus. That is why we are altering the membership requirements for ICBs. We are adding a requirement for strategic authority mayors, or a nominated representative, to be appointed to ICBs operating within their footprint. Strategic authorities will increasingly become key bodies for growth and prosperity in their localities. Mayors, or their nominated representatives, will highlight opportunities to improve health outcomes through a joined-up approach to their other devolved responsibilities, such as transport, housing and employment.

Although we recognise that the coverage of mayors and strategic authorities varies across the country, we will provide guidance to ensure that no area is disadvantaged, regardless of how advanced its local devolution arrangements are. In all cases, ICBs will have an obligation to ensure that their boards have a suitable membership to discharge those functions properly.

Given the larger geographical footprint of ICBs in the future, we are also removing the requirement for ICBs to have at least one member jointly nominated by local authorities. At present, local authorities collaborate with ICBs by sitting on health and wellbeing boards and local integrated care partnerships. The multitude of plans, committees and measures have resulted in confusion, siloed working and, too often, inaction. I think many of us would recognise that in our own areas.

I emphasise that we want to ensure a strong voice for local government in the work of the NHS. Our preferred approach is for local authorities to work with the NHS through health and wellbeing boards, co-commissioning and local authority health scrutiny. Those are likely to be more fruitful forums in which to resolve issues, agree joint approaches and tackle the needs of a local area.

As ICBs become more focused on effective commissioning, it is right that we remove any potential conflicts of interest. That is why the 10-year health plan and the Bill propose removing the requirement for one member jointly nominated by primary medical care providers and one member jointly nominated by NHS trusts and foundation trusts. The clause will provide ICBs with memberships that are best equipped to fulfil their commissioning responsibilities and role in health planning.

On amendment 45, which was tabled by the hon. Member for Sleaford and North Hykeham, I assure her that the Government fully appreciate the importance of general practice and primary care more broadly, and the role that they play in informing ICB decisions. However, as I have said, health and wellbeing boards should be the key forum for resolving local issues and making planning decisions for their neighbourhoods. GPs are well placed to contribute to those discussions and also vital to them. We expect health and wellbeing boards to ensure that they involve relevant stakeholders, including GP practices and primary healthcare providers, in their work.

There is an opportunity for health and wellbeing boards to play a much more proactive and important role in the local economy. To respond to the point made by the hon. Member for Winchester, we absolutely recognise that place is important in those arrangements. Although I agree that the experience of primary care is important, I hope that I have reassured the Committee that having a member nominated by primary care on the board of an ICB is not necessary.

A similar argument applies to amendment 46, which would require a local government representative on the ICB. I should start by saying that I wholeheartedly recognise the important role that local authorities play in the health and care system. As we have discussed, their work in social care and public health, and their influence on the wider determinants of health such as housing and employment, mean that they have a fundamental role in supporting the delivery of our ambitions to improve the health and wellbeing of the population and implement the three shifts identified in our 10-year health plan.

Rather than one local authority attempting to represent the interests of many on an ICB board, however, we think that it is more effective for local government to use health and wellbeing boards to address local barriers to joint working and support the development of neighbourhood health plans, which will shape the commissioning plans of the ICBs. I assure the Committee that we expect ICBs to work effectively with every one of their partner local authorities in the local authority footprint to deliver the neighbourhood health service and progress the integration of health and care services at that level.

I should stress that our changes are not designed to weaken democratic accountability in the NHS. ICBs are NHS statutory bodies that are governed by a unitary board that is jointly responsible for ensuring that the ICB discharges its legal duties. Given that specific role, the ICB board is not the forum in which democratic leaders hold the NHS to account; rather, that is conducted through the local authority health scrutiny functions and Parliament. Again, this is a good opportunity for those health scrutiny functions to be much more robust and proactive at local authority level.

Amendment 46 also proposes retaining provider representatives on the ICB board. As I said earlier, we think that an ICB should have a core focus on commissioning, so it is right to remove the requirement to have providers on them. That will also support the avoidance of potential conflicts of interest.

We debated these issues many times—the right hon. Member for Melton and Syston referred to it—in this Committee Room, or one very similar to it that was not quite as hot, during the passage of the Bill that became the Health and Care Act 2022. These are difficult and complex issues. I mean no disrespect to him—he had a difficult job to do at the time—but the architecture has not worked. It is confusing, and I do not know any area that particularly thinks it has worked. We think that clarifying the roles will make the system much more effective.

I think we agree that adding requirements for strategic authority mayors to make nominations to their ICB boards is a good thing. It will be an effective tool to harness the benefits of joint planning between an ICB and strategic commissioners and strategic authorities, who will have increasingly significant roles in shaping their areas. I ask hon. Members not to press their amendments, and I commend clause 21 to the Committee.

Question put, That the amendment be made.

Health Bill (Sixth sitting)

Edward Argar Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.

[Edward Argar (Melton and Syston) (Con)]

I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.

[Helen Morgan]

The right hon. Gentleman asks an extremely important question, and I am happy to clarify. It would be an appropriate clinician within the GP practice, and it could obviously be a telephone appointment, because that might be more convenient for the patient. Lots of patients are really happy with telephone appointments and we should be using them wherever that is the patient’s choice, because we want—I think we all do—to see an NHS that is patient-led and not politician-led.

--- Later in debate ---

[Gregory Stafford]

It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed.

I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.

[Edward Argar]

It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised.

The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned.

I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical triage as to what is the most appropriate access point to primary care services for the individual, based on their symptoms and needs.

For me, despite the work being done in Melton Mowbray at the moment to improve waiting times, it remains a very significant concern that despite the integrated care board having a few years ago acknowledged publicly the need for additional GP provision in the town, whether a second GP practice or a new satellite service, it said a few months ago—despite the fact that in the intervening period there has been considerable housing development in the town—that it considers that there is no need at the present time for additional GP provision, and so it does not appear to have a plan to expand that provision. That is obviously concerning. All of us in this House will from time to time have these issues in our constituencies and, I suspect, sometimes get frustrated by the fact that ultimately we can press our ICBs and ask questions of the Minister—who, I have to say, always responds in a courteous and measured fashion—but ultimately the decision maker is the integrated care board’s board and it will do what it wishes to do when it comes to commissioning those services. There is a disconnect there.

My challenge with regard to new clause 2, despite my being in agreement with the need to improve access to services, is that there is a lack of clarity about how that will be done and there is the fear that it may raise expectations that are not necessarily deliverable on in the current context. The Liberal Democrat five-year plan for GPs is in their 2024 manifesto, and the hon. Member for North Shropshire alluded to the commitment to 8,000 additional GPs. It is not my usual habit, but I have read the Liberal Democrat website, which sets out the background. I appreciate that this is from 2024 and the hon. Lady may have moved things forward a little bit since then, but it states that the five-year plan

“gives patients the legal right to see a GP within a week or 24 hours if needed urgently”.

The hon. Lady may wish to respond on that.

[Helen Morgan]

I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.

[Edward Argar]

I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation.

My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.

[Helen Morgan]

I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.

[Edward Argar]

I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.

We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.

[Dr Chambers]

Even when the right hon. Gentleman criticises, he does so in a charming way.

None of this is moving the discussion to how we keep people healthy and treat them early. He may criticise our funding models and challenge the detail for achieving this measure, but if we flip that round, the previous Government promised 40 new hospitals, which were not hospitals and did not materialise. The entire focus of healthcare has been on treating people once they are sick, while people cannot get GP appointments.

I hope that the right hon. Gentleman would agree that the thrust of the argument is to try to keep people healthy and treat them early, before they end up needing hospital treatment, and that that is what we should all be focusing on. If he wants to help with the details in order to get 8,000 GPs by the end of this Parliament, he can submit his suggestions to the Liberal Democrat website.

[Edward Argar]

The hon. Gentleman makes his point in a typically reasonable way. Of course, he is right to talk about the need to shift, where we can, from acute settings to either community settings or, ideally, a preventive setting or focus. The Minister may well disagree with me, but I think that is a desire or thread that, however well implemented or otherwise, runs consistently through Governments. It ran through the Blair-Brown Government, the previous Liberal Democrat and Conservative coalition, the Conservative Government and into what the previous Secretary of State announced and what the Minister today is seeking to achieve. I do not think that anyone would disagree with that. We will always need those acute settings for particular treatments and cases, as well as for those very specialist pieces of work or for people with significant illnesses.

There has always been a desire to push the care into the local community. GPS are a central part of that, as are—to address the points raised by my hon. Friends earlier—our community pharmacists and other pharmacists. Pharmacies remain an improving but underused resource as part of that preventive picture. I do not disagree with the hon. Member for Winchester in that, but one can agree with the objective, but nonetheless gently push a little on the detail. As we know, the devil is in the detail, and people will want to see a deliverable plan.

That is one of the challenges that I have had in Melton Mowbray, where the ICB says it will do one thing and then says, “Actually, no, we can’t do that anymore.” Expectations go up and down and people are understandably frustrated. When we put such proposals forward we need to be robust in how we are going to achieve them and in their practicalities. The Minister may wish to make further observations.

[Karin Smyth]

I have enjoyed the “back to the good old days” of the Lib Dem-Tories. They tell us we live in fractured political parties, but I quite like the old days.

On new clause 2, I understand the intention that GP provision is important to us all and to our constituents. We have recruited over 2,000 more GPs since 2024—the highest number of qualified GPs since 2015—and there is provision to ringfence money for even more. We all know the importance of timely access to general practice, and patients need to be confident that they can get that care urgently and receive it promptly.

We are seeing improving signs. According to the ONS, the number of people who say it is now easy to contact their GP practice is up 14% since 2024, and that satisfaction is rising. Importantly, 69% of patients are seen within seven days and 44% are seen within the one day that they have requested an appointment, irrespective of urgency. That is the progress that we are encouraging, but we are not complacent; we recognise that there is more to do.

We also recognise that not everyone not seen within seven days is experiencing an unnecessary delay. Not every patient requires an appointment within seven days, and many people book appointments in advance for routine reviews, medication checks, to ensure that they see their preferred clinician or to fit around work and other life responsibilities. The new clause would cut across that flexibility by imposing a more rigid approach to appointment allocation, weakening both clinical judgment and patient preference. We do not believe that would be the best for patients or safe care. We must protect both clinical judgment and patient choice. We therefore cannot support the new clause.

We are clear that if someone is unwell and a doctor needs to see them urgently, they should be seen that same day. NHS England’s medium-term planning framework, which was published in October 2025, sets out an ambition for all clinically urgent appointments to be delivered on the same day, ensuring that patients assessed as needing urgent care are prioritised appropriately. We have made changes to regulations to require clinically urgent requests to be dealt with on the same day to support that ambition within the 2026-27 GP contract. We will publish data on that progress soon.

On new clause 52, we know that dentistry is broken and that we need to rebuild it. That includes ensuring an urgent care safety net across the country by reforming the dental contract and developing the 10-year workforce plan This new clause is unnecessary; we have delivered 1.8 million more dental treatments, and from April we began introducing a package of reforms to address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will prioritise those with the greatest need, shifting care away from clinically unnecessary check-ups. We are also including dental school places, and we will make more provision in our upcoming workforce plan.

The Government are committed to more fundamental contract reform by the end of this Parliament, which will include publicly consulting on future proposals. I make no apologies for taking the time to get that right. The issues are complex; this has not been done for a long time and there is no consensus on the perfect approach. On that basis, I commend clause 14 to the Committee.

Question put and agreed to.

Clause 14 accordingly ordered to stand part of the Bill.

Schedule 1

Conferral of primary care functions on integrated care boards etc

Amendments made: 14, in schedule 1, page 60, line 19, leave out sub-paragraph (2).

This is consequential on NC21.

Amendment 15, in schedule 1, page 60, line 26, leave out “(a), (b), (c) and”.

This is consequential on NC21.

Amendment 16, in schedule 1, page 60, line 36, leave out paragraph 46.

This is consequential on NC22.

Amendment 17, in schedule 1, page 65, line 5, leave out paragraph 65.

This is consequential on NS1.

Amendment 18, in schedule 1, page 75, line 1, at end insert—

“(4) In subsection (5), in the definition of ‘relevant area’, after paragraph (b) insert—

‘(ba) in relation to an integrated care board, in a case where a person has at any time provided or performed services by arrangement or contract with the board, means the prescribed area (at the prescribed time).’”—(Karin Smyth.)

This adds an amendment to section 259 of the NHS Act 2006 that is consequential on the transfer to integrated care boards of NHS England’s commissioning functions in respect of primary care.

Schedule 1, as amended, agreed to.

Ordered, That further consideration be now adjourned.—(Emma Foody.)