Health Bill (First sitting)

Debate between Edward Argar and Sureena Brackenridge

Tuesday 16th June 2026 Public Bill Committees

[Sureena Brackenridge]

Q I feel that my question may have just been answered, but you may wish to add something, Dr Benneyworth. Will patient safety accountability be improved when a patient’s care spans different organisations within an ICB?

Dr Benneyworth: One of the things that we see regularly in our investigations is that people fall down the gaps between organisations. We have the ability to look right across the system and understand a person’s journey. As a recent example, we looked at medication errors on discharge from hospital. There are a lot of medication errors, and we looked at the process of how information was being shared and what was happening. Those are the type of things where we see a lot of concerns about patient safety. There needs to be much more clarity about accountability for patient safety.

No one is accountable for the discharge of a patient. There is not one person—no single individual—who is accountable when someone is discharged from hospital to social care. You go through multiple layers of accountability. We are keen to learn from other industries that have effective safety management systems. Part of those safety management systems is having much more clarity about accountability, which is lacking across the NHS. I very much hope that, with the changes to ICBs, they really do think about accountability for patient safety.

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

Q In her evidence earlier, Dr Dash said that one of the reasons for her recommendations in her second review of changes to the regulatory and investigatory landscape is that it is a problem for the provider landscape that there are so many different organisations making so many recommendations. You have just said that HSSIB makes very few recommendations. Will the merging or folding—however you wish to characterise it—of HSSIB into the CQC lead to any meaningful reduction in the number of recommendations that organisations have to cope with?

Dr Benneyworth: No, we do not make recommendations to provider organisations at all. All our recommendations go to national organisations. I completely agree with Dr Dash that there are too many recommendations. In fact, HSSIB raised that concern through our work two years ago and flagged it to Dr Dash. We wrote a report called “Recommendations but no action”. We are very concerned about the plethora of recommendations going to providers, which create a huge amount of noise but, distressingly for the families involved, do not lead to the changes needed.

I completely agree that there are far too many recommendations. I am leading some work to address that—we are setting up a recommendations hub with the Department of Health and Social Care—but we are not that problem. We have made 39 recommendations since investigations launched and HSSIB started three years ago, and they are all to national bodies. We might reduce the burden on national bodies by taking that away, but it will not have any impact on providers.

Health Bill (Second sitting)

Debate between Edward Argar and Sureena Brackenridge

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Sureena Brackenridge (Wolverhampton North East) (Lab)]

Q I would like clarity on a few views that we have heard, not just in this session but in previous ones. There is one mindset that says that by bringing patient voice into ICBs, they are going to be marking their own homework. Equally, I think about places like Wolverhampton, where we have such baked-in inequalities and we simply have not shifted the dial for far too long, as can be seen in the differences in life expectancy. I have also heard that if you want to bring real change, it is best to bring that change from within the system. I will open that up to you, Sarah.

Sarah Tilsed: I disagree with that. It is fine for ICBs to be involved, but it is all about local partnership working—bringing in the voluntary sector and really going into the community, and doing it in partnership. That is the only way of doing it. If you are bringing it into the ICB, consider how much funding there was when Healthwatch was doing it and—I do not want to repeat this point, but I will—the fact that it will be marking its own homework. For me, it is about partnership working going from the community—not within the system and not within the NHS, but going out to the community and feeding inwards.

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

Q I know that in this conversation some have highlighted that patients have stated that their experience has worsened or not improved, but I would argue that is not a Healthwatch failure; it is actually down to the NHS or ICBs not acting on Healthwatch recommendations. It seems to me perverse to give that voice to the organisations that are actually part of the problem through not acting.

As a Minister, I was on the receiving end of some quite sharp recommendations from Healthwatch, but they were always constructive. Whether right or wrong, my fear is that this measure risks a perception among patients that it will be down to NHS managers and ICBs essentially to make recommendations that reflect their priorities, rather than the priorities and voices of patients. Professor, even if the principles that you have enunciated that might mitigate that risk were applied to the new model, are you really confident that they could mitigate the risk to patients’ confidence that their voice is genuinely and independently heard, loud and clear, however unhelpful it is perceived to be by bits of the NHS?

Professor Croisdale-Appleby: I cannot be confident of that, because we are in the foothills, not up the slope, and the details have not been given. ICBs have received something approaching a 50% cut in their running costs. I will not comment on the appropriateness or otherwise of that, but one has to be realistic and think about how high a really informed patient voice—particularly one that seeks out the views of both communities and individuals where the health inequalities are the greatest—will be on the priority list. I would question that, but I will leave it there.

--- Later in debate ---

[Edward Argar]

Q Having been both a local councillor and a Health Minister, I am very conscious that the real test of any joint working arrangements between different bodies comes when budgets start getting a little tighter. We see that tension growing a little bit with the cuts made to ICBs’ budgets.

I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.

Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.

My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?

Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?

Councillor Wright: It will probably weaken it, unless we are given more say in our local health and wellbeing board. Our Thames Valley ICB has one director of public health. Thames Valley ICB I think has nine local authorities, and one chief executive and one director of public health sit on the board, so already the voice on it is quite small. If we lose that voice, where would we have those conversations? That brings me back to the whole thing about health and wellbeing boards needing to be stronger, definitely.

Sally Burlington: We would agree with that. If you take away the voice that is able to speak on behalf of social care, public health and wider public services, it will be harder and an additional job to bring in that consideration. It will be even harder to expect there to be notional teeth in that relationship, so we have concerns about that.

Maria Higson: It is also worth recognising that the delivery of any strategy or plan will require partnership working with local authorities, so whether or not they are in the room, they will be needed for delivery, and the proof is always in the pudding. For me, the partnership is somewhat non-negotiable in order to achieve delivery.

[Sureena Brackenridge]

Q Constituents have raised issues with me about when elderly patients or patients with dementia, in particular, come to discharge and the transfer of care, because of the lack of effective data and information sharing. To what extent do the provisions in the Bill on the single patient record allow data to be shared with social care providers? I will ask Councillor Wright to start off.

Councillor Wright: At the LGA, we are arguing for a single person record, so that we have a single patient record that brings in social care providers, or at least the local authorities’ social care statutory provision, too. Someone discharged into the community would therefore still have access to records and know what was going on, while others would know what has happened to that person and what they need. Yes, we agree: we hope that a single patient record would make things as smooth as possible from hospital discharge to home and would help when someone comes into hospital, so that the clinicians have a better idea of what the patient’s quality of life was like, what treatments they were on, and so on. We are definitely in support of the single patient record for that, and we would like it to become a single person record.

Sally Burlington: We are supportive as well. The Bill itself is unlikely to solve all the problems in this space. A huge number of practical cultural system problems exist in data sharing, so the regulations that follow the Bill will be important to enable that to work for social care providers and commissioners. It is worth noting that there are thousands of social care providers, so the implementation of the Bill and subsequent regulations will be important. We are keen to ensure that any approaches are co-produced with the social care sector, as well as the NHS. It will be a lot of thinking, a lot of planning and a lot of hard work to get it right, and social care providers will need lots of notice to upgrade their systems in the right, consistent way to enable them to speak to each other, if we are to see the vision of the single person record delivered. I guess it would also be helpful to think about the role of carers as we move into that space, because we know from covid that data sharing among carers was one of the issues that came up.