HCRG Care Group: Performance in the South-west

Emma Lewell Excerpts

Wednesday 28th October 2026 Westminster Hall

[Emma Lewell (in the Chair)]

I remind hon. Members that they may make a speech only with the prior permission of the Member in charge of the debate and the Minister. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates. I call Sarah Gibson to move the motion.

[Sarah Gibson (Chippenham) (LD)]

I beg to move,

That this House has considered the performance of HCRG Care Group in the south-west.

It is a pleasure to serve under your chairmanship, Ms Lewell. I am grateful for having secured this debate about the performance of HCRG in the south-west, and Wiltshire in particular. Over recent months, a growing number of constituents, carers and healthcare professionals have contacted me. I want to open by thanking the staff who have stuck their heads above the parapet and asked their elected representatives to put HCRG’s performance on the Minister’s radar. Some of those staff are sitting in the Gallery, and I thank them for coming.

The communities served by the HCRG contract are diverse: Bath and North East Somerset, Swindon and Wiltshire. Each has its own challenges, demographics and patterns of service use. The issue is not whether one area matters more than another; it is whether local circumstances are properly understood. District nurses covering rural Wiltshire face challenges very different from those of nurses working in more urban areas, yet many of the staff who contacted me feel that those differences have not been properly recognised.

Wiltshire is a large, rural county, where patients can live miles from healthcare facilities. Community nursing teams often spend significant amounts of the day travelling between appointments. Aggregate figures for a large contract area tell part of the story, but they can also obscure local pressures and problems. A successful service model is one that understands those differences and responds to them. I am afraid that I have concluded that HCRG does not understand those differences.

When responsibility for community health services was awarded to HCRG in October 2024, patients were promised more joined-up care, easier access to services and simpler overall experiences.

--- Later in debate ---

[Sarah Gibson]

It is just that that point is not true.

[Emma Lewell (in the Chair)]

Order. Will the hon. Member refrain from shouting out, please?

[Karin Smyth]

Industrial relations are also important. We cannot run a health and care service without good staff who are well supported, nor without maintaining good industrial relations at a local level. That is a matter primarily for the group, its employers and recognised trade unions. The ICB needs to continue to monitor that and go through those established processes for doing so. It needs to keep working with them and we certainly support that at a national level.

On the wider issues about supporting ICB performance, I sympathise. I have spoken many times in Opposition and Government about the frustrations of local Members of Parliament in understanding the very fragmented system left under the Lansley reforms. I appreciate what the hon. Lady is saying from her position in Chippenham, and that may be different from other positions—it is a large geographic area. That is one of the issues that we need to get right. We are working closely on it in the Health Bill, where we are devolving responsibility and accountability for commissioning and providing services at a local level. That is the right thing to do. We also need to get right the link to neighbourhoods and place through local authorities while strengthening health and wellbeing boards. That is the direction of travel in the Bill and what we are currently trying to make happen.

ICBs are held to account nationally for delivering for patients. The oversight framework provides a transparent approach for assessing performance. Another thing that we have changed since coming into power is that from 2026-27 every ICB will be placed in a delivery segment based on national performance measures. That will help to identify when greater support, scrutiny or intervention is needed at the national level. That will be complemented by an annual assessment of how effectively each ICB is discharging its statutory functions. Where performance is falling short, oversight can be increased and support can be targeted at the areas of challenge and, where necessary, formal intervention powers are available. That brings ICBs into line with other providers.

At the same time we are strengthening ICBs’ commissioning capability, partly through the Health Bill. We have the strategic commissioning framework setting out what effective strategic commissioning looks like, and the strategic commissioning development programme provides targeted support to strengthen those capabilities in local systems. We recognise that there is variability across the country. To be clear: ICBs are responsible for assuring the quality, effectiveness and value of the services that they commission, while NHS England oversees the performance of ICBs through the oversight framework, including consideration of how effectively they discharge those commissioning responsibilities.

Finally, we have heard about issues with palliative and end-of-life care. Patients approaching the end of life and those important to them—their closest friends and family—should absolutely receive compassionate, dignified and personalised care in an appropriate environment. That is why the Government are committed to improving access to high-quality palliative and end-of-life care, and to shifting more care from hospitals into the community and, where appropriate, the home. NHS England requires ICBs to commission appropriate palliative and end-of-life care to meet the needs of their local populations. To support ICBs in that duty, NHS England has published statutory guidance and service specifications.

In addition, we are developing a modern service framework for palliative and end-of-life care, which will be a clinically led, evidence-based framework to support sustained improvement in outcomes for patients and carers, including identifying, measuring and reducing health inequalities, and reducing unwarranted variation in access, experience and outcomes.

We continue to work hard to strengthen community care services and shift care closer to home. As the hon. Lady said, what was promised to her population and the wider ICB area must be delivered. All too often, community health services do not get the attention that they deserve, and staff on the ground do not get the recognition that they deserve. This debate has raised some important questions about how we hold organisations delivering and commissioning services to account.

The hon. Lady asked two questions about comparable data. If anyone has not read the transformation and opportunity packs that I sent all MPs last year about their local systems, I recommend that they do that. I will continue to get information on their local systems to them. The hon. Lady probably knows that we cannot compare like for like, but she should have that information; we are getting it on stream. I am happy to write to her with details of what is or might be made available.

The hon. Lady asked about the CQC. As she knows, it is an independent regulator, but I will ensure we write to her about it. I thank her and other Members who contributed to the debate.

Question put and agreed to.