Health Bill (Fourth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

My amendment would prohibit ICBs from limiting patient choice of provider based on commercial interest or organisational type. That would safeguard against ideologically motivated directions, which can undermine patient choice. The Minister is a sensible person, but some of her detractors, and future Ministers, may not be. They may view choice and private sector provision as part of a grand conspiracy. We cannot provide them with the tools to undermine many years of progress. For that reason, I hope that Members will support the amendment. I look forward to hearing the Minister’s choice.

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

I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59.

The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing.

Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.

[Peter Prinsley]

Does the hon. Member recognise that there are circumstances in which independent provision within a district has the effect of disabling the NHS service? A pertinent example is the ophthalmology world. Services have become difficult to deliver in NHS hospitals because large numbers of NHS staff have chosen to work in the independent sector. That makes the comprehensive provision of a service in an eye department difficult, as the staff are all off operating on cataracts.

[Gregory Stafford]

I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.

[Dr Johnson]

When I met surgeons, they said that one reason they like working in elective independent sector hospitals is that they can do more operations on a given day. The shadow Secretary of State visited a provider of cataract treatment yesterday. It is able to perform more treatments on a given day, partly for organisational reasons. The NHS, which is quite frustrating for surgeons, could learn from that. Does my hon. Friend agree?

[Gregory Stafford]

My hon. Friend is absolutely correct. I do not want to go down the cataracts route, but she and the hon. Member for Bury St Edmunds and Stowmarket have both mentioned them. Clearly, cataracts are a relatively low-complexity, high-volume type of operation. My hon. Friend is absolutely right to say that some providers can do five or six operations per list, while other places are doing two or three. That is often about the private sector being able to move more quickly, which is obviously better for patients, as well as for clinicians, who want to do the surgery that they have trained for.

Unlike the hon. Member for Bury St Edmunds and Stowmarket, I think that competition can play an important role in driving improvement. When providers must attract and retain patients, they have a stronger incentive to deliver timely, high-quality services, and to innovate in how they provide care. In that sense, competition is not an end in itself but a means of improving outcomes and responsiveness for patients. If both sides of the Committee support clause 5, because we are interested in choice and competition, amendment 59 is the logical extension of that.

The amendment is also clear about where the new obligation choices would apply. It covers a range of out-of-hospital services, including diagnostics, audiology, hearing-aid care, dietetics, physiotherapy, ambulatory cardiac monitoring and so on. By clearly defining the services in scope, it provides a realistic and workable road map for implementation.

As I said, the amendment is not about ideology—I think we all agree about choice and competition—but about ensuring that patients receive timely care and have a meaningful choice about where that care is delivered. By fostering healthy competition, making full use of the capacity in the system and putting patients at the centre of the decision-making process, it offers a practical route to improving access and raising standards of care. For those reasons, I support it and commend it to the Committee.

[Karin Smyth]

I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. We almost went down a cataract rabbit hole, but I think the points were well made. I will outline the Government’s general approach to choice and then move on to the amendment.

I recognise that hon. Members from both sides of the Committee are committed to protecting and upholding patient choice in our system, as are the Government. That is why clause 5 introduces new duties that require the Secretary of State to promote

“the involvement of patients, and their carers and representatives”

in decisions relating to the prevention or diagnosis of their illness, and their care or treatment. That applies when the Secretary of State is exercising health functions.

The clause also requires the Secretary of State to

“act with a view to enabling patients to make choices”

about the health services provided to them. The Government are committed to involving patients and carers in decisions about their care. We know that supports a better experience of care and, in many cases, better outcomes. Furthermore, if they want to be, patients should be active participants in decisions about their own care, rather than passive recipients of services.

I appreciate the sentiment of the amendment in the name of the hon. Member for Sleaford and North Hykeham, but I do not think it is necessary. It turns a general duty into one with more prescriptive detail, which risks adding complexity. Details on service types and operational details currently sit in secondary legislation, which allows them to be updated and amended as services evolve. I reassure the hon. Member that we will protect and maintain all the existing rights and duties set out in the choice regulations.

In any future consideration of expanding patient choice, which this amendment requests, I hope the hon. Member would agree that we would need to build up and test the evidence base to ensure that any changes were effective and meaningful for patients, before legislative changes were made. I am not sure what problem the hon. Member is trying to solve.

The Government are committed to protecting patients’ rights to choose. It is absolutely right that the duty to involve them in decisions will remain a central principle of the new health system and that patients are empowered to make informed, meaningful choices. I believe that the clause, unamended, does just that. For that reason, I ask the hon. Member to withdraw the amendment, and I commend the clause to the Committee.

Question put, That the amendment be made.

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[Dr Johnson]

The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress—in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation.

I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that—not because they are not taking higher rates of tax, but because they are squeezing the economy.

There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is also a risk that prizes will be awarded on the basis of who shouts loudest. Certain charities will want the Government to focus on awarding innovations in cancer care, for example; some unions will want the Government to focus on awarding innovators who achieve greater equity in service delivery. There is little doubt that Ministers will have a tough time batting away lobbyists calling for more funding to incentivise this or that type of innovation.

Clause 6 also gives the Secretary of State the power to set up a committee to provide advice on awarding prizes. It is right that the Health Secretary should solicit expert advice when determining which trusts, teams or individuals deserve incentive payments, but does that require the power to set up what is effectively a whole new quango? The Government created more than 25 arm’s length bodies and advisory councils in their first six months. Does the Secretary of State require the power to pay members of the advisory committee when there are many experts in their field who can give their time charitably? I notice there is no requirement for any prize committee to include the chief scientific officer or representatives from ICBs. It is ultimately an unchecked spending power.

[Gregory Stafford]

What my hon. Friend describes is the real nub of the Bill. If we are to abolish NHS England and move most of its functions to the ICB level or to the Department of Health under a Secretary of State, it would be utter madness for us to, at best, move one set of bureaucrats from NHS England to the Department of Health and therefore gain no extra efficiency, or at worst, as seems to be the case in this clause, not only transfer the NHS England bureaucrats, but create a whole new set of bureaucrats and committees to continue the functions already performed under NHS England.

We need to understand whether the Bill is really about making our NHS more efficient by removing levels of bureaucracy, as was the stated intent of the Minister and the previous Secretary of State, or whether it is simply a political power grab where we keep all the bureaucrats and the inefficiency of the current system.

[Dr Johnson]

My hon. Friend, as ever, puts things very succinctly. Much of what is said about the Bill is different from what it seems to mean in practice. We have heard the Government talk about the decentralisation of power so decisions are made locally, but in the oral evidence session, even the union rep said that the Bill is more of a centralisation of power. I agree that creating new bureaucracy to replace old bureaucracy—particularly if that involves redundancies—does not help to save money or to make the system more efficient.

I tabled amendment 58 to make the duty on innovation more robust. It would make clause 6 specifically require the Secretary of State to promote innovation in the provision of services, ensure that innovations are spread and adopted across the NHS, tackle barriers to innovation and consider the wider economic benefits of innovation. That is important, because when we talk to people in the life sciences industry, they tell us that one of the biggest challenges is the roll-out of innovation. They can develop innovations in the UK, but it can take a long time to get them on to the shop floor, which is a disincentive to innovating in the United Kingdom. That process needs to move more quickly.

As currently drafted, the clause does not make it clear what innovation is for or whom it is meant to benefit. Amendment 58 would make it clear that innovation should be to benefit patients, no matter their location or socioeconomic status. I welcome the principle of keeping innovation on the statute book, but innovation is an organic process, and it does not begin in the Department of Health and Social Care or in NHS England—that is a fundamental principle that I think the Government fail to understand across many areas. Innovation begins with the frontline workers: the scientists, the technologists and the people who have ideas about better ways to care for patients. I am encouraged that the Minister understands that.

The Government’s vision for ICBs is that they will have more responsibility and more freedom to innovate—although we will discuss whether the legislation actually delivers that later in the Committee’s consideration—and I hope that vision extends to other areas of health policy. The clause is not disagreeable, but it must be made more robust. If Committee members agree, I hope they will support amendment 58.

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[Joe Robertson]

I thank my namesake for his intervention. I do not completely understand what he says, because the amendment refers to cultural barriers. He is absolutely right that we have to be careful when we mandate things, but the strength of the amendment is that it has a broad application and does not seek to mandate specific detail. I accept that it has more detail than the Bill, but its strength is that it gives some direction without being overly detailed. I again draw his attention to the fact that it asks the Secretary of State and the Department to identify and remove cultural barriers.

[Gregory Stafford]

I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham.

We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector—I know that Labour Members have antibodies against the private sector—or to university research functions? It is very unclear who the prizes will go to.

Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to

“work done at any time (including work before the commencement of this section).”

So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to.

Then the clause says that the Secretary of State may set up a committee. I have been in enough Bill Committees to know that civil servants do not write something into Bills unless they have an idea of what they want to do with it. I would be very interested to hear from the Minister what sort of committee it will be, how many people will be on it, how much remuneration they will receive and how they will establish themselves and fulfil the function that the Secretary of State gives them. If we do not know that, the proposal is so open-ended that I would have real concerns about letting it go forward in the manner in which it is currently written.

My hon. Friend the Member for Isle of Wight East suggested—I do not think he was joking—that the word “prize” made this sound like a game show. That is part of what we need to understand. Will the Secretary of State set up a competition in various areas of healthcare, technology, disease or treatment? Will they say, for example, “We want to find the best technology for dealing with cataracts”? Will a call go out for people to submit bids and say, “We have produced this amazing new laser treatment,” in order to win the prize? Or will it be entirely open-ended? Will people come into the Department of Health and Social Care to this new committee and say, “We have created this amazing piece of innovation—give us some money for having done so”? It is so unclear in the Bill. As I say, I am absolutely certain that the Minister knows the answer to those questions because this clause and subsection would not be in the Bill if she had no idea what she was hoping to achieve by them.

[Dr Johnson]

My hon. Friend is describing something a little like “Dragons’ Den”, which is a very good TV programme—perhaps it will be televised or livestreamed. How will the Government ensure that there is no conflict of interest?

[Gregory Stafford]

My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out—I will not say what that makes me.

What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham— I hope I am not misrepresenting her—is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of

“timely adoption and spread of clinically effective innovations”.

Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system.

By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for innovation to flourish, not one that shuts it down, as some Labour Members have suggested. Crucially, paragraph (d) of the amendment represents a significant and commendable commitment to fairness and inclusion by prioritising equal access to new technologies, medicines and models of care regardless of geography or socioeconomic background. It would help to tackle long-standing inequalities and move decisively towards ending the postcode lottery that we often see in care quality.

The focus of the amendment would ensure that innovation benefits all patients, not just those in the most advantaged areas. It would ensure that rural and coastal communities are aligned with the urban. As someone who represents a semi-rural seat, I see those inequalities in service delivery, quality of care and innovation. The large towns in my constituency receive far more money and get far better services than the surrounding villages.

I have many concerns about the clause as it currently stands, and I hope that the Minister will be able to clarify some of the Opposition’s questions. I entirely endorse amendment 58.

[Karin Smyth]

I am grateful to hon. Members for bringing this discussion to the Committee. We heard about the excitement in our constituencies around innovation—my hon. Friend the Member for Blaydon and Consett mentioned Newcastle University at the start and the hon. Member for Sleaford and North Hykeham mentioned her visit to Imperial College. Those visits are inspiring. Other universities and centres of excellence are available, but they made the case for why this is so important to the Government’s approach to innovation. I will talk about that and then turn to the amendment.

The Government are fully committed to innovation. It is absolutely central to our ambitious priorities to digitise health and care, support prevention and early diagnosis, and enable a shift to neighbourhood care, to growth in our economy, and to regaining our place in the world as a centre for innovation, which was lost under the Conservatives over those 14 years. That is why clause 6 places a clear duty on the Secretary of State to promote innovation in the provision of health services, including in how services are arranged and delivered.

The clause also incorporates the Secretary of State’s existing power to incentivise innovation and research through the payment of prizes, as we have discussed. That is a flexible tool that will allow him to stimulate breakthrough ideas and reward innovation across the life cycle, including an early-stage report.

On some issues that have been raised, the Conservative party knows that Ministers have to act reasonably as this transfers from NHS England, and we would obviously want to tailor a committee to the matter in question, including membership. The clause will allow that flexibility. The equivalent duty was on NHS England; I understand that it has not actually been used over the past five years, but it was previously suggested as a way of promoting innovation.

In practical terms, the Secretary of State already supports innovation in a number of ways, for example through the work of the Health Innovation Network, supporting workforce developments in schemes such as the clinical entrepreneur programme and providing funding support for developing and evaluating promising innovations.

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[Peter Prinsley]

As the Committee knows, my hon. Friend the Member for Worthing West (Dr Cooper) is one of the five medical doctors in the parliamentary Labour party. It is a great pleasure to move the amendment, which she tabled.

The amendment is about education and training. My hon. Friend would like us to consider whether there should be an additional subsection after proposed new subsection (1)(a), which is about ensuring that

“there are sufficient people with appropriate education and training to meet the workforce needs of the health service”.

My hon. Friend would like to include within that specific training about wider health determinants, which, as we discussed earlier this morning, consist of things like housing, air quality, occupation, and substance abuse—tobacco, alcohol and so on. Her opinion is that that needs to be specifically incorporated into the legislation.

[Gregory Stafford]

I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised.

I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good.

Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency.

Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world.

Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care.

I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.