Health Bill (Seventh sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

It is a pleasure to serve with you in the Chair, Dr Huq. I am moving this amendment on behalf of my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), who is the Chair of the Health and Social Care Committee. She designed the amendment to explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State.

The Liberal Democrats support clause 15 more broadly, and particularly the plans to involve affected patients, carers and representatives in planning and commissioning arrangements. Carers are a priority for our party, so it is really important to us that they have a meaningful say in the design and delivery of their care. I would be grateful if the Minister could elaborate on what that might look like in practice.

The amendment would tighten up the clause to make some of its provisions more explicit, so that we can be confident that anyone involved in an individual’s care has the ability to influence it in an appropriate way.

[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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[Helen Morgan]

I want to speak to amendment 63, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron). As hon. Members know, he has campaigned passionately and for a long time on the provision of radiotherapy. His amendment seeks to ensure that there is sufficient and equitable access to radiotherapy. Radiotherapy is required by half of all cancer patients, and it is incredibly cost-effective, but England has fewer radiotherapy machines than comparable European countries, and thousands of people have to travel long distances and over 45 minutes for their treatment, particularly in my hon. Friend’s Cumbria constituency, as he has noted on many occasions.

The Darzi review noted that radiotherapy services are on their knees. They have some of the longest waiting times for treatment and vast parts of the country are classed as radiotherapy deserts, because of lack of accessibility. Radiotherapy currently has the worst 62-day performance of all main cancer treatments, and if we are serious about ensuring that all cancer targets are met by 2029, then we need the infrastructure, people and equipment to deliver them.

Cancer cases are expected to rise 30% by 2040, meaning that radiotherapy centres must be able to keep pace. Importantly, radiotherapy can also be used at an earlier stage in treatment, potentially saving lives, saving money and meeting important waiting time targets. We really ought to be leading the way on this and keeping pace with our European counterparts so that no one is left without the treatment they so desperately need. I add my support to amendment 52, because we do need to build confidence in the reduction of waiting lists, and more transparency around reductions would be helpful.

[Gregory Stafford]

Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect.

We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences.

Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about resources. While I think that we all agree in this Committee that the NHS should be free at the point of use, one of the downsides of that is that patients rarely think about what the cost of their care contributes. I personally think that if people understood how much crutches or medicines cost, they would use them much more usefully. Plenty of times I have spoken to pharmacists in my constituency who tell me that once a patient has unfortunately died, their family then comes to the pharmacy with a sackload of drugs that have never been used. I think that if people understood the cost of those things, they would use them more effectively and with more caution.

This is not an isolated issue but indicative of a wider problem across the system. If we were to introduce firm timelines for provision, we would need to ensure that there is a robust process for recovery, reuse and proper management of that equipment. Therefore, while I am not supportive of amendment 35 or new clause 35, I ask the Government to consider how those proposals could be strengthened by embedding clear expectations about the return and reuse of that equipment so that public funds are used as effectively as possible.

I will now turn to the two amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham. Amendment 51 is important because, while I understand the Government’s intention in clause 16, as my hon. Friend has mentioned, her amendment will prevent any artificial delays in treatment by ensuring patients are seen as soon as clinically appropriate, rather than being required to wait a minimum period. It simply protects the principle that care should be based on medical need—which I think we would all agree on—rather than some administrative target. It helps avoid situations where waiting times are managed on paper rather than reduced in reality. That ultimately safeguards patient outcomes and timely access to care.

Moving on to amendment 52, I add my strong support to this amendment, because it goes to the heart of trust, transparency and patient safety in the health system. I have been speaking to constituents and individuals from across the country who have contacted me after a video I posted on my social media that contributed to the exposure of the removal of 351,000 patients from waiting lists in March of this year. The stories I have heard are deeply troubling. Those include patients who have waited years for potentially life-changing treatment only to receive notification late—or in some cases not at all—that they have been removed from the list. For many it came as a shock, while for some it came after months or years of uncertainty. This is not some trivial administrative matter. I would sum up the Minister, when responding to questions on this point, as: “Nothing to see here, this is what always happens.”

There has been such a significant jump over a period of two months that there has to be something going on here. The experiences of patients who have spoken to me about this suggest that that is happening. For those patients it is the difference between treatment and deterioration, between hope and abandonment. It is also undoubtedly affecting more vulnerable and less technologically savvy pockets of society, such as the elderly.

[Dr Johnson]

I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?

[Gregory Stafford]

My hon. Friend makes two important points. First, of course there has to be a validation process. There has been for a long time, and I do not think that anyone is objecting to that. However, it is a question of how it is being articulated and the people it is focused on. It is being focused on vulnerable people. I have anecdotal evidence from conversations with a significant number of people since I posted that social media video that they feel pressured into coming off the lists. It does not help that trusts have financial incentives to take people off lists. Earlier this month, the Health Service Journal said that three trusts are earning more than £1 million in having people taken off lists. There is no problem with giving trusts a financial reward to do due diligence and validate the lists, but there is potentially a perverse incentive for trusts to try to knock people off them.

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

I am not entirely clear why there is a problem with the financial incentive. People coming off lists that they have been on for a long, long time may well have a clinical condition that is changing. In my practice, I deal with the management of children with glue ear, who need to have grommets. From time to time, the condition fluctuates and the glue ear goes away.

Equally, the reason that we do a tonsillectomy is that people get recurrent acute tonsilitis, but it is actually quite a good idea for people to wait some time because often the recurrent acute tonsilitis simply settles down and they do not need their operation. Sometimes, when a patient comes into hospital for an operation on their tonsils and I ask them, “When did you last have an attack of tonsilitis?” they say, “I can’t remember.” We have to take account of the fact that the condition of the patient may fluctuate.

[Gregory Stafford]

The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list—I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason.

While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.

[Dr Johnson]

Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.

[Gregory Stafford]

My hon. Friend is absolutely right. The danger in this process—especially the multiple instances of chasing within a period of weeks, which sometimes happens—is that pressure is put on patients. Again, I know anecdotally from patients who have been speaking to me that those who are most compliant—if I can put it like that—and do not want to make a fuss are generally older and vulnerable people, who feel that they are perhaps causing an inconvenience to the system. They see people with, in their view, more serious conditions or a greater need. We need to be very careful about creating perverse incentives, financial or otherwise, to try to take some of those people off the list. As I say, the significant jump that we have seen deserves more scrutiny and inquiry, and that is why I am very supportive of my hon. Friend’s amendment.

We need to understand whether patients are being removed because they no longer require treatment, as the hon. Member for Bury St Edmunds and Stowmarket said—which is, of course, entirely appropriate—or just to improve targets, present an improved picture of waiting lists, and unlock the financial benefits tied to performance metrics. There is a troubling echo here. We saw similar practices in the 2000s when patients were removed or reclassified in ways that reduced waiting list numbers without genuinely improving access to care; it damaged confidence in the system then and it risks doing so now. What concerns me most is that we may be repeating that pattern. If the Government find they cannot meet their waiting list targets, there is a real danger that the pressure to do so will translate into decisions that, intentionally or not, compromise patient safety and fairness.

[Sojan Joseph (Ashford) (Lab)]

We are in 2026. Social media and the media scrutinise everything that we do. Will the hon. Member confirm if there has been any report in the media that somebody, anywhere in the country, has had their condition made worse, or died, or did not get treatment?

[Gregory Stafford]

There have been a number of reports of situations where people have not received care and have died because of that, so I do not see the hon. Member’s point. I think that, with amendment 52, my hon. Friend the Member for Sleaford and North Hykeham is trying to ensure that when the statistics are published, we can scrutinise the reasons behind them. The hon. Member for Ashford may be entirely right; let us imagine that is the case, and there is no gamifying or pressure going on. Why not allow the public to see that? Why not put to bed the HSJ stories that say there is something fishy going on? He should welcome that level of transparency and scrutiny to back up his argument if he is correct.

[Dr Johnson]

The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.

[Gregory Stafford]

My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar.

I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved.

If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.

[Karin Smyth]

There are a number of amendments in the group. Amendment 35 was not moved but as the hon. Member for Farnham and Bordon spoke to it, I will comment on that amendment, which is in the name of my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). Community equipment and wheelchair services are really important to us and—to allay the concerns of the hon. Member for Farnham and Bordon—that is why the medium-term planning framework requires that, from this year, all ICBs and community health services must actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. I assure the Committee that we will hold the ICBs for their performance. The community health services situation report has a specific monitoring line, covering children and young people and covering adults, for the wheelchair, orthotics, prosthetics and equipment category. We intend to continue that work following NHS England’s abolition. Consistent national standards will help us to identify the best and the weakest-performing areas, to identify what improvements need to be made and to tackle the longest waits.

Amendment 52 was tabled by the hon. Member for Sleaford and North Hykeham. We are committed to ensuring that all patients receive the NHS care they need in a timely manner, and I recognise the importance that Committee members have placed on that matter. The NHS constitution sets out that patients should start consultant-led treatment within 18 weeks of referral, and it is imperative that the system continues to work towards returning to and then upholding that standard.

I listened with great care to the comments from Members on the Opposition Benches, but I was here—as were you, Dr Huq—during the last couple of Parliaments; I was here as waiting lists rose and rose after 2012, under the previous Government’s stewardship, until they reached 4 million people, all waiting an inordinate amount of time. That Government had no kind of approach to reducing the numbers; they were quite content to have 4 million people on waiting lists, and to never bring forward measures to change that. They were quite content not to challenge NHS England or trust boards about why people across the country in all our constituencies were languishing on those lists. We are determined to resolve that situation.

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[Dr Danny Chambers (Winchester) (LD)]

We have a few concerns about the clause in general, especially about the removal of local authority and primary care representation on the ICB. Some ICBs are already stepping back from joint commissioning arrangements with social care and the health and wellbeing boards, and it is vital that social care has a seat at the table. We have talked about this extensively in many Committees and in the Chamber, but the Liberal Democrats have been emphatic that we cannot solve any of the problems in the NHS without solving social care. At any given point, our hospital in Winchester certainly has 160 people in it who are well enough or would be better cared for in the community with a social care package; instead, they are stuck in a hospital, obviously affecting flow through the whole hospital and even affecting A&E waiting times.

Combined with the changes to the pooled budgets that will affect the better care fund, we are seriously concerned that the Bill is increasingly separating the NHS and social care just at a time when the service and experts are screaming out for greater integration and collaborative working. We discussed GPs this morning. They have long-standing concerns about getting their voice heard, given their unique place in the health system. They are the front gate to the NHS and they have the most patient contact of any NHS service. Removing the duty seems to be a step in the wrong direction in that regard.

Finally, the change will leave in limbo areas such as Hampshire that do not yet have a fully functional mayoral authority—our elections will be in the next couple of years. There has not yet been sufficient clarity about what the interim arrangements will be.

[Gregory Stafford]

The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with or includes the whole or any part of the ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates.

The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities.

Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care.

For as long as I can remember, Governments of all colours have talked about bringing health and social care together. Some have been more successful at that than others, but there should be agreement across the House that much more needs to be done. With this clause, the Government seem to be taking at least one step back—I would say numerous steps—from trying to bring health and social care together. Like my hon. Friend the Member for Sleaford and North Hykeham, I watched the Health and Social Care Committee’s discussions with the Minister for Care yesterday, and I too cannot fathom why the Government are doing it. I hope that it is an oversight and that, once the Minister goes away and reflects on it, she will look to table some amendments further down the line—I am sure that she will vote against ours today—so that we can bring these matters back.

I am especially concerned about the removal of local authority representation. We are effectively asking local authorities to continue to deliver vital services while removing their voice in the room where strategic decisions about health and social care are made. That raises a fundamental question about how the integration is intended to work in practice. There is also a broader concern about the direction of travel. We are moving away from place-based representation towards a model that places greater emphasis on these mayoral structures, yet the legislation is not prescriptive about who the mayors appoint, and colleagues within and without this Committee have already raised concerns that there is a gap in the understanding at the centre about how local authorities operate in practice.

That brings me to the point raised by my hon. Friend the Member for Sleaford and North Hykeham and the hon. Member for Winchester. I apologise; the Minister said that she did not want a geographic tour of our constituencies, but I am afraid that she will get one now. Part of my constituency sits in Hampshire in the Hampshire and Isle of Wight ICB, and as the hon. Member for Winchester said, we may or may not have mayoral elections in a year’s time. Hampshire county council has launched a judicial review against the proposed local government reorganisation; if that is successful, or even if it delays the process, this Bill will come into effect without our having a mayor, and there will be no representation for anybody on this board. We need clarity from the Minister on who will represent the people on the board if there is no mayoral authority. I would say that local authorities—Hampshire county council in this case—should remain on that board, at least until there is a mayoral authority.

[Dr Johnson]

Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.

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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.