Health Bill (Thirteenth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

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

I hesitate to intervene on the hon. Gentleman, because he seems to be straying into the next grouping and I do not want to encourage him down that route, but now that he has raised it, I share his concern. I do not know what it is like in his area, but the ICB areas that local branches of healthwatch will be absorbed into are even larger than counties. In my area, Surrey and Sussex make up three administrative counties. That is an even larger area. The provisions are clearly not the solution to the problem that the hon. Gentleman is outlining.

[Dave Robertson]

In isolation, that criticism would be legitimate, but, alongside other changes being introduced, there are ways to mitigate that problem.

I am concerned that local healthwatch branches are not truly local. The healthwatch in Staffordshire has not held an event in my constituency for a number of years. I think its last three events were just volunteer fairs to get more volunteers involved. That is not to say that there are not significant numbers of people there who work very hard to support people in their engagement with the health service, but geographic changeability is real. On a national scale, Healthwatch England has a huge role to play.

--- Later in debate ---

[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.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship again, Ms Lewell. I think right hon. and hon. Members will be disappointed to know I am not going to speak too long on this, but they need not worry: in the next grouping, usual service will resume.

I want to pick up a few points on the abolition of national Healthwatch. When we took evidence from Sarah Woolnough of the King’s Fund, I asked her a fairly open-ended question about when she gave evidence at the Health and Social Care Select Committee. I put it to her that she

“seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.]

She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied:

“Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 16, Q24.]

We already know from the evidence that we received, unprompted, from National Voices and the King’s Fund that the abolition of NHS England will not solve the problems that the Minister, the Government and the Department think are there, and indeed it could be done in a different way.

I listened closely to the hon. Member for Lichfield. He seemed to be presenting a number of problems, but the solution that the Government have come up with does not hold water. As right hon. and hon. Friends have said, the removal of Healthwatch England and the introduction of a director for patient experience simply does not work because the independence—which is so fundamental to the HSSIB that we talked about— of local healthwatches, which we will talk about, and of Healthwatch England is fundamental to the ability of that organisation to do its job.

In a previous career I worked for the Getting It Right First Time programme in the NHS. When that programme first started, it sat outside the structures of what was then NHS Improvement, latterly NHS England. At that point we could make recommendations to the NHS— I do not mean this flippantly —in a way that was unrestricted. As soon as we were brought into NHS England, into a governmental structure, the recommendations that we put forward were looked at and scrutinised and we were told often, “We do not have the money to afford that”, or, “That is not in our plan.” And that is precisely what will happen if recommendations are put through the director of patient experience. As others have said, when this director of patient experience arrives at a Select Committee, he or she will be there to represent and defend the Department and Ministers, understandably, because that is who he or she will work for. They will not be able to stand up, go on television or the radio, do the broadcast interviews or make representations, because they will be a creature of the system rather than a scrutineer of the system and an advocate for patients. That is a fundamental problem, and while I accept that there may be ways to improve Healthwatch England, as Members have outlined, this simply will not do it.

--- Later in debate ---

[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 Chambers]

New clauses 3 to 5 are related to the publication of risk assessments of contracts between NHS organisations and suppliers based outside the UK. They would place a duty on the Secretary of State to prioritise domestic, UK-based suppliers in the case of technology systems and contracts involving the handling of NHS patient data, and place restrictions on the signing of such contracts with non-UK-based suppliers. New clause 5 would require the Government to publish an NHS digital sovereignty strategy setting out how they intend to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

We had a Westminster Hall debate on this subject recently. The lack of transparency in how some contracts are awarded is one of the central concerns about Palantir’s involvement with the NHS. We are particularly concerned about the national security considerations of offshoring the whole of our nation’s health data to any foreign company, which makes us vulnerable to political and economic changes in other countries, but especially to companies of questionable integrity in an increasingly authoritarian jurisdiction with little respect for privacy and sovereignty. We should all be worried that our health data has been so closely linked with such an organisation, which has shown itself all too eager to work closely with Donald Trump’s Administration. We know that his Immigration and Customs Enforcement agency has been using health data to identify people’s immigration status, and there is a lot of concern that people are not coming forward for medical treatment as a result. Doctors and patients have already voted with their feet and shown that they do not trust Palantir and its system for this very reason, which is also a key reason for the limited uptake of the federated data platform so far.

As such, we have tabled various new clauses to try to address those concerns, to ensure that they do not plague the single patient record, which we absolutely support and want to help the Government to deliver, along with any other vital technology or data system. New clause 3 would ensure that a risk assessment is conducted of all non-UK tech and data suppliers, with particular regard for national security. It is centrally important that doctors and patients trust the systems that hold their health data and that, as a country, we trust them to be safe and secure. We should not trust rogue actors with our nation’s health information. New clause 5 deals with how we mitigate that risk. It would require the Government to publish an NHS digital sovereignty strategy, setting out how they intend to address the risks of foreign interference and reliance on foreign technologies.

Our potential answer to both those questions lies in new clause 4, which would prioritise domestic suppliers that handle sensitive or confidential NHS data. We recognise that that will not always be possible, but where domestic capability does not exist and it is therefore necessary to work with foreign suppliers, to ensure the transparency and effective oversight of a contract with a foreign supplier, it must be brought before Parliament. Should a contract be signed with a non-UK supplier, it would also be subject to consultation with patient groups, national security experts and staff unions to make sure that the system is onside. If it is not, uptake of it will be stunted, as we have seen with the federated data platform.

[Gregory Stafford]

Obviously, I have sympathy for what the hon. Member is trying to achieve—ensuring that our data systems are free from potential hacking by either state or non-state actors is very important—but I cannot see anything in new clause 4 about the size of contracts. Does his suggestion relate to any contract, however small, that was given to a non-UK-based company? It is not clear what he means by a non-United Kingdom company. Is that one that is headquartered here, one that is listed on our stock exchange, or one that has a CEO who is a British citizen? I am not quite sure what he means by a UK-based company, but if we can define an outside-based one, is he saying that any contract of any size given to such a company will have to come to Parliament?

[Dr Chambers]

The size of the contract would be pretty much irrelevant; what matters is the implications arising from the contract being signed. Does a contract potentially compromise our data sovereignty? Alternatively, if a contract failed for any reason, whether it was because of the action of a state actor or a non-state actor, would the service continue to function?

Health Bill (Thirteenth sitting)

Gregory Stafford Excerpts

Tuesday 7th July 2026 Public Bill Committees

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

I hesitate to intervene on the hon. Gentleman, because he seems to be straying into the next grouping and I do not want to encourage him down that route, but now that he has raised it, I share his concern. I do not know what it is like in his area, but the ICB areas that local branches of healthwatch will be absorbed into are even larger than counties. In my area, Surrey and Sussex make up three administrative counties. That is an even larger area. The provisions are clearly not the solution to the problem that the hon. Gentleman is outlining.

[Dave Robertson]

In isolation, that criticism would be legitimate, but, alongside other changes being introduced, there are ways to mitigate that problem.

I am concerned that local healthwatch branches are not truly local. The healthwatch in Staffordshire has not held an event in my constituency for a number of years. I think its last three events were just volunteer fairs to get more volunteers involved. That is not to say that there are not significant numbers of people there who work very hard to support people in their engagement with the health service, but geographic changeability is real. On a national scale, Healthwatch England has a huge role to play.

--- Later in debate ---

[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.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship again, Ms Lewell. I think right hon. and hon. Members will be disappointed to know I am not going to speak too long on this, but they need not worry: in the next grouping, usual service will resume.

I want to pick up a few points on the abolition of national Healthwatch. When we took evidence from Sarah Woolnough of the King’s Fund, I asked her a fairly open-ended question about when she gave evidence at the Health and Social Care Select Committee. I put it to her that she

“seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.]

She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied:

“Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 16, Q24.]

We already know from the evidence that we received, unprompted, from National Voices and the King’s Fund that the abolition of NHS England will not solve the problems that the Minister, the Government and the Department think are there, and indeed it could be done in a different way.

I listened closely to the hon. Member for Lichfield. He seemed to be presenting a number of problems, but the solution that the Government have come up with does not hold water. As right hon. and hon. Friends have said, the removal of Healthwatch England and the introduction of a director for patient experience simply does not work because the independence—which is so fundamental to the HSSIB that we talked about— of local healthwatches, which we will talk about, and of Healthwatch England is fundamental to the ability of that organisation to do its job.

In a previous career I worked for the Getting It Right First Time programme in the NHS. When that programme first started, it sat outside the structures of what was then NHS Improvement, latterly NHS England. At that point we could make recommendations to the NHS— I do not mean this flippantly —in a way that was unrestricted. As soon as we were brought into NHS England, into a governmental structure, the recommendations that we put forward were looked at and scrutinised and we were told often, “We do not have the money to afford that”, or, “That is not in our plan.” And that is precisely what will happen if recommendations are put through the director of patient experience. As others have said, when this director of patient experience arrives at a Select Committee, he or she will be there to represent and defend the Department and Ministers, understandably, because that is who he or she will work for. They will not be able to stand up, go on television or the radio, do the broadcast interviews or make representations, because they will be a creature of the system rather than a scrutineer of the system and an advocate for patients. That is a fundamental problem, and while I accept that there may be ways to improve Healthwatch England, as Members have outlined, this simply will not do it.

--- Later in debate ---

[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 Chambers]

New clauses 3 to 5 are related to the publication of risk assessments of contracts between NHS organisations and suppliers based outside the UK. They would place a duty on the Secretary of State to prioritise domestic, UK-based suppliers in the case of technology systems and contracts involving the handling of NHS patient data, and place restrictions on the signing of such contracts with non-UK-based suppliers. New clause 5 would require the Government to publish an NHS digital sovereignty strategy setting out how they intend to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

We had a Westminster Hall debate on this subject recently. The lack of transparency in how some contracts are awarded is one of the central concerns about Palantir’s involvement with the NHS. We are particularly concerned about the national security considerations of offshoring the whole of our nation’s health data to any foreign company, which makes us vulnerable to political and economic changes in other countries, but especially to companies of questionable integrity in an increasingly authoritarian jurisdiction with little respect for privacy and sovereignty. We should all be worried that our health data has been so closely linked with such an organisation, which has shown itself all too eager to work closely with Donald Trump’s Administration. We know that his Immigration and Customs Enforcement agency has been using health data to identify people’s immigration status, and there is a lot of concern that people are not coming forward for medical treatment as a result. Doctors and patients have already voted with their feet and shown that they do not trust Palantir and its system for this very reason, which is also a key reason for the limited uptake of the federated data platform so far.

As such, we have tabled various new clauses to try to address those concerns, to ensure that they do not plague the single patient record, which we absolutely support and want to help the Government to deliver, along with any other vital technology or data system. New clause 3 would ensure that a risk assessment is conducted of all non-UK tech and data suppliers, with particular regard for national security. It is centrally important that doctors and patients trust the systems that hold their health data and that, as a country, we trust them to be safe and secure. We should not trust rogue actors with our nation’s health information. New clause 5 deals with how we mitigate that risk. It would require the Government to publish an NHS digital sovereignty strategy, setting out how they intend to address the risks of foreign interference and reliance on foreign technologies.

Our potential answer to both those questions lies in new clause 4, which would prioritise domestic suppliers that handle sensitive or confidential NHS data. We recognise that that will not always be possible, but where domestic capability does not exist and it is therefore necessary to work with foreign suppliers, to ensure the transparency and effective oversight of a contract with a foreign supplier, it must be brought before Parliament. Should a contract be signed with a non-UK supplier, it would also be subject to consultation with patient groups, national security experts and staff unions to make sure that the system is onside. If it is not, uptake of it will be stunted, as we have seen with the federated data platform.

[Gregory Stafford]

Obviously, I have sympathy for what the hon. Member is trying to achieve—ensuring that our data systems are free from potential hacking by either state or non-state actors is very important—but I cannot see anything in new clause 4 about the size of contracts. Does his suggestion relate to any contract, however small, that was given to a non-UK-based company? It is not clear what he means by a non-United Kingdom company. Is that one that is headquartered here, one that is listed on our stock exchange, or one that has a CEO who is a British citizen? I am not quite sure what he means by a UK-based company, but if we can define an outside-based one, is he saying that any contract of any size given to such a company will have to come to Parliament?

[Dr Chambers]

The size of the contract would be pretty much irrelevant; what matters is the implications arising from the contract being signed. Does a contract potentially compromise our data sovereignty? Alternatively, if a contract failed for any reason, whether it was because of the action of a state actor or a non-state actor, would the service continue to function?

Health Bill (Twelfth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

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

I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals.

In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website.

The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short term.

The requirement would also limit clinical judgment. A patient may have a particular set of symptoms or conditions or be on a particular set of medications that mean that the doctor or clinician looking after them needs to vary from the guidance. NICE intends the guidance to be just that, guidance, not law, but if guidance becomes law, the doctor or clinician will not be able to vary from it. My concern is that the amendment would be overly restrictive. Although it is well-intentioned, and it is a good idea to ensure that guidance is followed where possible, it would be too rigid. I therefore do not support the amendment, while continuing to support the aim of better treatment.

Clause 58 amends the Health and Social Care Act 2012 by inserting a new section 237(8A), which states:

“Provision made under subsection (8)(b) may include provision about the period within which a recommendation is to be complied with (including provision for the period to be determined by NICE or the Secretary of State).”

At the moment, NICE technology appraisals check the value of a product, whether a drug or a technology, then NICE makes a recommendation. It is then supposed to be the case that within 90 days or three months, ICBs ensure that those technologies are available, but we know that in the real world it can take longer—sometimes 12 to 24 months—for some things to become available. That could be because technology needs to be bought or training needs to take place.

I understand why there could be variation and why the Government may want to consider varying the period, but it is not clear why they need to do so in legislation, because it is possible now to vary the period on an individual basis. For example, the Government imposed a five-year limit rather than a 90-day limit for the introduction of hybrid closed loop systems for diabetes, because that is a technology that requires proper training and they were never going to be rolled out in such a short period. The other product that notably has a longer time is tirzepatide, which is more commonly known as Mounjaro. I suspect that that is down to cost, but I am not certain.

Why do the Government want to change the 90 days? The patient’s right to treatment with a NICE-approved product within 90 days will become a right to getting the product when the Secretary of State says so. That is not really a right at all, because it does not give patients any comfort and may mean that products are received later. The Government have put this power into the Bill, so they clearly intend to use it. Given that they have the power to vary on an individual basis, why do they need the power to vary on a blanket basis? Do they intend to extend the 90-day limit across the board? If so, by how much? There is no ceiling. The Committee received written evidence from Henry Burkitt from Oxygen Strategy, who made the point that there is no ceiling, no maximum time, no duty to consult and no necessity for the Secretary of State or NICE to give reasons why a delay has occurred.

The life sciences industry talks about how it wants products to be rolled out. When it is investing and doing research in this country, it wants to see new products rolled out as quickly as possible once they have been approved, and the clause is a sign that roll-out might be delayed. I understand that the Government might want to be able to vary on certain products, but they already can; why do they want to vary on a more general basis? It is presumably to slow down roll-outs, but by how much?

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

On a point of order, Sir Roger. I am a parliamentary patron and champion of Action on ME. I feel I ought to put that on the record, as we have an amendment on ME.

[The Chair]

Thank you. That is a matter of record. Any other takers? No.

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[Dr Johnson]

The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear.

Dr Benneyworth made it clear to the Committee that

“we are still working in a culture of fear”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]

and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that

“people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”.—[Official Report, 1 June 2026; Vol. 786, c. 915.]

[Gregory Stafford]

As my hon. Friend said earlier, the problem comes when this new body within the CQC has to investigate the CQC. In the oral evidence session, I asked Dr Dash what would happen if the problem was CQC, and she gave what is probably the most extraordinary answer out of the many extraordinary answers she gave. It is worth repeating:

“Well, we then have to deal with that as a problem. That is the same as saying, ‘What happens if the problem is this organisation or that one?’…What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]

She did not answer my question at all. In fact, she entirely sidestepped it. How can we have confidence in the Government’s proposal if the architect of the procedure cannot answer the most basic questions about the investigatory framework?

[Dr Johnson]

My hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer.

It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”—according to the impact assessment—of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State.

The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the Government have produced, but I do not think it is enough.

We have also tabled some amendments, including new clause 42, which would ensure that there is some operational independence in the choice of investigation by requiring the Secretary of State to adequately fund and resource patient safety investigations, including some of those initiated by this unit within the CQC.

Amendment 55 is a probing amendment. We noticed that much of the legislation has been lifted and shifted from the previous Act, but some things are missing, including national security grounds. We want to understand why that ground has not been included in the Bill. Very occasionally, health events have national security connotations—the Salisbury chemical weapons attack, for example. In such circumstances, restrictions on investigatory capabilities could be necessary. I do not know—I was just interested in why the Government have chosen deliberately to remove that particular clause.

Amendment 56 would allow

“the Commission to recoup charges in excess of the costs incurred in providing assistance.”

The HSSIB programme is world-leading. People look at it from across the globe, and some have asked for training or information on it, for which we have been able not just to recoup costs but actually charge. I do not understand why the Government have removed that provision, because it is an opportunity for them to get extra money without taking it off people in taxes. Do the Government want HSSIB to lose its international standing, or do they want British taxpayers to subsidise training for foreign health services? It is not clear. I would be grateful if the Minister explained that.

We need to come back to what the hon. Member for Bury St Edmunds and Stowmarket said at the beginning: what is the purpose? The purpose is patient safety.

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[Helen Morgan]

I declare an interest as a member of the all-party parliamentary group on patient safety, which is opposed to the changes to HSSIB proposed in the Bill. Over the last couple of weeks, we have been reminded why we need an appropriate safety landscape when things go wrong. We have had the Donna Ockenden review into Nottingham maternity services. We have had Baroness Amos’s national review into the picture following a range of maternity scandals across the country. Yesterday evening, I attended the debate on the regulations to compensate victims of the infected blood scandal. Safety is at the top of all our minds at the moment, as it should always be.

Something that has come across very strongly from Members of all parties, on both sides of the House, is that culture is critical to ensuring that those types of issues—the huge scandals—never happen again. Indeed, smaller scandals must never happen again, because people need to be free. Staff in particular need to have the confidence that, if they report concerns about the way they operate, they will be safe to do so without jeopardising the rest of their career, and that those concerns will be acted on and the lessons learned. Everybody here wants to achieve that. I do not think anybody is arguing about the fundamental principle that, when there are concerns, they need to be raised in a safe place and that the lessons from those concerns need to be learned.

That is why I share the lack of understanding of the shadow Minister, the hon. Member for Sleaford and North Hykeham, about why rolling HSSIB into the CQC will change that culture, because the CQC is a regulatory body and HSSIB is an investigatory one. Their missions are fundamentally different. Putting them together compromises the independent investigation element in a way that is very difficult to overcome. We were told in the evidence to the Bill Committee by HSSIB’s chief executive that it is often told, “We tell you this; we wouldn’t tell a regulatory body.” It is clear that this perception of safety is critical to the way in which people interact with HSSIB.

We also heard in evidence to the Committee that the CQC warned that, as it stands, the Bill could leave it fighting against itself in the High Court. We could get a scenario where the regulatory arm of the CQC sought access to HSSIB’s confidential investigation reports, while HSSIB, the investigative branch, tried to keep them secret to protect its independence. That is not a situation anyone wants to end up in, and I am sure that is not the intention of this clause.

I think the shadow Minister has already made this point, so I will not labour it, but it is also important that the investigatory body must be able to examine the regulatory frameworks, commissioning decisions and oversight arrangements without institutional conflict. When I look back, for example, at the scandal that unfolded at Shrewsbury and Telford hospital NHS Trust over the maternity failings, I see that the CQC had given that trust a good rating during the course of all those terrible things going wrong. The CQC’s process clearly failed in that situation. It is difficult to imagine an arm of the CQC turning around in that scenario and saying that the CQC got its own assessment wrong. If it had tried to do that, it is difficult to imagine how that might have played out and that people might have had confidence in raising that problem.

I am also concerned about this because, as the Minister has alluded to, the CQC has faced significant criticism and publicly admitted that it has failed to carry out its functions to the best of its abilities over recent years. Although I welcome the Minister’s assurance that the transfer would happen only once the CQC was in a better place, the CQC might—again—be part of the problem in some instances, and HSSIB must be able to point to that where appropriate.

Lib Dem amendment 5 attempts to introduce the principle that, if this must happen, there needs to be a firewall in the CQC to keep HSSIB operationally independent. To achieve that, the amendment proposes to insert into the process a committee that is operationally independent of—with a majority of people who are not on—the CQC. Opposition new clause 42 seeks to do the same thing. I would be open to any suggestions that the Minister might make to reassure us that HSSIB will continue to be operationally independent, for all the good reasons that hon. Members have outlined.

[Gregory Stafford]

Before I address the clauses, I say for the record that 21 years ago this morning, 52 people were murdered and 784 injured by Islamist terrorists in London. I pay tribute to all the medical professionals who treated those people in such difficult circumstances.

I will speak to clauses 59 to 63 together because they all concern one of the most significant structural changes proposed in the Bill: the abolition of the Health Services Safety Investigations Body as an independent statutory organisation, and the transfer of its functions to the Care Quality Commission. At first glance, that may appear a relatively modest machinery-of-government change. The Minister argues that HSSIB’s functions will continue, its statutory safe-space protections will remain and operational independence will somehow be preserved. However, when one examines the evidence presented to the Committee, and that given to the Health and Social Care Committee, of which I am a member, it becomes increasingly difficult to identify the problem that this merger is intended to solve. Instead, what emerges is a remarkable degree of consensus among those with the greatest expertise in patient safety that this proposal carries significant risks while offering little measurable benefit.

The question before us is therefore not whether HSSIB’s statutory functions can be transferred to another organisation, but whether Parliament should abolish an institution that it deliberately created to be independent. That distinction matters. Across public life, we recognise that effective scrutiny depends on institutional independence. Government expenditure is examined independently by the National Audit Office, citizens complain to independent ombudsmen rather than to the organisations about which they are complaining, air accidents are investigated independently by the Civil Aviation Authority, and rail accidents are investigated independently of the regulator. In each case, Parliament has recognised that organisations charged with investigating failures should not also be responsible for regulating, inspecting or enforcing against those they investigate. Healthcare should be no different.

Indeed, if anything, healthcare should demand an even greater degree of independence. Learning from failure depends on the confidence of patients, clinicians and families that they can speak openly and without fear that the information that they provide will later be used for regulatory or enforcement purposes. That is precisely why HSSIB was created. Its purpose was never to attribute blame but to understand why systems fail, identify the underlying causes of patient harm and ensure that lessons are learned before similar tragedies occur again. That philosophy represented a deliberate shift away from a culture of blame and towards one of learning. It was modelled consciously on the air accidents investigation branch, whose success over many decades has demonstrated that independent, no-blame investigations produce better safety outcomes than investigations driven primarily by enforcement.

It is therefore difficult to understand why the Government now seek to move away from the model that other safety-critical industries continue to regard as fundamental. Clause 59 would abolish that independent body and transfer its functions to the Care Quality Commission. In doing so, it would bring together two organisations with fundamentally different statutory purposes, different powers and, perhaps most importantly, different cultures. HSSIB investigates and the CQC regulates. One exists to ask why the system failed; the other exists to ask whether the organisation complied with required standards—those are not the same questions. Nor do HSSIB and CQC require the same relationship with those from whom evidence is obtained. An investigation depends on trust; a regulator depends on compliance. An investigator encourages candour; a regulator necessarily retains enforcement powers. The different roles are not a weakness of the system; they are precisely why Parliament chose to establish separate organisations.

I would be grateful, therefore, if the Minister could explain what assessment has been made of the impact on public confidence of the investigator and the regulator becoming part of the same statutory organisation. More specifically, what assessment has been made of the likely effect on clinicians’ willingness to speak openly if the organisation receiving confidential evidence also contains the regulator responsible for inspecting and enforcing standards? That concern has been expressed not only by the Opposition, but repeatedly by independent experts—and indeed, we just heard the hon. Member for Lewisham East asking similar questions.

Even the Care Quality Commission has expressed reservations. Evidence that it submitted to the Health and Social Care Committee earlier this year acknowledged that a lack of clarity remains regarding the respective roles of HSSIB and the CQC. Rather than resolving that uncertainty, the proposed merger risks deepening it. The CQC warned that preserving an effective separation between its investigatory and regulatory functions would be essential if confidence in HSSIB’s safe space were to be maintained, and it recognised the genuine risk of perceived conflicts of interest if those functions become blurred.

I think that should give the Committee pause for thought. When the organisation receiving the additional responsibilities is itself warning about the difficulty of maintaining the boundaries, we should listen very carefully. If the CQC believes that the risks exist before the merger has even taken place, what confidence can Ministers offer that those risks will somehow disappear afterwards? Similarly, the all-party parliamentary group on patient safety, of which I am a member, has expressed concern that HSSIB should remain institutionally independent so that its evidence-based recommendations can continue to command confidence across the health system.

Such concerns, as I said, are not confined to Parliament, nor are they confined to one political party. They are shared by patient safety organisations, healthcare professionals and those directly involved in investigating serious incidents. During our oral evidence sessions, I put a straightforward question to Dr Penny Dash. I observed that I could find almost no one apart from her and the Department who believed that moving HSSIB into the CQC was the right course of action. That was not intended as some sort of rhetorical flourish; it reflected the evidence before us. Former Secretaries of State, patient safety experts, independent investigators and numerous professional organisations have all questioned the proposal.

Despite the breadth of concern, the Government have not produced compelling evidence that HSSIB, as presently constituted, is failing. Nor have they demonstrated that the separation between investigation and regulation is itself creating harm. Instead, Ministers have repeatedly assured us that HSSIB’s operational independence will remain, that safe space protections will remain and that independent investigations will remain. If that is indeed the Government’s position, an obvious question follows: if HSSIB will continue to operate independently, if its investigations will continue to be conducted independently and if its statutory protections will remain intact, why is it necessary to abolish the independent organisation at all?

That question goes to the heart of clauses 59 to 63, and throughout the evidence presented to the Committee, I have heard no convincing answer. The Government ask Parliament to believe that everything that makes HSSIB valuable will continue unchanged, but at the same time, they ask Parliament to dismantle the very institutional structure deliberately designed to protect those characteristics. That is not merely an administrative contradiction, but a constitutional one. If institutional independence genuinely matters, it should be preserved. If institutional independence does not matter, Ministers should explain why Parliament was wrong to establish it in the first place.

That question of necessity leads directly to the Government’s principal justifications for clauses 59 to 63, the Dash review. The Government have repeatedly relied on that review as the intellectual basis for abolishing HSSIB as the independent body, yet when one examines the report and the evidence given by its author to this Committee, the case becomes increasingly difficult to sustain.

Without doubt, the review identifies a genuine problem: it concludes that the patient safety landscape has become crowded and in places confusing. Dr Dash told the Committee that she had identified more than 150 organisations operating across the wider patient safety landscape, and that clinicians were spending considerable time responding to different organisations, requesting information, completing forms and participating in overlapping reviews. She said that the system had become “busy and confusing”, and that that was distracting clinicians from improving the quality of care.

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[Joe Robertson (Isle of Wight East) (Con)]

My hon. Friend is making a comprehensive speech and getting to the nub of all the relevant points. He talks about the system failing; to me, that is the absolute nub. The CQC is absolutely part of the system and of the establishment. If anyone is put off from making a complaint to the CQC when they think the CQC may be to blame, how on earth can the functions currently exercised by HSSIB continue in any effective way?

[Gregory Stafford]

My hon. Friend makes several key points, and he is absolutely right: what problem are the Government trying to solve here? If we believe in independence, believe in an investigatory body and believe it is working well—and it demonstrably is working well—why on earth would we change it? That goes to a further point: these clauses not only potentially provide for a transfer of HSSIB into CQC but add risk and failure in that procedure.

My hon. Friend asks how we can be confident that the system is going to work if a patient or a clinician does not want to put their head above the parapet because they are frightened that there will be regulatory consequence. That is a fundamental problem with the Government’s proposal. As I have said several times in this speech, we have not had the answer to that and no answer seems to be forthcoming. I may touch on that in a bit more detail in a moment.

My right hon. Friend the Member for Godalming and Ash was clear on this topic when he gave evidence to the Committee:

“My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 29, Q52.]

That is the problem that HSSIB was created to address and why I struggle with the Government’s argument. If the problem is that the NHS does not learn lessons effectively, the answer should be to strengthen the organisation designed specifically to help it to learn, not to weaken the independence of that organisation. My right hon. Friend the Member for Godalming and Ash identified the precise part of the system that remains broken. He said:

“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.]

That is the crucial point. The Government’s justification for the merger appears to be based on a concern that there are too many recommendations, too many reviews and too much duplication, but the evidence of my right hon. Friend highlights a different problem. The issue is not that we do not know what needs to change but that we too often fail to act on what we already know. The answer to that problem is not fewer independent investigations but stronger accountability for implementing recommendations. Indeed, my right hon. Friend made that point powerfully in his evidence. He explained that

“What there needs to be is a formal system with a legal obligation on the Government.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q53.]

He warned that too often recommendations disappear into what he described as “agree in principle”, which allows organisations to acknowledge a problem without committing to a timetable for fixing it.

The Government are proposing structural change because recommendations are not always acted on, but the problem is not the existence of HSSIB; it is the absence of sufficient accountability when recommendations are made. The Government appear to be addressing the wrong failure. There is another important point from my right hon. Friend’s evidence. He explained that one of the long-term purposes of HSSIB was to reduce the need for expensive public inquiries. He told the Committee that

“Ideally, when something goes wrong, what you want is for there to be an investigation and for lessons to be learned, so that grieving families can say, ‘Well, at least we are confident that this wouldn’t happen again.’”

However, because families often lack confidence that lessons will actually be learned, they understandably seek public inquiries. My right hon. Friend explained:

“families still think the only way they can get real change is through a public inquiry”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 32, Q56.]

That is an important warning. If confidence in HSSIB is reduced, the unintended consequence may be more public inquiries, not fewer—more cost, more delay and, most importantly, more time before lessons are learned and acted on. That is the opposite of what the Government say they want to achieve.

The Government’s second argument is that safe space can be protected through legislation. I accept that Ministers intend to preserve those protections; however, the evidence we have heard demonstrates that the issue is not simply one of statutory wording but of culture and confidence. My right hon. Friend the Member for Godalming and Ash gave a particularly important example: he explained that the CQC plays a vital role because it rates healthcare organisations. Hospitals and GP practices care deeply about whether they are rated “outstanding”, “good”, “requires improvement” or “inadequate”. His concern was this:

“If a staff member is talking openly to HSSIB about a failure of governance in their organisation, and that is the same organisation that could decide whether they get stripped of their ‘outstanding’ rating and downgraded to ‘good’ or ‘requires improvement’, my concern is that some people may worry and say, ‘Maybe I shouldn’t be open, because this could affect my hospital’s rating.’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 33-34, Q59.]

That is the practical problem: the Government’s argument relies on the assumption that staff will distinguish perfectly between different parts of the same organisation, but the concern is that a frontline clinician may not see those internal distinctions. They may simply see that the investigator and the regulator now sit under the same roof. When people are deciding whether to disclose something that may have consequences for themselves, their colleagues or their organisation, perception matters. As my right hon. Friend said,

“we have to be really careful that people still have confidence in the safe space function if this merger goes ahead.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 34, Q59.]

A similar point was made by Professor Carl Macrae from the University of Nottingham. While giving evidence to the Health and Social Care Committee, he said that it is difficult to conceive how legislation alone could overcome the fundamental conflict created by merging an independent safety investigation body with a regulator, given that the two organisations perform inherently different functions.

The Government’s case depends on trust surviving that merger, but the evidence tells us that trust is precisely what is at risk. Dr Benneyworth made a similar point from HSSIB’s perspective. She told this Committee:

“There needs to be much more clarity about governance and how that will work in the legislation to protect independence.”

She went further and suggested that if the Government proceed, there would need to be much stronger safeguards, including

“a legal duty on the CQC to protect the safe space.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 26, Q44.]

That evidence is significant because it is not a witness arguing that change is impossible; it is the organisation at the centre of this proposal telling this Committee that the legislation, as drafted, does not provide sufficient reassurance.

The Government’s response cannot simply be that they intend to be careful. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that the integration would be approached with “enormous care”, but we have to ask what that actually means in legal terms. Where are the enforceable safeguards? What prevents a gradual erosion of independence once HSSIB is part of the regulator? History tells us that institutional safeguards matter precisely because they protect against future changes in culture, leadership or priorities. A body can begin with the best of intentions, but still drift over time—that is why Parliament creates independent institutions in the first place. It is not because Ministers are untrustworthy; it is because good governance recognises that structures matter. In this case, the structure matters enormously.

Those concerns become even more significant when we consider the legal framework around protected information and the practical operation of safe space. The Government’s argument appears to rest on the belief that if the right protections are written into legislation, the independence of HSSIB can be preserved, but the evidence we have heard suggests that the challenge is much more fundamental. The question is not simply whether information is legally protected but whether staff, patients and families will continue to believe that it is protected. That distinction matters.

During our evidence session, Dr Benneyworth highlighted a very specific concern about the drafting of the legislation. She explained that, at present, the clauses related to connected individuals could create uncertainty about who in the CQC might have access to protected material. She said:

“The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.”—[Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.]

That is the crucial point: the success of HSSIB depends on confidence that information provided in confidence will remain within the investigation process. If there is uncertainty about whether information could move elsewhere in the organisation, the very existence of that uncertainty risks undermining safe space.

Dr Benneyworth went further. She explained:

“There needs to be a legal duty on the CQC to protect the safe space.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.]

That is a remarkable admission. The organisation whose functions are being transferred to the CQC is telling Parliament that the Bill, as drafted, does not provide that sufficient certainty. The Government’s response cannot simply be that everyone involved will act in good faith. Good governance requires more than good intentions; it requires a structure that protects independence, regardless of who happens to lead an organisation in future, who is Secretary of State or who is in government. That is why Parliament creates these independent bodies in the first place.

There is also a practical issue that cannot be dismissed. Dr Benneyworth explained that HSSIB is unique because it can investigate every part of the healthcare system, including national bodies. She told the Committee:

“At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 23, Q38.]

That includes looking at how national systems operate, how regulators function and how different parts of the health service interact. That independence is important, because sometimes the problem is not the provider delivering care; sometimes the problem is the system around it.

A regulator may look at whether an organisation has complied with standards; an independent investigator may ask a different question: why did the system make it possible for failure to happen? The questions are complementary, but not interchangeable. Dr Benneyworth made precisely that point when discussing national failures. She explained that some problems cannot be solved by regulating an individual organisation, because the underlying issue sits elsewhere in the system. She said that is not something that can be changed by a regulator—a fundamental distinction. Regulation can identify whether standards have been met and independent investigation can identify whether the system itself needs to change. Both functions are necessary, but combining them risks weakening both.

Those concerns sit within a wider challenge on candour in healthcare. The statutory duty of candour was introduced following the Francis inquiry into the failures of the Mid Staffordshire health trust. The duty’s purpose was straightforward: when something goes wrong, patients and families should receive an honest explanation. Despite that legal duty, however, evidence remains of a defensive culture within parts of healthcare. Legal advice can sometimes encourage organisations to think first about liability, rather than about learning. Administrators can understandably become concerned about litigation risk—and where fear dominates, openness suffers. That is precisely why the safe space matters.

HSSIB was created to provide an environment where the priority is not defending an organisation, but understanding what happened. If we weaken confidence in that environment, we risk making the wider culture of candour even harder to achieve. The irony, of course, is that the Government argue that the merger will strengthen patient safety, and yet the evidence suggests that it could weaken one of the most important ingredients of patient safety: openness.

I also want to express concerns shared with me directly by people working within HSSIB. During a meeting with some of my constituents who work in the organisation, individuals involved in patient safety investigations raised significant concerns about the proposed move. They believe that bringing HSSIB into the CQC represents a backward step for patient safety. They also expressed concern that the rationale for the merger has shifted. Initially, the argument appeared to focus on streamlining and reducing duplication; increasingly, however, it appears to be about reducing the number of safety recommendations being made. That misunderstands the problem.

As I have pointed out before, the challenge is not the existence of recommendations but ensuring that those recommendations lead to action. Indeed, I was informed that HSSIB has already been developing a recommendations monitoring system, specifically designed to improve implementation and oversight. In other words, the organisation is already working to address the very issue now being used as justification for restructuring it. That brings me back to the evidence given by my right hon. Friend the Member for Godalming and Ash. He identified what I believe to be the central weakness in the Government’s argument:

“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.]

That is the point that Ministers need to answer. If recommendations are not being implemented, strengthen implementation; if accountability is weak, strengthen accountability; and if learning is not embedded, create mechanisms to ensure that learning happens—but do not weaken the independence of a body responsible for identifying those lessons. The risk is that the Government solve the wrong problem. They will remove the independence of the investigator, while leaving untouched the failure to act on what investigators discover.

After considering the evidence presented to this Committee, the evidence that we heard in the Select Committee and my conversations with my constituents and others, I remain unable to support clauses 59 to 63. That is not because I oppose reform or believe that the patient safety landscape cannot improve—of course it can. The NHS must continue to learn, adapt and improve, but improvement requires honesty about what is working and what is not. The evidence suggests that HSSIB’s independent investigative model is one of the things that is working and that failure lies elsewhere. It lies in whether recommendations are being implemented, whether organisations learn quickly enough and whether staff feel safe enough to speak up. The answer to those problems is not to remove independence, but to strengthen it.

The creation of HSSIB represented a recognition by Parliament that healthcare needed the same principles of independent safety investigation that serve aviation, rail and other high-risk industry so well. Those principles exist for a reason: when something goes wrong, society needs an organisation that people trust to ask what happened, why it happened and what must change to prevent it from happening again. That organisation must be separate from those responsible for regulating the system. It must be able to investigate without fear or favour. It must command the confidence of patients, families and healthcare professionals.

The Government say that the protections will remain, but the evidence we have heard overwhelmingly demonstrates that confidence in those protections is precisely what is at risk. Once institutional independence is removed, it simply cannot be recreated through internal guidance or assurances. The structure matters, the culture matters and the trust matters.

For those reasons, I urge the Minister to reconsider clauses 59 to 63. If the Government believe that improvements can be made to co-ordination, accountability or implementation, discussions on that should absolutely continue and the Opposition would welcome them. However, the clauses go much further. They remove the independent status, which is so important. Given the enormous human and financial cost of avoidable harm in healthcare, Parliament should be extremely cautious before weakening one of the few mechanisms specifically designed to prevent it.

--- Later in debate ---

[Joe Robertson]

It is a pleasure to serve under your chairmanship, Sir Roger. The issues relating to clause 59, principally the abolition of HSSIB, have been well articulated, not least by my colleagues on this side. I wish to add some of my own views too.

The debate has been framed as a transfer of the functions of HSSIB to the CQC, and indeed that is the title of the clause. The Minister has certainly articulated her arguments in that way. Effectively, it is the abolition of HSSIB. In fact, clause 59(1) plainly says:

“The Health Services Safety Investigations Body is abolished.”

Its functions may be transferred, but that is quite a significant change, and I do not want that to be lost within the context of this debate. At the heart of it is this idea around investigatory and regulatory functions. While the argument remains technical—and it is of course easier for the Government and indeed Dr Dash to make the arguments to abolish HSSIB in the abstract—when we talk about the real-life implications and how real people react to different circumstances, it is plainly very significant and negative.

That is particularly true when it comes to investigating where things went wrong and when the system is at least in question and could be at fault. When there are things that need airing that people are afraid to air, confidence in the new framework is essential. Regardless of the systems, processes or protocols that the Government may wish to put in place to ensure that the safe space concept continues to exist, who on earth, if they are worried about making disclosures, will be satisfied and confident that those in the CQC, who may themselves be at fault, will not learn about a disclosure to the arm of the CQC that is empowered and entrusted with investigating the problem? An independent organisation, which HSSIB currently is, provides not just technical confidence but genuine confidence that people can speak freely on matters that may well be extremely unhelpful to their employer or the CQC—the national regulator itself.

As the hon. Member for North Shropshire noted about the Shrewsbury and Telford situation, it developed while the CQC gave a good rating. It may be that the CQC was fair in doing that, but it does not look good in the eyes of the public, and it will be a consideration for individuals seeking to make disclosures to an investigation. What will the public think?

[Gregory Stafford]

As I said throughout my speech, I am against this proposal whatever the nature of the CQC. However, does it strike my hon. Friend, as it strikes me, that the problems of moving the functions of HSSIB into the CQC are compounded given that the CQC, as he alluded to, is not functioning well and does not have the confidence of patients and clinicians?

[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.

Health Bill (Eleventh sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Chambers]

The amendment was tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire), and would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

I will not read through all my speaking notes but, in a nutshell, a person rightly undergoes mental health checks before they acquire a firearms licence, but that will not be reviewed until they are due to renew their firearms licence a few years later. If their mental health status changed during that time, the amendment would enable them to be flagged to healthcare workers and GPs as a person who has a firearms licence, so that any necessary proactive measures could be taken to ensure that they are still safe to have that licence, or should have it removed, rather than waiting for them to apply for a new licence in a few years’ time.

The British Medical Association supports the amendment and the Royal College of General Practitioners thinks it would be valuable. A survey carried out by the Association of Police and Crime Commissioners found that 87% of existing certificate holders believe that GPs should inform the police if they become aware of health issues that could have an impact on the certificate holder’s ability to own a gun safely. Quite often, however, the GP is not aware that the person is in possession of a firearms licence.

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

In essence, we debated the amendment in a Westminster Hall debate some months ago, when I had the dubious honour of being the shadow spokesman for the Conservative party despite not being a Home Office shadow Minister. It became clear in that debate that mandatory medical markers do not exist. It is still a voluntary system. How does the hon. Gentleman propose to make the system equitable?

The hon. Gentleman and I support mandatory medical markers, and there seemed to be cross-party support for them in the Westminster Hall debate. If they are not mandatory, some people will potentially be put under a different system, because their sufficiency or ability to hold a shotgun licence could be taken away from them, while those who are not on the system, because it is not mandatory, would not lose theirs. How does the hon. Gentleman deal with the equity issue and the potential for some people to be missed?

[Dr Chambers]

The hon. Gentleman makes an interesting point. I suppose this is another chance to use the developing single patient record to ensure that we close the gap. The record could be formed in such a way, and the process put in place, to ensure equity in the system, with mandatory markers.

Amendment 72, also tabled by my hon. Friend the Member for Epsom and Ewell, would require prior membership of the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. It would also require the Secretary of State to publish a report on making prior armed forces membership visible on the single patient record.

There are just over 1.85 million armed forces veterans in the UK, 13.6% of them women and 86.4% men. The transition from serving in the armed forces to civilian life can mean that many of those individuals struggle with mental health issues, such as post-traumatic stress disorder. The issues are often specific to the service the individuals have given. Some stats show that more than half of England’s Army veterans have some sort of health problem. I should point out that veterans do not only have mental health problems. Specific back and knee problems are much more common among infantry soldiers because of the type of training they have done over many years.

The amendment seeks to make prior armed forces membership visible to all relevant healthcare workers, and to make the Secretary of State consult on the merits of doing so, so that when a GP is treating a patient, they are aware of that person’s service history without having to ask about it specifically.

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

I have a couple of questions about amendment 71 for the hon. Member for Winchester. First, can he comment on why the amendment refers to firearms, which have stricter licensing conditions than shotguns? Also, the GP should be aware, because all relevant medical information should filter back to them, that the person has a firearms licence, which, as I say, has stricter criteria. It is essentially harder to get a firearms licence than a shotgun licence. I am interested to hear the hon. Gentleman’s thoughts on that.

On amendment 72, I have a large veteran population in my constituency, and I am very grateful to all those who have put their lives on the line to keep us safe, both today and in the past. I can see that there may be benefits to the amendment in respect of the delivery of the armed forces covenant and aspects of veterans’ care, but I am curious about how it is written. Proposed new subsection (3A) of proposed new section 250E of the National Health Service Act 2006 says that

“regulations must make provision for prior membership…to be visible to all relevant healthcare workers under the establishment of a single patient record”,

but proposed new subsection (3B) requires a report on the potential merits of doing that. It seems slightly counterintuitive to do it and then decide whether it is a good idea, rather than decide whether it is a good idea, consider the pros and cons, and then do it afterwards. I am interested to understand why the hon. Gentleman thinks the amendment is drafted in that way.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything.

As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon. Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea.

There would clearly be a benefit to the proposal in amendment 71. If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information.

For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.

[Dr Johnson]

Before my hon. Friend moves on, may I ask him about security? It might also be possible for someone who looked at the records to identify where guns are kept. That information is currently is more protected than that.

[Gregory Stafford]

I thank my hon. Friend for that helpful intervention; I had not appreciated that. If that is true, the security and safety of the individual who holds the firearms licence, and indeed of anybody else in the vicinity, is paramount, and we generally would not want people to know precisely where guns are held, because that could be a security risk. I think the hon. Member for Winchester has the best of intentions, but the consequences have not been fully thought through.

[Dr Chambers]

Will the hon. Gentleman give way?

[Gregory Stafford]

I will, but first I want to be kind to the hon. Gentleman and say that, as with his previous amendment, he has opened up a conversation about the single patient record that we really need to have, to ensure that what is on it needs to be there for the treatment of patients. As legislators, we need to have a wide conversation to decide what it includes and how it is going to be used.

[Dr Chambers]

The hon. Gentleman makes some good points, especially given his experience as the Conservative spokesperson in the Westminster Hall debate on this subject, for which he did a lot of research. I do not think we need to worry about medical professionals seeing that someone has a firearms licence and potentially treating them differently because of assumptions they make about them. Medical professionals are trained to be dispassionate, and they try to show little bias. I would be very surprised if a doctor, seeing it flagged on a single patient record that someone was in possession of a firearms licence, changed their attitude towards or approach to the treatment of that individual. I think that particular point is probably not relevant.

[Gregory Stafford]

I admire the hon. Gentleman’s optimism. I am not belittling his point—I, too, hope that no one would be treated, both in the traditional sense and in the medical sense, based on their background or anything else, including their recreational hobbies. Unfortunately, we have seen cases in the NHS in which someone’s religious background has led to antisemitism and other unfortunate issues. Unfortunately, sometimes the system itself has a problem. The Health and Social Care Committee published a report relatively recently on black maternal health. We could see the difference and the fact that, unfortunately, black women experience a worse level of care, often because of assumptions made about their backgrounds. I agree with the hon. Gentleman that I hope everyone is treated dispassionately, but I am afraid it does not always happen. We need to make sure that we root out that kind of behaviour, but we also need to protect people from it.

Amendment 72 is another that was tabled with the best of intentions. The improved identification of veterans is an interesting idea, because I do not think many veterans actively identify themselves when they access healthcare. A visible marker could help to ensure that healthcare professionals are aware of a patient’s service history without relying on self-disclosure. There may be direct benefits to a veteran, because they may be eligible for dedicated NHS services—including mental health, rehabilitation and other veterans’ healthcare pathways—through the armed forces covenant. A marker could, then, assist clinicians in directing patients to appropriate support more quickly.

--- Later in debate ---

Any public awareness campaign should, as the amendment specifies, seek to reach audiences that might not otherwise be reached. I am referring not only to age, but I raise age as an example. The shadow Minister has already highlighted digital exclusion for coastal and rural areas, which is another reason why I support amendment 49.

[Gregory Stafford]

As we move towards a single patient record, we have to ensure that technological progress does not come at the expense of those who are least digitally connected. As others have said, I am particularly concerned about older patients and many disabled people, who often rely most on NHS services but can face the greatest barriers when healthcare systems—and all systems—become increasingly digital. For some elderly patients in my Farnham and Bordon constituency, navigating online platforms is challenging, and others may not have regular access to the internet at all. Unfortunately, my constituency has one of the worst full-fibre broadband roll-outs in the country, and it has extraordinarily poor mobile phone reception in the central rural parts of the constituency, despite my best efforts with BT Openreach and others.

Disabled people may also face accessibility barriers that these systems do not always anticipate in their design. Modernisation should never mean creating a two-tier NHS—one for those who are digitally confident and another for those who are not. The people at risk of being left behind are often those with the most complex healthcare needs and the greatest reliance on the continuity of care. A proper assessment of digital exclusion is therefore not just a bureaucratic exercise, as some may describe it; it is an essential safeguard. We need to understand how the single patient record will affect elderly patients, disabled people, carers, those with learning disabilities and those who may struggle to engage with digital services.

[Sojan Joseph (Ashford) (Lab)]

My understanding is that the single patient record is just a single place where all of a patient’s medical records will be kept. It will not necessarily change the ways in which they access healthcare services, such as A&E, the GP or a dentist. Those ways of accessing healthcare will stay the same, whether we have a single patient record or not.

[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.

--- Later in debate ---

Division 14

Question accordingly negatived.

Ayes: 6

---

Conservative: 4
Liberal Democrat: 2

Noes: 7

---

Labour: 7

[Gregory Stafford]

On a point of order, Ms Lewell. Are we not voting on amendment 49?

[The Chair]

We will vote on amendment 49 later if the hon. Member for Sleaford and North Hykeham wishes to.

--- Later in debate ---

[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.]

[The Chair]

Order. As Members can hear, there is a fire alarm. Can everyone return to this room as soon as possible, when it is safe to do so?

--- Later in debate ---

On resuming—

[Gregory Stafford]

Before I was rudely interrupted by the fire alarm—I am not taking it as a hint, much to the Minister’s disappointment—I was saying that this is a unique system and that with the unique benefits come unique risks. I was trying to answer the points made by the hon. Member for Ashford.

As my hon. Friend the Member for Sleaford and North Hykeham and my right hon. Friend the Member for Melton and Syston have mentioned, we already know that despite the regulations, whether they are from professional regulators or the ICO, people will get round the system. One of the biggest concerns that patients will raise is not simply whether patient records will be accessed by nefarious people from outside, such as cyber-hackers, hostile states and so on, but whether they are secure from inappropriate access by people who have access to the system. As my hon. Friend the Member for Sleaford and North Hykeham pointed out, those people could be situated anywhere across the country. Patient records should be accessed only where there is a clear clinical, professional need. The public rightly expect robust safeguards, strong audit trails and meaningful consequences where the rules are breached. Amendment 48 raises that important issue. The Minister should explain how inappropriate access will be prevented, how misuse will be detected and what sanctions will apply when the standards are not met.

My hon. Friends have already mentioned a number of cases and I pick another one: the unfortunate case of the three-year-old boy who was hospitalised after being attacked by a crocodile at a zoo. Cambridge University Hospitals trust is currently investigating 40 members of staff who appear to have accessed that boy’s medical records inappropriately.

While we would always hope that that would not happen, unfortunately it clearly does. This single patient record means that someone will potentially be able to look at patients’ records regarding anything and from anywhere in the country. My hon. Friend the Member for Sleaford and North Hykeham slightly generously described some people as “nosey”. Along with those who have an actual ulterior motive, that presents a real challenge. I say to the hon. Member for Ashford that just because the current system is in place to protect patient records as they currently exist, that should not be a bar to making sure that we make the system even more robust given its potential risks.

It goes directly to proposed new section 250F(4B)(b) of the National Health Service Act 2006, which is the system of audit logging to be applied to each record, so that every time someone accesses a patient record or part of that patient record, the identity of the person obtaining that information should be recorded. I believe that the patient should be able to easily see, hopefully in real time, who has been accessing their record and at what time.

We on this side have mentioned a number of big events: that poor boy with the crocodile, terrorist attacks in Southport and so on. I suspect that those data breaches have been identified because they were big events. People have gone out to check that nobody has been inappropriately accessing those records. I worry that every patient record will potentially be available to every single person, and I doubt that there will be an ability to check every single person proactively rather than reactively. That means patients need access themselves to look at their record and see who has been accessing it. If the name of the person who has accessed the record, or the organisation they belong to is available, patients can say, “Well, there is Mr Smith, my child’s paediatrician, and that is fine. However, who is this guy from elsewhere in the country who has looked at the record?” They can then raise that. That is absolutely vital.

[Dr Johnson]

My hon. Friend is making a very important point. Does he also think that it is possible for the system to have some designs built into it that identify that someone from another area of the country, or from another department or different profession is unexpectedly looking at results? Perhaps AI could help with this.

[Gregory Stafford]

My hon. Friend is right. I will not sit here and propose a solution to this problem, but what her amendment does is ensure that the Government look at this and present a plan before both Houses of Parliament, before we get to a single patient record.

I have now touched on the nefarious and the nosey. I think there is also a case of inadvertent access. With this new system, despite what the professional regulators might think, and despite the best training from the Information Commissioner’s Office, there will be occasions in a new system where people do not understand the limits of what they are allowed to look at or the appropriateness of access. There could well be inadvertent access to these systems. Again, the Government need to have a plan and system in place to ensure that there is not inadvertent, non-nefarious access to patient records as well. That is why I am very supportive of amendment 48.

To make sure that this system is trusted by patients, we need to have the highest level of safeguarding possible, both from external attacks and from internal misuse. My hon. Friend’s amendment goes a long way to putting some of that trust in place.

[Joe Robertson]

Plainly, there is already scope for this to happen and sadly patient records are wrongly accessed, either inadvertently through mistake or deliberately in bad faith. However, from a technological and design point of view, the single patient record inevitably makes that easier and more likely, whether through mistakes or deliberate acts. That is just one of the many considerations and downsides of a single patient record that is otherwise beneficial.

It is incumbent on the Government to do what they can to mitigate against those inevitable structural problems that the record will produce, and amendment 48 is an entirely sensible way of achieving that. I am always slightly reluctant to use analogies from other sectors, because plainly there are differences, but in my former life as a family law solicitor, even within a small private law firm, there were structures in place to ensure that only people who needed to access data could do so, and much of it was arguably less sensitive than patient records.

That was the case in a small firm, and because we have a national system of healthcare in this country, which is a good one, the scale of fallout and harm that could arise from such mistakes or deliberate acts is so much greater. I urge the Government not to see the amendment as seeking to undermine their overall plans, but as a means of strengthening them.

--- Later in debate ---

[Sojan Joseph]

I do not know whether there will be the same system in Scotland, but my understanding is that in the north of England doctors will be able to see the same system. Again, we can hear more detail from the Minister.

A single patient report has the potential to transform patient experience and safety by ensuring continuity of care, by reducing unnecessary repetition, by enabling better informed clinical decisions and the smoother discharge of patients, and by creating a more efficient and joined up healthcare system.

[Gregory Stafford]

I thank all those who have spoken so far in this debate. I have never seen the hon. Member for Lichfield so animated—Data Dave is clearly alive and well.

As we have discussed, the clause creates the legal power for a single patient record in the UK. It is important to say, as others have, that the Bill does not create the system but gives the Secretary of State the power to create it later through regulation. That does not mean, however, that we should not have a debate about some of the issues that we have raised.

I should state at the start that I support better information sharing when that helps patients receive safer and better care, and I think that the single patient record could well do that. Anyone who has worked in healthcare, as I have, knows the frustration that results from the records not following patients between services. Clinicians can lose valuable time in searching for information, if they can get it at all. As others have said, patients are often asked to repeat the same details over and again—not, as my hon. Friend the Member for Isle of Wight East rightly said, because it gives a richer experience but simply because people do not have the information. Better joined up records have the potential to improve care.

We have, however, been here before. I was a lot younger—we all were—but back in 2002, the national programme for IT, under the last Labour Government, was a £10 billion unmitigated disaster, which the Public Accounts Committee described as

“one of the worst and most expensive contracting fiascos in the history of the public sector.”

I want to make sure that there are safeguards, from both a contracting and a data safety point of view, so that we do not go down that route again. As my hon. Friend the Member for Isle of Wight East clearly outlined, creating such a record is fiendishly complicated from both a technology and patient information point of view and from a data sharing and data protection point of view.

The record could contain some of the most sensitive information about people, so Parliament has the responsibility to make sure that the legal framework is right. We also know that the record will work only if the data in the single patient record is worth the electronic paper that it is electronically printed on. As I am sure the Minister knows from her time in the NHS, the information is getting better but continues to be patchy across the country. Different trusts and organisations record things in different ways. I take my hat off to those who work in clinical coding, as they do one of the most difficult jobs in a trust. Again, we need to make sure that the data is accurate. Someone mentioned AI earlier; I think AI could help with that, but we are still some way off.

I want to canter through my concerns about the breadth of the powers being given under the clause. The Bill allows the Secretary of State to make regulations establishing the system and to decide how it operates. Those regulations may require or authorise the sharing and processing of patient information, decide who can access the information and create enforcement powers and financial penalties. Some of those important questions are not answered in the Bill. Parliament is being asked to approve a broad framework before seeing some of the detail.

My second concern is that the Bill says little about patient choice. There is no clear statement about whether patients will have the right to opt in or out and no explanation of whether patients can restrict access to all or part of their records. There is no mention of whether someone could choose to limit access to particularly sensitive information, such as mental health records, sexual health information or information about substance dependence. There are major questions for public trust but those are left, I would say, entirely to future regulations. We need clarity about them now.

My third concern is the scope of the information that may be included. The definition of “patient information” is extraordinarily broad. It covers information about physical health, mental health, diagnosis, treatment and care, including social care. The definition of “patient” includes people receiving social care or having their care needs assessed. What we do not know from the Bill is exactly how that data will be presented. Will it use language that a patient can understand? Will it talk about having a heart attack, or will it use medical information that a medical professional will need to assess? Or will it include both, so that the patient knows that they have had a heart attack, for example, but the medic can see the precise detail on what sort of transient ischaemic attack it was. We need to understand what the data is recording and at what level of detail.

[Dr Johnson]

If it is to include both, who will translate it into the simplest form and how much will that cost?

[Gregory Stafford]

Precisely. These questions need to be thought about when the Government are creating this system.

As hon. Members have described in their speeches and in their amendments, the system could contain much wider information, including highly sensitive information about disability, safeguarding, care assessments, addiction, pregnancy, military service, caring responsibilities and many other personal matters. This is not simply about a hospital record; it is about bringing together health and social care information. That makes it even more important—indeed, essential—that safeguards be clear and robust.

That leads me on to my fourth issue, which is confidentiality. The Bill says that where information is processed under the regulations, doing so will not breach any duty of confidence. I think that that is a significant legal challenge and change. Confidentiality has been one of the foundations of healthcare. Of course there are already situations in which information can and should be shared, but where Parliament is creating a new legal basis for disclosure, it is reasonable to expect strong safeguards alongside it.

That brings me to my next concern. The Bill says that the Secretary of State must have regard to the need for “adequate safeguards”. That is welcome, of course, but the Bill does not say what those safeguards are. There is nothing in it about role-based access controls, audit logs or whether patients would be able to see who had looked at their records. There is nothing about minimum cyber-security standards, about how inappropriate access will be detected or about independent oversight. Those matters may appear later in regulations or in guidance, but they are not guaranteed in the Bill.

[Liz Twist (Blaydon and Consett) (Lab)]

I thank the hon. Member for his clear summary, at the start of his speech, about what we are discussing, which is the regulations. He and other Members have rightly pointed out many issues that need to be resolved, but does he agree that the proper way to work through this very detailed and very real concern is through the regulations, which will come with expert advice and ensure that we cover all these points properly?

--- Later in debate ---

[Gregory Stafford]

On the hon. Lady’s specific question, I agree: the regulations will answer these questions. But I think it is entirely appropriate to have them asked here and to have a statement of the principles, at least, on a number of these things from Ministers, so that within a broad scope we can ensure that the Bill is appropriate. The amendments tabled by my hon. Friend the Member for Sleaford and North Hykeham, for example, seek to do so. They were clearly within the scope of the Bill; otherwise, they would not have been accepted.

The next issue is geographical scope, which I do not think anyone has touched on yet. The Bill allows information to be made available to people involved in

“health care or social care anywhere in the British Islands”.

That naturally raises questions about governance across different health systems. How will information be shared between England and the devolved nations? I think my hon. Friend mentioned some of the self-governing territories. I assume that she meant the Isle of Man, the Channel Islands and places like that—Crown dependencies. What rules will apply? How will accountability work where different organisations operate under different arrangements? Again, the Bill does not answer those questions.

[Helen Morgan]

The cross-border point is really important. A number of people will come into England from Wales to have their secondary care delivered, because that care is not available in Wales. The single patient record will presumably not be available to the clinicians in the hospitals in England who are dealing with the patients. I wonder whether we should consider how that will work when we get to the regulation stage, because other systems will clearly be needed to deal with the people who are coming from outside England to be treated in English hospitals and other settings.

[Gregory Stafford]

I read the clause differently. I am sure that the Minister can provide an answer, but my reading is that the single patient record could be—but not necessarily that it must be—used in Wales and Scotland as well. I do not know whether it has to be used, but the clause, as I read it, suggests that it would be. If a patient is travelling from Oswestry to somewhere in Shropshire or vice versa—

[Helen Morgan]

Oswestry is in Shropshire.

[Gregory Stafford]

My geography A-level has clearly departed me. If a patient is travelling from somewhere in Wales to Shropshire, the single patient record would be used. That also presents challenges the other way, if Wales and Scotland are using different technological solutions and systems and operating under different legal frameworks. That is especially the case for Scotland: it has quite a different legal system from England and Wales, so there could be issues.

[Dr Johnson]

The clause says that information could be made available

“to people involved in the provision to patients of health care or social care anywhere in the British Islands”.

That implies that the English system will be used to share information with people outside England—in the Isle of Man, the Channel Islands, Scotland, Wales or Northern Ireland—but it does not imply that those areas will necessarily have the same systems to share information with us.

[Gregory Stafford]

That is an interesting question. I do not know the answer, but perhaps the Minister can pick that up.

The Bill also creates powers for financial penalties. It sets out a process for notices and opportunities to make representations and a right of appeal. Those procedural protections are sensible, but the Bill does not tell us who might be fined or what conduct would trigger a penalty, and it does not set out a maximum penalty level. Those decisions, again, are left to regulations.

It is also important to remember that the Bill does not replace existing data protection law, as I think the Minister outlined in her opening remarks. Organisations will still have to comply with the Data Protection Act and other UK data protection rules. However, the Bill would provide a new statutory basis for processing information through the single patient record. That makes the wording of the Bill especially important. Ultimately, public confidence will determine whether the system succeeds. People are generally willing for information to be shared when it improves their care, but they also expect transparency, security and accountability and expect to know who can see their information and why. Those expectations are entirely reasonable.

There are several questions that I believe the Committee should ask before these powers are granted. Will patients have a genuine choice about participation? Will they be able to restrict access to particularly sensitive parts of their records? Who exactly will be able to access the system? Will patients be able to see a record of who has viewed their information? What minimum standards will apply? How will misuse be identified and punished? What independent oversight will exist? Those are not technical details; they are central to public confidence.

In conclusion, the clause will create a legal framework rather than a system itself. It will give broad powers to establish the single patient record while leaving many of the most important questions to future regulations. Clearly most people support the goal of improving patient care, but because the system will involve some of the most personal information that people have, Parliament should ensure that patient rights, safeguards, transparency and accountability are clearly built into the framework from the beginning. It should ensure that questions are asked now rather than decided on later.

[Karin Smyth]

I turn first to new clause 7. Patient data is at the heart of the NHS, and it is important to help plan and run health and social care services; we have discussed that before, and a lot of these points have already been recorded in our earlier conversations. The security and privacy of people’s health and care data are paramount. To be clear, the Bill does not rewrite our data protection laws; it works alongside them, allowing the NHS to use existing, lawful frameworks to share information safely and legally for the direct care of patients. Article 25 of the UK general data protection regulation already applies to the federated data platform, and will apply to the single patient record. The new clause is therefore not necessary.

In the NHS, there are different ways in which patient information is used, and not all of them involve asking for explicit consent each time. For example, if a GP refers someone to a hospital, that person would not expect the clinician reviewing the case to ask their permission before looking at their medical record; their agreement is understood as part of seeking care. That is called implied consent. Although a national data opt-out exists, it applies only to data used for secondary purposes such as research and planning.

The single patient record is expected to operate roles-based access control, whereby permission to access patient information is restricted to authorised users only, with an audit trail of who has accessed the patient’s data. Inappropriate or unauthorised access to health records, often referred to as snooping, is a serious offence. There are mechanisms to manage that, including prosecution and fines.

In 2025-26, we invested £75 million across health and social care, building on the £375 million invested since 2017. Through our ambitious cyber improvement programme, we are tackling the changing cyber risk head on, expanding protection and services to better protect the health and care system. The single patient record system is expected to be assessed as critical national infrastructure, with the highest standards of cyber-security and information governance to meet our existing duties to keep personal data safe under the data protection legislative framework.

I turn to new clause 8. No decision has been made about who will be the IT suppliers of the single patient record. It is expected and intended that it will be delivered through contracts with multiple suppliers, which will reduce dependency on a single supplier. Furthermore, no decision has been made as to how, if at all, the single patient record will link to existing infrastructure such as the federated data platform. As hon. Members will expect, I would not support using the Bill to try to rewrite the contract for the federated data platform.

Hon. Members have discussed a wide range of issues relating to this area. They probably know that negotiating the intellectual property in relation to software in digital services is complex and often contentious. The new clause would make it a condition of any single patient record IT supplier contract that the NHS owns the intellectual property in data connector software, regardless of the circumstances. In practical terms, that would be likely to disincentivise suppliers from offering their services if they were required to sacrifice the IP of a product. It is unnecessary to impose such a condition, as there are other ways in which the NHS can ensure that software is reusable, such as broad general licences to use the data connector software in whatever manner, requirements to use industry standard code and interfaces, and information standards.

The recent changes to the NHS information standards in the Data (Use and Access) Act 2025 make relevant IT suppliers accountable for meeting information standards and enable the Government to monitor and enforce compliance with information standards by IT suppliers. We wish to see a vibrant UK market in digital and technology, while ensuring that patients get the best technology to improve care outcomes and to keep the NHS financially sustainable. That will give the NHS more choice and help to improve standards while supporting economic growth.

We have had what they call a wide-ranging discussion on some things that are not actually in the clause. I agree with the hon. Member for Farnham and Bordon that it is absolutely right, and we have heard some excellent examples from Members with clinical experience. My hon. Friend the Member for Lichfield will now be forever known as Data Dave—sorry about that. The hon. Member for Sleaford and North Hykeham has clinical experience and my hon. Friend the Member for Ashford has NHS experience, as do I. That experience is really valuable. The Liberal Democrats tabled amendments and had a long list of questions, most of which are addressed in various pieces of information that we have put forward. However, I take the point about the intellectual difficulties of what the clause does. We all agree with it, as does the country, and patients think it already happens.

We are an outlier in this sphere. The Government are going to change that situation. However, these questions and concerns are the reason why we take through secondary legislation, which is something that we all understand but the outside world does not. We need to bring people with us. Our officials have come to talk to Members of Parliament about the Bill. I am open to suggestions from Members about the best way to address the issues, and particularly about the best way to inform Members on behalf of constituents. These discussions are important to building public trust and security.

I will finish on a broader point. I commend clause 47, which gives an enabling power, but let us be very clear that patient information will still be held in the system in which it was originally created. These bodies, whether GPs or hospitals, will continue to be responsible for ensuring that the data is handled securely and lawfully and is accessed for valid reasons only. As I mentioned earlier, we have shared systems operating already. Some parts of the country and some of our constituents are already experiencing some of the benefits of a shared system. We will use that experience and learn the lessons of the past, under whichever Government, to build for the rest of the country the shared systems that some people have already. We will come on later to provisions on devolution arrangements, on working for the future and on operating more efficiently across devolved areas.

Health Bill (Tenth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[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.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. As has been said, we all know how important investment in primary care is, particularly as this Government shift to neighbourhood health, and that is why we have invested so heavily.

Although we are absolutely interested in the outcomes, the inputs merit some attention too. We have provided an additional £601 million for general practice to reinforce the front door of the NHS, bringing the total spend on the GP contract to £14 billion in this year. That builds on last year’s £1.1 billion of investment, which was the biggest increase to GP contract funding in over a decade. In community pharmacy, we have increased funding by £340 million, bringing the total spend to £3.636 billion. That represents a 10.3% uplift on the back of an uplift of more than 19% across 2024-25 and 2025-26, which again was the largest uplift in funding of any part of the NHS at the time.

In 2024-25, we invested around £3.7 billion in primary care dentistry, and we reduced the underspend from £392 million in 2023-24 to just £36 million in 2024-25, maximising the treatment provided across all our constituencies from taxpayers’ money. We are investing £20 million to support digital integration between primary care optometry and secondary care, supporting more eye care in the community.

--- Later in debate ---

[Gregory Stafford]

I will start by addressing Liberal Democrat amendments 9 and 10; once again, I see the impetus and reason behind tabling them. As the hon. Member for Winchester said, new clause 27, tabled by the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon, has a similar but subtly different—in my view, usefully different—impetus and emphasis.

I am a member of the Health and Social Care Committee, and we published a report into community mental health in December last year, which laid bare the shocking state of mental health services in this country, especially community mental health services. Mental health accounts for over 20% of the demand for health services in this country, but in the period 2025-26, it is forecast to receive only 8.7% of NHS expenditure.

The spend in that period is expected to be higher than in the previous year, 2024-25, but it will actually be a smaller proportion of total NHS spending, decreasing from 8.78% to 8.71%. That reduction also means that 2025-26 will be the first year since 2016-17 in which mental health spending will not rise as a proportion of total health spending, which is in contravention of the mental health investment standard that has been introduced. In fact, on 17 November last year, NHS England confirmed that the proportional increases will not take place over the next two years to 2028-29, and that there will instead be “flat real funding growth”.

Overall, although I accept that the Government have increased spending on mental health, the fact that it is going down as a proportion of the total bill is one of the many reasons why we on the Health and Social Care Committee were very concerned about the future of mental health funding. It is also why we supported our Chair, the hon. Member for Oxford West and Abingdon, in tabling new clause 27.

The differences between new clause 27 and amendments 9 and 10, tabled by the hon. Member for Winchester, relate to the financial penalty. If we want people to spend more on mental health, it would seem perverse to punish them by taking money away from them, because there might be reasons why they could not meet this requirement. I totally accept what the hon. Member is trying to achieve, because as he said, Claire Murdoch, the national director for mental health, resigned in September over the fact that she did not feel that the Government were spending the right amount on mental health.

New clause 27 would put the mental health investment standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health, and then requiring integrated care boards to incur that expenditure. It also differs from amendments 9 and 10, in that rather than increasing the amounts as a total of expenditure—an approach for which I have sympathy—it has the more realistic requirement that it must only go up every year. Over some years, I would like the amount to increase as a total proportion from the current figure of 8% or 9% to 20%, which is the real cost or burden of mental health care in this country. I think new clause 27 is a much more fair and appropriate way of achieving that.

I accept the arguments of my hon. Friend the Member for Sleaford and North Hykeham about a potential loss of local flexibility, but I think the new clause is written in a way that gives ICBs at least some flexibility to decide how they spend that money. Also, unlike amendments 9 and 10, there is not a financial penalty if for some reason they do not manage to do so it.

In principle, I see merit in new clause 33. Like my hon. Friend the Member for Sleaford and North Hykeham, I represent a semi-rural seat, so I know that understanding delays in accessing mental health treatment is essential if we are to have services that meet patient needs and ensure greater transparency on waiting times. All this can help identify inequalities and inform better policymaking. The requirement to examine the disparities between rural and urban areas is particularly welcome given the challenges that rural communities can face in accessing specialist mental health services. However, it should be noted that the new clause would primarily deliver a reporting mechanism rather than a solution to the problem. Although annual reviews might improve our understanding of treatment delays, they do not in themselves guarantee improvements in access, workforce capacity or service provision. There is also a question as to whether the health service already collects much of this information in other ways, and whether a new statutory review would add significant value beyond the existing reporting arrangements.

Better evidence about the scale and geographic distribution of mental health treatment delays could support more targeted interventions and help to ensure that patients are not disadvantaged simply because of where they live. The challenge will be ensuring that the findings of any review actually lead to meaningful action, rather than just becoming another reporting exercise or inquiry.

[Joe Robertson (Isle of Wight East) (Con)]

Does my hon. Friend agree that reporting between urban and rural, which runs through these amendments, is particularly useful? Many of the solutions put forward throughout this Bill involve mayoral areas or authorities, which of course do not currently exist in many rural areas, and in some may never exist.

[Gregory Stafford]

My hon. Friend is absolutely right. We have talked about this issue while debating numerous clauses of the Bill. If someone were being ungenerous, they might say that there is an urban bias to this Bill. I think that it is less that than the fact that the Government have decided to use, as my hon. Friend rightly says, these mayoral structures to base health services on, when in fact, in so many areas, they either do not exist yet or, as far as we can tell, will never exist. Maybe Manchesterism will change that; we do not know. The Minister is smiling, so maybe she knows.

Regarding new clause 34 and the promotion of positive mental health, the prevention of mental illness and the reduction of stigma are obviously vital and important goals. I welcome the intention of the new clause to ensure that mental wellbeing is taken seriously across the health service. However, I have a few concerns about placing such a broad duty on a statutory footing, not least because, as my hon. Friend the Member for Sleaford and North Hykeham asked: is that not the job of the Secretary of State anyway?

As far as I can tell, new clause 34 essentially duplicates many of the responsibilities that already exist. The Secretary of State and NHS England—as currently exists—along with integrated care boards and other public bodies, are already subject to duties relating to improving health, reducing inequalities, promoting public health and improving the quality of services. Many of the objectives listed in the new clause are already capable of being pursued under those existing powers and obligations. The question therefore arises as to what additional legal effect the new duty would have.

Secondly, the concept of “mental health wellbeing”, while perhaps being a term we kind of understand, is inherently broad and rather difficult to define when we are talking about writing it into law. Unlike things such as waiting times, staffing levels, or access standards, “wellbeing” is not really a measurable outcome. I have some sympathy with my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who said in evidence that he wanted to see fewer targets, because they often have unintended consequences and skew the system towards the targets rather than what is actually required.

Mental health wellbeing could encompass life satisfaction, emotional resilience, social connections, employment, housing security and many other factors. As a result, I do not think it is clear what compliance with the duty in this new clause would look like in practice, how the success would be measured or how public bodies could demonstrate that they had fulfilled the obligations.

Finally, although the requirement for an annual report may improve visibility, as with the provision in new clause 33, there is a risk that new clause 34 could create an additional reporting obligation without necessarily improving services or outcomes. Before Parliament imposes a new statutory duty, it should be satisfied that there is a clear objective, a measurable standard against which performance can be assessed and a distinct purpose that is not already served by existing legislation or rules. I am afraid that, unless the hon. Member for Winchester comes back with a devastating argument in his wind up, I am not yet convinced that new clause 34 amendment meets that test.

[Karin Smyth]

I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. I will turn to amendments 9 and 10 along with new clause 27, which address similar points. These amendments would require integrated care boards to increase their spending on mental health services at least in line with their growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties for non-compliance, and new clause 27 would also place the mental health investment standard, or MHIS, on a statutory footing by requiring the Secretary of State to specify an annual increase in the proportion of mental health expenditure for each integrated care board and require integrated care boards to meet that level of expenditure.

I want to be really clear with the Committee: mental health remains a priority for this Government, and the Government are already making record investments in mental health services. Spending on mental health continues to increase in real terms and is forecast to reach a record £16.1 billion in 2026-27. That represents a real-terms increase of around £140 million, compared with 2025-26 and around £900 million of real-terms growth since 2023-24.

--- Later in debate ---

[Dr Chambers]

The hon. Member for Sleaford and North Hykeham covered most of the points I was going to make, so I will be very brief. The changes that are proposed to the better care fund seem like another example of decision making being taken away from local authorities and other organisations, which are often the ones that are best placed to understand the health and care needs of their local populations. This measure centralises power rather than devolving it.

Ultimately, the Bill leaves the impression that social care is being pushed more and more on to local authorities. That seems like an ill-judged move, given the ongoing stand-offs we have on the funding of social care and continuing healthcare up and down the country, and it is hardly encouraging the integrated working that everyone accepts is needed to address the joint issues in social care and the NHS. We are worried that there are multiple measures in the Bill that are separating social care and the NHS at a time when greater integration and closer working are so clearly needed. If we want to grasp the nettle on corridor care, overcrowded hospitals, ambulance delays and delayed discharge, we need to get the NHS and social care working together. All those issues seem to have their roots in social care—or the lack of it.

Taking these changes alongside others, such as the removal of local authorities and GPs from ICBs, it looks as though ICBs will not be capable of living up to the ambition of acting as joint committees that co-ordinate care with local trusts, GPs and social care. In summary, this all boils down to the fact that we cannot keep treating NHS services and social care as separate entities.

[Gregory Stafford]

While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats.

On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges.

The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs.

The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.

[Dr Johnson]

My hon. Friend is talking about uncertainty. Essentially, those powers could not be used at all to direct or they could be used to micromanage. It is not clear what the intent is.

[Gregory Stafford]

My hon. Friend is right, and I have mentioned that in relation to other clauses. I am perhaps a cynic in my belief that if stuff is being written into legislation, that probably means that the Department has some idea of what it wants to use those powers for. It would be useful to hear from the Minister what her and the Department’s intentions are for these powers. How directing or otherwise will they be of ICBs?

Specifically, proposed new section 223GB to the NHS Act 2006, relating to service integration, also exposes that inherent contradiction. It enables the Secretary of State to require ICBs to allocate designated funding into pooled budgets with local authorities, and at the same time to impose centrally approved spending plans and performance objectives. It is not possible to take the clause forward without having some clarity on exactly how those powers are going to be used in future.

As my hon. Friend the Member for Sleaford and North Hykeham said, clause 44 is shorter. She covered most of the points that I was going to make, but I think the Government should explain how effective oversight of the system-wide financial discipline that we have talked about will be maintained in the absence of the provisions omitted from the 2006 Act and the Health and Care Act 2022 by the clause.

[Dr Johnson]

I note that proposed new section 223GA to the 2006 Act, inserted by clause 43, includes the duty to “publish any directions” but there is no timing for that. Does my hon. Friend agree that it is important to understand how soon after the direction is made we should expect the Minister to publish it?

[Gregory Stafford]

My hon. Friend is right again: there is a lack of clarity in these two clauses, as I have highlighted. I am sure the Minister, having heard my hon. Friend’s question, will respond when she gets her moment.

[The Chair]

That moment is now. I call the Minister.

--- Later in debate ---

[Dr Johnson]

Clause 45 makes technical changes to the licence conditions, allowing the Secretary of State to use those conditions as a tool to ensure compliance with legal requirements beyond those in the Health and Social Care Act 2012. That power is somewhat open-ended, which reduces certainty for providers, particularly independent ones, as they will not be able to easily anticipate what additional legal duties might be folded into the licence. The Minister said that there would be a consultation, but does she have any more details on how long the consultation process will be, or on how much notice of changes providers can expect? Like other clauses in the Bill, despite the Government’s discussion of devolution, the clause introduces another centralising power.

Clause 46 is about the specifics of to whom legal documents can be served and through what mechanism. I understand the Minister’s argument on the need for modernisation, but everyone will have had emails that were bounced by spam filters or the like. How will she ensure that the emails are not just sent but received, so that there is a fair playing field for everyone?

[Gregory Stafford]

I understand the purpose of clauses 45 and 46, as there is clear public interest in ensuring that providers that hold licences in our health and care system comply with the law. Patients, taxpayers and staff are entitled to expect high standards, proper governance and accountability. Where a provider delivers vital public services, it is reasonable for the licensing scheme to help to uphold those obligations. In that sense, the intention of the clauses is good.

My hon. Friend the Member for Sleaford and North Hykeham outlined a number of questions for the Minister. Could the Minister explain in more detail how clause 46, which essentially provides for the enforcement of the provisions in clause 45, will operate in practice?

[Karin Smyth]

I do not have any more details on how the clauses will operate in practice and follow through into guidance; that will obviously be in the usual guidance on the operation of the system. It is usual practice for people doing the work to make contact with the receiver of the email to check that they have received it and are acting on it appropriately.

Question put and agreed to.

Clause 45 accordingly ordered to stand part of the Bill.

Clause 46 ordered to stand part of the Bill.

Clause 47

Single patient record

--- Later in debate ---

[Dr Chambers]

All the stakeholders have said that the single patient record is part of the Bill that could be genuinely transformative. I would also like to note the Bill’s many references to carers, including the Secretary of State’s duty to promote the involvement of carers alongside patients in decision making around care and commissioning. However, the Bill is currently quite vague as to whether carers will be able to access the single patient record, and we want that to be made explicit. We want to reiterate the lack of focus on social care, which is the biggest issue facing the NHS, and emphasise our call for carers in general.

The benefits that the single patient record could bring to patients have been well-established, and it is well-supported, but we believe that the single patient record could also be of huge benefit to carers. It could allow them to care more effectively for their loved ones, and it could allow it to be flagged on their own records that they are carers, so they receive the support that they need.

[Gregory Stafford]

I have a lot of sympathy with this amendment and what the hon. Gentleman is trying to achieve through it. Does he have any idea of how a patient would nominate a carer in such a circumstance? Indeed, would it be done by the patient themselves? If not—for example, the patient might have mental health issues or capacity issues—could the carer be nominated by a health professional or a statutory body?

Although I absolutely agree with the intentions of the amendment, could he give some examples? For instance, would a carer be able to access all of the patient’s record, or just the part for the period in which they have been providing care? It is entirely right that a carer should see the patient record relating to whatever it is they are providing care for, but—I am not trying to be flip—should carers know that at 17, the person who they are caring for was treated for a sexually transmitted disease or something similar, which the patient might not want them to know?

[Dr Chambers]

The hon. Gentleman makes some very good points. Obviously, the whole point of this amendment is to equip people who are providing what is often the daily care for someone else with the information they need to provide that care. My family cared for my father at home for many years when he had dementia; he was on medication for other physical health issues as well, and he was not capable of administering his own medicine, or even of understanding what he was on half the time.

--- Later in debate ---

[Dr Johnson]

I understand the hon. Member’s point, but we need to start with the patient at the centre and ask what is best for patient care. It is about what the patient wants to share with their carers. The patient may make an informed decision not to share information that is potentially useful, but if they have capacity, they are free to do that. It is about starting with the patient.

I have huge sympathy with the principle of what the hon. Gentleman is trying to achieve, but I am not sure that that is not already included in proposed new section 250E(2)(c)(i) of the NHS Act 2006, which mentions “making” information

“available to people other than a patient on the patient’s behalf”.

The important thing is that patients make the decision if they have the capacity to do so, or that someone acting with power of attorney has done so on their behalf.

Amendment 65, which is also in this group, talks about support needs. I have some sympathy with that as well. When I see a patient in clinic—I am a paediatrician, so they are all children—I look at the notes, which say they have a particular issue, and I go out into the waiting room and call the child’s name. There is nothing on the record, necessarily, to tell me that the patient and the mum are deaf, or that the other parent is deaf and may not be able to hear me calling them in the waiting room. So I have sympathy with the idea that the record would flag up reasonable adjustment needs; I think there is a place for that.

There is something called the reasonable adjustment flag on the NHS Spine, and perhaps the answer is to use that rather better than is happening at the moment. With carers, as the hon. Member for Winchester said, or with parents or legal guardians looking after children, we should consider whether reasonable adjustments also need to be made for the parent, guardian or carer who is likely to bring the patient to be seen.

[Gregory Stafford]

As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—

[Dr Chambers]

It is by design.

[Gregory Stafford]

I will be charitable and take him at his word. We have opened a vital conversation about who will have access to this record, how it will be shared, which bits of it will be shared, and how we ensure that the laudable aim of a single patient record—to ensure that a clinician treating a patient has all the vital facts in front of them—is balanced with that patient’s privacy. As the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham said, we must make sure that the patient is put at the centre of this.

We need to look at the amendment under that microscope of scrutiny. We must use our role as legislators to ensure that gaps in legislation are closed so that loopholes cannot be exploited. I am fully in favour of the Government’s intention on that. However, I have some concerns about privacy and access, and amendment 8 potentially highlights those.

The amendment provides for a nominated carer to access a patient’s record, but who nominates the carer? Is it always the patient, and how will that consent be verified and continually checked so that if the patient wishes to remove consent for the carer to see their record for whatever reason, there is a way of doing so? What protections exist for vulnerable patients who may feel pressured or even coerced into granting access? If circumstances change, how easily can that access be withdrawn, by whom and through what process?

Although I am not being critical specifically of the amendment, the Government will need to think about those questions when they introduce the single patient record. It is not as simple as saying, “Here is a wonderful record and everyone can access it,” because it will contain some of the most sensitive information an individual holds, including details of their physical and mental health.

I entirely accept that carers often play a vital role in supporting patients, but unrestricted or poorly governed access could undermine patient confidentiality and therefore trust in the system. I am sympathetic to the concerns of the hon. Member for Winchester and think that, not just in relation to this amendment but as the record is pulled together, we really need to consider these vital issues.

On amendment 65, like the shadow Minister, I have a lot of sympathy with the point about reasonable adjustments. We need to be careful when deciding as legislators the purpose of the single patient record. Is it simply a repository of treatments, illnesses, conditions and so on, or does it give a wider commentary on those conditions and treatments? In the example given by the shadow Minister, knowing that someone has hearing difficulties would be useful, but is the single patient record the appropriate place for that? I do not know the answer, but we need to discuss and decide that, because there is a danger of scope creep. If we try to make it all things to all men and women, it could lose the stated purpose, which is to ensure that a clinician has the full facts when dealing with a patient.

[Dr Johnson]

I understand what my hon. Friend is saying; he is making a very good speech. I wonder whether he agrees that one of the challenges for us as legislators, in looking at all the amendments on the single patient record, and indeed at the single patient record itself, is that while the principle of a single patient record might be a good, it is all about the devil in the detail and the delivery. We do not have a delivery plan or a vision of more of the detail relating to how it will look, so it is difficult to make judgments on many of the clauses.

[Gregory Stafford]

As ever, my hon. Friend is entirely right. It would be helpful to have more clarity on what the single patient record will look like. I will not repeat my earlier questions, but I think they are prescient. I hope that the Minister—even if she cannot answer now, which I accept—has those in mind when she and her colleagues start to look at this.

Even if the Minister cannot provide detail, all I ask is that she provides reassurance that access to the single patient record will be based on explicit consent, limited to what is necessary for either the caring role—as in the amendment of the hon. Member for Winchester—or the clinical role overall, subject to some kind of regular review and supported by some robust audit mechanism. If we are to create a system on this scale, we must ensure that the safeguards are just as strong as the benefits.

Health Bill (Ninth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

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

Clause 31 introduces schedule 4, which essentially makes series of amendments to other Acts. It amends the Public Finance and Accountability (Scotland) Act 2000 to remove a cross-reference to other categories, and it amends the Audit and Accountability (Northern Ireland) Order 2003 and the Public Audit (Wales) Act 2004 for similar purposes. It also amends the National Health Service Act 2006 by deleting section 62 and schedule 10, relating to the audit of accounts of NHS foundation trusts, to end the old audit scheme.

Schedule 4 amends section 3 of the Local Audit and Accountability Act 2014 so that foundation trusts are now included in the list of bodies that must keep accounts in the standard way, it amends section 4 to specify which documents count as accounts of foundation trusts for the purpose of auditing, and it amends sections 8 and 10 so that the auditor appointment procedure and the auditor panel’s role now cover foundation trusts.

In addition, schedule 4 rewrites section 13 of the 2014 Act so that if a trust fails to appoint a local auditor, it is the Secretary of State’s job to step in. Previously, that was NHS England’s job; clearly, that needs to change, because NHS England is being abolished. The schedule also amends section 21 so that the auditors’ general duties now apply to foundation trusts too, and it amends section 30, relating to unlawful expenditure and activity, and section 32B, relating to the independence requirement, to remove a now-redundant item from the list.

Schedule 4 also amends schedule 2 to the 2014 Act to formally add foundation trusts to the official list of audited bodies; schedule 5 so that the rules on who can be a local auditor now cover foundation trusts too; schedule 6 to remove an outdated segment from the audit practice code rules; schedule 7 to tidy the reporting rules and extend them to foundation trusts; schedule 9 to realign data matching rules that apply to foundation trusts in the new system; and schedule 11, relating to the disclosure of information, to remove a reference to NHS England, which is no longer necessary because NHS England is being abolished. In general, clause 31 aligns the audit process for accounts of foundation trusts with those of standard trusts and integrated care boards.

Clause 32 removes the need for NHS England to maintain a register of foundation trusts and the fees associated with maintaining it. Section 39 of the NHS Act 2006 requires NHS England to maintain a current register of NHS foundation trusts and specifies what must be in that register. Section 50 states that an NHS foundation trust must pay NHS England a fee that NHS England may determine in respect of exercising its functions under section 39, which relates to keeping the register, and section 39A, relating to a panel for advising governors. Clause 32 deletes sections 39 and 50. The explanatory notes say that the requirement to maintain a register does not need to be transferred to the Secretary of State when NHS England is abolished because, the Government argue, the information will already be available centrally, and there is no need for a fee to keep that in place. That seems sensible to me.

Clause 33 enables the Secretary of State to impose limits on a foundation trust’s annual capital or revenue expenditure. Section 42B of the 2006 Act allows NHS England to make an order imposing a limit on the capital expenditure of a foundation trust in a single year. Section 42C sets out that NHS England must publish guidance about the exercise of its power under section 42B, including about the circumstances in which it is likely to make an order and the method it will use to determine the capital expenditure limit. Clause 33 entirely replaces sections 42B and 42C with rewritten sections, with some notable changes. The wording is changed from “capital expenditure” to “expenditure”. The power is therefore widened from capital expenditure limits to limits on any expenditure—capital and revenue. The Secretary of State replaces NHS England as the entity with the power to impose limits, which makes sense, and the subsection requiring an order to specify the trust, the financial year and so on has been removed in full.

The change gives the Government financial control to stop overspending by NHS foundation trusts. I note that in financial year 2023-24, NHS trusts overspent by £1.2 billion, so presumably this is the Secretary of State getting a tighter grip on spending. In some respects that is sensible, but overspending is often due to staffing costs and day-to-day pressures, not capital expenditure, so there is an argument that the capital limits themselves are not sufficient to deal with the problem. Under the new governance model, the Secretary of State has oversight and responsibility for the health service, and financial control aligns with those changes. The new power could prevent one organisation’s failures from undermining the health service’s wider financial position or impacting other providers.

However, the purpose of foundation trusts is supposed to be that they have greater independence over spending, and the Government have stated that their aim is to create a more devolved and autonomous health system. How does broadening the Secretary of State’s ability to interfere in expenditure devolve power or make foundation trusts more independent? Imposing expenditure limits may control overspending on paper, but it does not address the reasons why it is happening, so limits could lead to a deterioration in the health services delivered by some trusts. What plans does the Minister have to deal with that?

Because the power moves from an arm’s length body to the Secretary of State, interventions could be politically motivated, rather than in the best interests of the NHS. How does the Minister consider that that will be managed?

The power for the Secretary of State to impose expenditure limits at any time during or before the financial year could create uncertainty among trust leadership and undermine long-term planning. If a trust is given a budget for the year, it knows what it has to work with, but if somebody says halfway through the year, “Actually, you are going to have to work with less money than that,” it is very difficult for the board to plan its expenditure, because it is always looking the other way. Why does the Secretary of State need that power? Can the Minister clarify that, if there is a change in the expenditure limit during the year, it will always be revised upwards, and never downwards?

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

My hon. Friend is making a prescient point. Has she thought about the word “limits”? To me, it is not clear from the clause as drafted—perhaps it is clearer to her—whether that is an overall limit on capital and revenue expenditure, or whether the clause is saying that the Secretary of State could impose limits on individual line items or departments. The word “limits”—plural—suggests that he or she may be able to do that.

[Dr Johnson]

I do not think the Bill is very clear on that. It says that the Secretary of State

“may by order impose limits on the expenditure that may be incurred by an NHS foundation trust in respect of a single financial year.”

However, it does not say whether that is an overall limit, whether it is for capital or revenue or whether it is a limit on a specific item, so the degree to which the Secretary of State has control is not clear. I presume it is an overall limit and that it is for dealing with budgets, but perhaps the Minister can provide some clarity for my hon. Friend.

Clause 34 requires foundation trusts that have been newly authorised, or that have recently acquired another trust or another foundation trust, to prepare the final accounts for their predecessor trust or foundation trust. It does that by modifying section 36 of the NHS Act 2006 to add new provisions that require foundation trusts to prepare accounts for the final period for which they were an NHS trust, establish that part of schedule 7 and part of the Local Audit and Accountability Act 2014 apply in relation to those accounts, and define the final accounting period. It does the same for section 56AA of the 2006 Act.

--- Later in debate ---

[Gregory Stafford]

I want to touch briefly on clause 39, Government new clause 20, and new clause 26, tabled by the hon. Member for Oxford West and Abingdon in her role as Chair of the Health and Social Care Committee.

I recognise the intention behind clause 39. Greater collaboration between the NHS, local authorities and other public bodies has the potential to improve the co-ordination of services and deliver a more integrated approach to population health, which I think we all welcome. However, it sits slightly uncomfortably with other clauses we have debated that appear to draw local authorities and the NHS further apart. In this case, it looks like they may be brought together.

As the clause expands delegation and joint working powers, I would be interested to understand from the Minister where the oversight and safeguards for accountability for spending the joint budgets would sit. Would it be with the NHS, local authorities or somewhere else? We hope that everything goes well, but if services fail or financial problems emerge, the public deserve to know who precisely is accountable for those budgets. As I have said in debates on numerous other clauses, I continue to be concerned by the broad powers that the Bill gives to the Secretary of State. I have the same concerns about this clause.

On Government new clause 20, bringing health services and wider local government functions together is really important, particularly where combined authorities have responsibilities that affect the wider determinants of health. However, once again, I am concerned about the fact that the new clause further complicates an already crowded accountability landscape. As more functions are delivered through pooled budgets and joint arrangements, it becomes harder to identify who is responsible for outcomes, spending decisions and—hopefully not, but potentially—service failures. I welcome the flexibility, which I think has value, but it must be balanced with transparency and democratic accountability. I am not convinced that the new clause gets that right.

On new clause 26, as I have said before concerning amendments and new clauses that have come from the Health and Social Care Committee, it is often difficult to get entire agreement on these things because of the cross-party nature of the Committee. Therefore, new clauses and amendments that come out of the Committee are in some ways aspirational, rather than ones that hit the nail on the head.

The new clause suggests that the Secretary of State carry out a review of how effective section 75 arrangements are—the hon. Member for Winchester outlined evidence that in some cases, the use of section 75 arrangements has not always been effective—consult NHS bodies, local authorities and anyone else considered appropriate; consider whether existing powers should be used to improve those arrangements; publish a report and lay it before Parliament; explain whether the Government intend to use their powers to change regulations or guidance and why; and complete all that within 12 months of the Bill passing, which I think is a reasonable timeframe.

Section 75 arrangements already play an important role in bringing together health and social care. It is reasonable to ask, as the hon. Member for Winchester did, whether they are delivering the benefits in the most effective way possible. I would potentially say that this proposal does not go far enough. The new clause would require a review, a consultation and a report, but would not require any action to follow that. The Secretary of State need only “consider” whether existing powers should be exercised and explain the reasons for any decision. If the review identified significant weaknesses, there is no obligation in the new clause, as far as I understand it, to implement those changes.

I agree that the new clause is well-meaning. It has some good recommendations, and I hope the Minister takes on board its sentiment, but it probably does not have the teeth and the power to make it an effective part of the Bill.

[Karin Smyth]

I got a little confused at the end, but I think the Opposition generally accept the power in this clause. The hon. Member for Farnham and Bordon contended that this Bill and previous amendments to it will drive local authorities and the NHS further apart; just to have it on the record, I do not accept that that is true at all. Section 75 of the National Health Service Act 2006 and the work that we are doing on this further highlights the effect of some of the things that we are trying to do.

The hon. Member for Winchester raised new clause 26. I have sympathy for the intention behind the new clause. We all want health and care services to work closer together, as I have said repeatedly, and we agree that the partnership framework under section 75 of the National Health Service Act 2006 is a useful tool for doing so. While I understand the new clause, it is not necessary. The Department can review the section 75 framework without needing legislation, and indeed it has already done so. The Department carried out a review of section 75 in 2023, as has been said. Since then, we have continued to consider how these partnership arrangements can best support health and care integration.

The new clause would risk duplicating ongoing work. Furthermore, that work is not a one-off exercise but an ongoing process of learning and improvement across the country, and we want something that is responsive and flexible enough to respond to changes in health and care services and to the changing needs of people who use them. For that reason, I do not consider requiring a single statutory review to be the most effective approach.

Hon. Members raised important issues about clarity of accountability and responsibility. To reiterate, the legislation is clear: the legal responsibility or liability for a function being carried out properly rests with the receiving party; however, the delegating party is accountable for that function being carried out, and they must know how it is being carried out and make sure that any issues are addressed. The hon. Member for Sleaford and North Hykeham rightly alluded to one of the examples that we are exploring around section 75, which is how it might support key priorities in delivering neighbourhood health, to make absolutely clear and sure that we bring services closer together.

Both spokespeople outlined a quote from Melanie Williams of ADASS. Although I do not know the whole context of the quote, I understand the frustration of colleagues in social services and this whole area as it is one that I worked in myself. I understand the issue, but it is slightly different because it concerns the what, rather than the how, of what is being discussed. Section 75 is part of the how. We want to make this easier for people who are trying to do the right thing, and these provisions, which I commend to the Committee, do just that.

Question put and agreed to.

Clause 39 accordingly ordered to stand part of the Bill.

Clause 40

Consolidated accounts

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[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.

[Karin Smyth]

I am pleased that, in an outbreak of cross-party agreement at 3.20 pm on a Tuesday, I completely agree with the comments made by the hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston. It is a point that I made myself: the ability of Members of Parliament and the public to understand the granularity relating to their local providers and ICBs is very important for transparency and accountability. I hope Committee members recognise that I have tried to drive much more transparency in that system. They are absolutely right that that is separate from this clause, and we will continue to expect providers and ICBs to do that; I hope that addresses that point.

To add further clarity on the wider point the clause deals with, the consolidated accounts we prepare include some analysis by different types of body. That will mean separate information about NHS providers being included in the document, such as a summary of income and expenditure. Separately, providers and ICBs will continue to publish accounts so that people can look at those. The Government will listen to any feedback from users to adapt the nature of this content in future years after the initial publication, recognising that this is a new development following the abolition of NHS England. We are also mindful that too many separate publications add to administrative costs and risk losing focus. The intention is to have transparency at the local level, building that up to do something more sensible and cost-effective that is also transparent at national level. I commend the clauses to the Committee.

Question put and agreed to.

Clause 40 accordingly ordered to stand part of the Bill.

Clauses 41 and 42 accordingly ordered to stand part of the Bill.

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

Health Bill (Eighth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[Helen Morgan]

We cannot see the resources allocated, so we cannot confirm that, but it is clearly a concern. We are not yet discussing the part of the Bill that deals with Healthwatch, so I should keep my powder dry, but we know that local authorities will get some additional funding to deal with their elements of Healthwatch, while ICBs will not. There is a concern that that streamlining is, in fact, slimming down.

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

It is a pleasure to serve under your chairmanship, Sir Jeremy. I want to pick up where the shadow Minister left off. Essentially, she said that the cart is being put before the horse in terms of mayoral authorities.

As my hon. Friend the Member for Isle of Wight East outlined, many areas have no plans for a mayoral authority; our area of Hampshire and the Isle of Wight is some way down the track. As I expressed last week in Committee, we have a strange anomaly in the new Surrey and Sussex ICB, because Sussex will get a mayor and Surrey will not, so Sussex residents will have representation on the ICB whereas Surrey residents will not. I hope that the Minister has had a chance to reflect on that strange paradox over the weekend and that she will now be able to answer specifically, as she did not last week, how that lack of representation for Surrey residents will work locally.

The abolition of the integrated care partnerships and their allied strategies continues a theme whereby the Government, under the veneer of slimming down, are actually decoupling—or weakening or whatever terminology Members wish to use—health and social care. For many years, all parties have regarded the bringing together of health and social care as essential, but the Bill not only looks like it is not trying to encourage that bringing together, but in fact is doing the opposite of that—it seems to be looking to pull them apart and decouple them. That is strange, because it does not appear to be the expressed policy of the Government, but it is the only logical explanation for many parts of the Bill, including the abolition in clause 23.

The shadow Minister pointed out that a number of areas will keep the ICPs in some form or other. I ask the Minister, does the Government support that feature? Was it the Government’s intention to remove the statutory footing of the ICPs and strategies in the hope and expectation that they would continue on a non-statutory footing? If so, we come to the paradox: if the Government support local authorities and health services continuing to work together in informal ICPs, why is the Minister trying to get rid of them? If they do not support that, is it now stated Government policy to separate social care and health services?

[Joe Robertson]

It is a pleasure to serve under your chairmanship, Sir Jeremy. There is a consensus—not just in this room, but within Parliament and going back several decades—that we want more integration and partnership working, particularly to bring together health and social care services, but this clause drives a coach and horses through that, and does so in a way that weakens rather than strengthens the Government’s plans to replace the system.

Local authorities bear responsibility for social care and public health in their areas, but they will no longer have a direct voice when it comes to integrated care boards. What we have seen to date is not an ideal system, or even a system that works particularly well, so I understand that the Government want to strengthen it, but we should not do that by removing the local government voice or making it indirect via a mayor who does not have the direct responsibility for delivering social care locally. Mayors may have some strategic oversight, but that is different.

Just last week, the Minister of State for Care appeared before the Health and Social Care Committee and was questioned on this very issue by me and others. His view was that the mayoral strategic partnership would be more than sufficient to make up for the local authorities losing their seat, but he faced particular scrutiny from the hon. Member for Chelsea and Fulham (Ben Coleman), who made some excellent points, which I will not repeat or paraphrase as they are on public record.

The gist of his argument was that local authorities have been ignored for too long when it comes to joining up health and social care services. This measure puts local authorities in an even weaker position and threatens what the Government are trying to achieve with social care, particularly for areas such as mine that have an older population and a relatively small unitary authority with so much responsibility to deliver on.

As my hon. Friend the Member for Farnham and Bordon has already said, the combined area of Hampshire and the Isle of Wight—or the Solent, as the Government like to call the Isle of Wight, despite the fact that fish cannot vote—is not set to get a mayor for a couple of years, but it will be at the vanguard of the Government’s plans. What about those areas for which there is no date, or even no plan for a mayor at all? It seems extraordinary that the Government would do away with the current set-up, imperfect as it is, and replace it with something that does not yet exist.

The Government have time deal with this problem. I am sure they quietly understand that there could be a problem. It is now on their shoulders to deal with it. I welcome the Minister’s reflections.

--- Later in debate ---

[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.

[Gregory Stafford]

Will the Minister give way?

[Karin Smyth]

I will not; we need to move on from this point. Of course, if people want to keep the partnerships, they are totally able to do so. That will be up to local leaders to decide.

Question put, That the clause stand part of the Bill.

--- Later in debate ---

[Dr Chambers]

The hon. Lady makes a good point. The purpose is to ensure that those who are deeply embedded in community care are consulted by the ICBs, so that they do not miss obvious localised issues in their demographics when developing care plans.

Just to give a brief example from a surgery I held recently, Joanne Cook is an occupational therapist who is campaigning for occupational therapists who have received specific training to be able to prescribe, and crucially de-prescribe, medications, in the same way that trained paramedics can. Often, occupational therapists see patients on a daily basis. They give them intimate and regular care, and are even better placed than GPs to notice small changes and adjust medications to keep people out of hospital.

If integrated care boards are not drawing on the experience, knowledge and data from primary care providers in all their forms, any healthcare plans they come up with will not be relevant to those demographics. We will not be keeping people out of hospital or treating them as effectively in the community, and the whole system will not be as efficient or as targeted as it could be. I would appreciate it if the Minister considered accepting the new clause.

[Gregory Stafford]

I am not convinced that clause 24 delivers the transformation that the Minister claims. At its core, it appears to be little more than a rebranding exercise. It replaces joint local health and wellbeing strategies with neighbourhood health plans, but does remarkably little to strengthen the underlying duties on local authorities or integrated care boards. Merely changing the name of a document does not improve patient outcomes, reduce waiting lists or deliver more integrated care.

The duty created by the clause is also remarkably weak. Local authorities and ICBs need only prepare a plan and then “have regard” to it when exercising their functions. That is one of the least demanding obligations available in legislation. It requires consideration, not compliance. An ICB could acknowledge the plan, but decide to depart from it and still satisfy the legal test. If neighbourhood plans are genuinely intended to drive local health policy, the Bill should do a lot more to require decision makers to act in accordance with them, or at the very least to explain publicly why they have chosen not to.

I am also concerned that the clause creates additional bureaucracy without any clear accountability. It requires the production of another planning document, another consultation exercise and another set of reporting expectations, but provides for no—for want of a better phrase—enforcement mechanism or measurable outcomes against which success can be judged. There is a risk that local systems will spend their time drafting plans rather than delivering services. Public involvement is of course essential, and indeed welcome, as we have heard, but the clause offers no detail about what meaningful involvement looks like and contains nothing to prevent a token consultation from satisfying the statutory requirement. If the objective is genuine neighbourhood-led healthcare, the legislation needs to be drafted much more tightly.

Moving on to new clause 70, I do my absolute best not to be flippant when it comes to Lib Dem amendments and new clauses, but once again we have an idea that is fine in principle—in fact, I think we would all support it in principle—yet the hon. Member for Winchester could hardly articulate how the new clause would work and whom it would involve.

--- Later in debate ---

[Helen Morgan]

The hon. Member will be aware that the new clause is a probing amendment. It is designed to push the Minister to describe how we will ensure that this range of expertise is taken into account when the plans are put together. We will not press the new clause to a vote, but we want to use it as a discussion point to probe how the range of expertise in the health service will be fully utilised, so that the plans are the best they can be.

[Gregory Stafford]

I thank the hon. Lady for that clarification. It is helpful to understand that the Liberal Democrats will not press the new clause to a vote, but if we are to use probing amendments effectively, they need to be drawn much more tightly, so that a Minister does not have the opportunity—I am sure that today’s Minister would not do this—to wriggle out of it because it is so poorly drafted.

[Dr Chambers]

What we are desperately trying to do is ensure that we are drawing on the expertise of primary care providers. The hon. Member seems not to understand that talking about 40 new hospitals the whole time with no plan to deliver them is looking at the wrong end of the health service. We need to try to keep people healthy and in the community. The new clause is an attempt to refocus thoughts on keeping people healthy in the community, rather than talking about hospitals that never existed.

[Gregory Stafford]

We can go back to the record in Hansard, but I do not remember mentioning anything to do with hospitals in what I just said; I may have had some sort of amnesia at that point. If the hon. Member is referring to the plan of the last Government, which was fully costed, for 40 new hospitals, then I am afraid I did not mention that. On his wider point, Conservative Members want to understand how local authorities and deliverers of primary care—dental services and so on—will be included and can have influence over the plans and strategies that ICBs draw up. I fully support that ambition; I just feel that, if we are to have that ambition, we need to table amendments and new clauses that the Minister might actually accept, so that we can go forward.

[Karin Smyth]

I thank hon. Members for their comments. I accept those made by the hon. Members for Winchester and for North Shropshire. I offer the Liberal Democrats the assurance that the Government fully appreciate the important role that primary care plays in informing ICB decisions, which is why we have retained the requirement that ICBs engage with their system partners, including primary care services, in the exercise of their planning and commissioning activities.

It is universally recognised that full engagement with providers, including primary care, is fundamental to good commissioning, and this is reflected in the strategic commissioning framework. The neighbourhood health framework sets out how neighbourhood health plans should be developed through health and wellbeing boards and with the involvement of system partners. We expect primary care to be fully involved in the process.

In addition, ICBs will continue to engage local representative primary care committees, such as the local medical committees. ICBs must comply with their duty to obtain appropriate advice from persons who have broad professional expertise in prevention, diagnosis or treatment of illness and the protection or improvement of public health. Primary care practitioners will remain key sources of such advice. Although I agree that experience of general practice is fundamental—as a commissioner, I worked very closely with general practitioners, who deal with 90% of patient contacts—I do not believe that placing an additional requirement on ICBs to engage specifically with primary care providers is necessary.

I will take this opportunity to clarify matters. We are moving between the roles of ICBs and local authority health and wellbeing boards. I know this is a subject of great interest and will continue to be debated in relation to those bodies’ commissioning and providing functions. The planning structure will be improved under clause 24, reflecting our commitment to neighbourhood health and making it a reality.

Planning begins with a joint strategic needs assessment developed by health and wellbeing boards; that assessment informs the new neighbourhood health plan, replacing the joint local health and wellbeing strategy. Meanwhile, ICBs will produce population health improvement plans, aligning multiple joint strategic needs assessments, neighbourhood health plans and local priorities. Patient and local voices must, of course, be embedded in ICB decision making and in the planning process. ICBs are being supported to do that. The strategic commissioning framework published on 4 November 2025 clearly set out that user involvement is key to strategic commissioning.

Having proper plans that address the needs of neighbourhoods will help the NHS to deliver for every community in our country. That is where the patient focus is and where people experience healthcare the most, and it is why we have made these commitments in neighbourhood health plans. I commend clause 24 to the Committee as the means to make that a reality.

Question put and agreed to.

Clause 24 accordingly ordered to stand part of the Bill.

Clause 25

NHS trust accounts

Question proposed, That the clause stand part of the Bill.

--- Later in debate ---

[Dr Johnson]

Special health authorities are, in essence, specialist health authorities set up by the Secretary of State, usually to provide an England-wide service of some form. Examples include NHS Blood and Transplant, and the NHS Business Services Authority, which provides NHS pensions—I should declare that I have an NHS pension—admin for prescription exemptions and other such business-type functions. We also have NHS Resolution, which deals with clinical negligence claims, and the NHS Counter Fraud Authority.

In principle, special health authorities are useful in some cases, but they are effectively a form of quango. Can the Minister explain when she thinks the Government might want to set up a special health authority, rather than using a department within the DHSC to deliver the same thing? There are plenty of other nationally delivered services, and although the Government have suggested that some services, such as screening, will become localised as part of the Bill, some things will remain national. Can the Minister give some examples of what the new provision will be used for?

I can see there is provision for flexibility, but the special health authorities would require setting up, and there are set-up costs and costs associated with branding and those sorts of things. How does the Minister envisage those costs being provided for, and when will it be necessary for the Government to use them rather than just using the Department?

Special health authorities have been created, reconfigured and shelved many times. For example, the National Treatment Agency for Substance Misuse became part of Public Health England in 2013, and the NHS Institute for Innovation and Improvement was closed in the same year. The functions of the National Patient Safety Agency went to the NHS Commissioning Board Special Health Authority, later known as NHS England, in 2012 and then to NHS Improvement in 2016. Widening the scope could leave us with more quangos than are necessary.

Which specific functions do the Government plan to move into special health authorities under this widened power? Have the Government just decided that they need this power and are increasing the scope because they are abolishing NHS England without a proper plan? Is this power just to cover themselves in the event that, as they start to make a plan, they find out they need it?

Clause 28 enables the Secretary of State to make regulations for the transfer of staff from one special health authority to another, or to an ICB. Paragraph 3(8) of schedule 6 to the National Health Service Act 2006 states:

“Regulations may provide for the transfer of officers from one Special Health Authority to another”,

or to NHS England,

“and for arrangements under which the services of an officer…are placed at the disposal of another Special Health Authority”,

or NHS England, or a local authority. Paragraph 3(12)(a) states that the Secretary of State may give directions

“to place the services of any of its officers at the disposal of another Special Health Authority”,

or NHS England. Paragraph 13 states:

“Provision may be made by regulations with respect to the recording of information by a Special Health Authority, and the furnishing of information by a Special Health Authority to the Secretary of State, another Special Health Authority”,

or NHS England.

Clause 28 modifies that paragraph such that regulations can now provide for the transfer of an officer to an ICB—that is a new power—as well as a special health authority and a local health authority, but no longer to NHS England because NHS England is being abolished. Regulations can now provide for an officer’s services to be placed at the disposal of the ICB and the Secretary of State, which is a new power, as well as the special health authority or local authority, but no longer NHS England. The clause modifies paragraph 3(12)(a) of schedule 6, so that directions may be given about placing the services of officers at the disposal of the special health authority and, newly, the Secretary of State or an ICB, but not NHS England. As the Minister said, the clause also modifies paragraph 13 of schedule 6, so that a special health authority can be required by regulations to pass information to integrated care boards, which is a new power, but no longer to NHS England.

NHS England is to be abolished, so it is sensible to say that staff can no longer be placed there—that seems an entirely reasonable exercise—but the legislation providing for special health authorities essentially contains open-ended spending power. Remuneration of the special health authority chairman and staff can be determined by the Secretary of State, with the approval of the Treasury. Does the Minister foresee an upper limit to those sorts of salaries?

People will essentially be able to transfer from one special health authority to another, or to an ICB—or be placed at the disposal of another special health authority, an ICB, a local authority or the Secretary of State. Will the Minister talk about the location, pension and salary of those individuals? We heard yesterday that the future Prime Minister, the right hon. Member for Makerfield (Andy Burnham), may want to move a whole load of civil servants from London up to Manchester. That will clearly be within his gift if he becomes Prime Minister, but for individuals who work in one location to be asked to move to another is disruptive to their family and social lives, and involves significant relocation costs. If people are moved in the way that clause 28 describes, particularly by transfer, what choice will they have? What will happen to their pension, salary and other terms and conditions, and will they have a choice of location or not?

[Gregory Stafford]

Very briefly, on clauses 27 and 28, I am sure the Committee is aware that special health authorities were initially established under the National Health Service Act 1977. Since then the number of special health authorities has expanded and contracted a number of times over the years to leave us with, currently, NHS Blood and Transplant, and the Business Services Authority, which covers pensions, as my hon. Friend the Member for Sleaford and North Hykeham mentioned—I should declare that I have an NHS pension, albeit a very small one—as well as the NHS Litigation Authority, also known as NHS Resolution, and the NHS Counter Fraud Authority.

The mood music and the direction of travel, certainly since 2006, has been to reduce the number of special health authorities. On my reading, clauses 27 and 28 suggest that the Government are potentially looking to expand the number of special health authorities, given the Secretary of State’s direction under clause 27 and the practical steps for staff transfers in clause 28. Is the Minister looking at, for example, a special health authority to deal with artificial intelligence? Clearly that is something the NHS will have to embrace—or deal with, depending on which end of the AI argument one is on—rapidly over the coming years. Is that a potential area for a special health authority? Perhaps the Minister could outline where she sees the special health authorities acting and what their remits might be.

[Karin Smyth]

To be clear, in response to the comments of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, it is not currently our intention to set up any new special authorities to deliver any specific functions. We are taking this opportunity to update the legislative framework and ensure that in future the functions that a special health authority could carry out are less limited. The current legislative framework limits the remit of such authorities to their functions under the NHS Act 2006, which is outdated and does not reflect changes since that time. There are functions of the Secretary of State under the Health and Social Care Act 2012 that we may want special authorities to carry out in future. I agree with the Opposition spokesperson that the situation is complex. We have had a lot of changes over many years, as both she and the hon. Member for Farnham and Bordon said. I agree that we need flexibility for future provision, and that is what the clauses provide.

We have no immediate intention to delegate specific functions of the Secretary of State. However, following the abolition of NHS England, a range of functions may need to be established, as the hon. Member for Farnham and Bordon outlined. Those functions could, as an example, include the data and information functions in part 9 of the Health and Social Care Act 2012, which currently sit with the Secretary of State.

I assure the Committee that the clauses do not change the existing processes or scrutiny that exist around setting up a special health authority. They are, as I think the Opposition spokesperson said, about future-proofing. I commend the clauses to the Committee.

Question put and agreed to.

Clause 27 accordingly ordered to stand part of the Bill.

Clause 28 ordered to stand part of the Bill.

Clause 29

Constitution of NHS foundation trusts

--- Later in debate ---

[Helen Morgan]

As I mentioned in my previous remarks, one imagines that a Secretary of State would set out criteria to ensure that the best people for the job are appointed. We are in a situation where a current Parliament cannot bind a future one, but we do need to set a precedent that political capture of these important leadership roles is not an unintentional consequence of this legislation. I accept that it is unintentional; I think the Secretary of State and the Minister have drafted this legislation with the best of intentions, but this is something we should guard against.

[Gregory Stafford]

On clause 29 and the relevant amendments, the membership model and the council of governors were originally introduced to give patients, staff and local communities a formal voice in the governance of NHS organisations. I worry that by removing them the clause concentrates power in the hands of the trust board at a local level and, potentially, the Secretary of State at a national level, while reducing opportunities for local scrutiny and public participation. As my hon. Friend the Member for Sleaford and North Hykeham said, there is a real danger that organisations will be independent in name only.

That brings us back to the never-ending tension in the Bill between the centralisation of power in the Secretary of State, through the abolition of NHS England and all the other bodies we have talked about, and the Government’s stated desire to have more accountability for decision making at a local level.

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

I am aware of the role of governors in some of our NHS trusts and the way in which they are appointed, but governors have said to me that they are sometimes disappointed by the level of influence they can in fact have in their trust. Can the hon. Member think of examples of where governors have particularly influenced the activities of individual trusts? I have not found that to be the case in my experience.

[Gregory Stafford]

The hon. Gentleman’s intervention neatly brings me to my next point. I have some sympathy for his viewpoint—and apparently the viewpoint expressed to him by governors—that in many cases, if not most, governors do not have the teeth, the influence or the ability to change things in the way they would like. My argument is very similar to the one we will expand on later regarding the abolition of the Healthcare Services Safety Investigations Branch and Healthwatch: the Government’s response to something not working as effectively as it could is to abolish it, but why not give those organisations the teeth—the powers—to achieve the things they were set up to do, unless the hon. Gentleman and the Government feel that there is no need, in Healthwatch’s case, for that level of independent scrutiny or, in governors’ case, that level of independent influence on boards?

There is a fundamental difference here: the Conservatives would take something imperfect and make it better; the Government’s response is to take something imperfect and abolish it. That is the wrong way round.

[Dr Johnson]

Does my hon. Friend think that this leaves a bit of a gap? The Secretary of State will not have the level of local oversight that the governors had, so how will that local oversight feed into the Secretary of State so that he or she can make the decisions instead?

[Gregory Stafford]

My hon. Friend is right that there will be a gap in local decision making on these issues. It goes back to that tension I described some moments ago: the Government’s stated intention is to devolve powers locally, but they seem to be pulling so much power up to the Secretary of State that we will lose the ability to make local decisions for the benefit of local populations where appropriate. We have a stated ambition for neighbourhood health, but those neighbourhoods are rapidly expanding in this legislation to become areas of millions of people. Local people who are interested in their local health delivery or local hospital trust would not see that as local decision making, and there is the gap that my hon. Friend describes.

I do not think that amendments 74 and 75 have been moved, so I will not talk about them. Government amendment 19 will require

“NHS foundation trusts to have at least one executive director who is a registered medical practitioner or a registered dentist and another who is a registered nurse or a registered midwife.”

As also stated in the explanatory note, and as the Minister mentioned, regulations may create exception—for example, for ambulance trusts. That is the right decision, and it is important that we have medical experience on foundation trust boards. I am interested in understanding from the Minister, first, why she has chosen a medical practitioner or registered dentist. Does she see some equivalence in their expertise that could be substituted? I have great respect for doctors and for dentists, but they have potentially different clinical expertise. If a foundation trust does no oral healthcare or maxillofacial reconstruction, and does no dentistry or allied specialties, would it really satisfy requirements to have a dentist on the board? Likewise, given that the amendment also refers to a registered nurse or midwife, if a trust has no maternity services, would having a midwife on the board really satisfy the requirement of that trust to have nursing care input? I ask those questions, and I would be interested in the answers.

Likewise, there is the exemption for ambulance trusts. Like my hon. Friend the Member for Sleaford and North Hykeham, I would be interested to understand from the Minister why she thinks ambulance trusts do not need a medical practitioner on their boards, given that they are doing medicine. Plenty of consultants work alongside paramedics and in ambulances, so again I am not quite sure why she is making that exemption. I would be interested to hear from her on that.

I understand the intention behind Liberal Democrat amendment 36. Once again, it is trying to soften the Secretary of State’s power grab over decision making—like the hon. Member for North Shropshire, I am not saying anything against the current Secretary of State, but a future Secretary of State could be different. The aim is to try to temper that in some way. Unfortunately for the hon. Member—I have sympathy for the amendment—the stated intention of the Bill is to pull more power to the Secretary of State. The Minister may surprise me, but I fear that the amendment will not find favour with the Government, because the whole Bill is about pulling more power to the centre, certainly when it comes to appointments, and to the Secretary of State.

However, the Minister should think about how future Secretaries of State may have to go through some process whereby their decisions are checked and justified, especially at local level. If we want local people to have influence and say over their local health systems and trusts, there needs to be some sort of bridging legislation or bridging process to ensure that whatever a Secretary of State decides, it has the confidence and support of local people and local service providers.

[Karin Smyth]

I think I am almost going to agree with the hon. Gentleman on his final point. It is important that local people have confidence in how their local systems are run and managed and, clearly, in the outcomes.

I will come first to the issue of governors and boards and then move to the amendments. I think we have all had emails, as is quite right, from local board members. Let me say, as I did earlier, that that is with good intent; they are very good people, who have given public service to be part of their local health system. As I said, this provision is no judgment on them; it is, as we heard, about effectively making the really important patient voice and patient experience central to the functions of the organisations delivering our healthcare. As I said in previous sittings, a debate will continue to be had about where we most effectively have that, but our intention throughout the 10-year health plan and this Bill is about devolution to providers and to ICBs and about making boards, as I also said in a previous sitting, responsible and accountable for the outcomes.

Let me outline broadly, because I think this is of interest to people, the impact on governance and the role that governors had. Just to be clear, since the creation of foundation trusts in 2004, NHS England—and, before it, NHS Improvement and Monitor—has had a statutory role to oversee the governance of NHS foundation trusts, including holding the whole board to account and taking steps where it identifies weaknesses in how foundation trusts are being run. The regulatory function is underpinned by the NHS provider licence, which will continue when NHS England’s functions pass to the Secretary of State. That is why we do not consider that the removal of the council of governors will have a negative impact on the governance of FTs, as some hon. Members have suggested.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Health Bill (Sixth sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Helen Morgan]

Yes, we would support the amendment, which is a reasonable way to get there, but an assurance from the Minister that the Department will consider specialist commissioning and really think that through properly before the powers are delegated to ICBs would be sufficient.

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

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

It is right that Ministers are ultimately responsible to the House for the performance of the health service and subjected to the scrutiny of Parliament for its execution, but there is an important distinction between accountability and operational control, which I fear the clause risks eroding in some cases. The national health service has over many years developed a structure that seeks to balance political accountability with operational independence, and that balance exists for a reason. Decisions on what services are commissioned, where they are delivered and how resources are allocated are not purely political judgments; they are complex, technical decisions that ought to be guided—primarily, in my view—by clinical evidence, patient need and professional expertise. Transferring commissioning functions directly to the Secretary of State, as the clause will do, risks drawing those operational decisions more directly into the political sphere, even if that would not happen in every case.

The more that Ministers are involved in determining which services are commissioned nationally and which are not, the greater the risk that over time those decisions will be influenced by short-term considerations and short-term pressures rather than long-term patient outcomes. Even when no such influence is intended, the perception that that could occur will be damaging. As I said in discussions on previous clauses, the NHS depends heavily on public trust, and that trust rests in part on the belief that decisions are being made in the best interests of patients and on the basis of evidence, rather than political expediency. We should therefore be cautious about any measure that threatens to blur that line.

Despite the Minister saying that the stated intent in the Bill is to decrease centralisation, the clause appears to move some parts of the system closer towards centralisation, rather than maintain that balance. I do not believe that the Committee should take that step without careful consideration of the potential consequences.

There is also a practical dimension to this issue. Under the clause, the Secretary of State potentially assumes direct responsibility for any and all decisions currently exercised at arm’s length. That raises legitimate questions about capacity and focus. As I said previously, the health service, as we all know, is vast, complex and complicated, and decisions, especially about specialised commissions, are technical and require detailed expertise and understanding. What is not immediately clear from the clause is that such decisions are best taken by the Secretary of State rather than by bodies with dedicated expertise and a degree of operational independence.

Both my hon. Friend the Member for Sleaford and North Hykeham and the Liberal Democrat spokesman, the hon. Member for North Shropshire, spoke about highly specialised services, where essentially there is a capacity issue and a need to be able to look at the demand as a whole. They both raised the danger that, if those commissioning decisions are taken at local level, those at that level may not have the expertise, the finances or indeed the capacity to truly understand those highly complex, low volume specific needs.

I have some sympathy for the Minister, because the danger that we have seen in the NHS is that everything becomes more and more specialised and the ICBs push it away. I understand why the Government are proposing some of these changes, but we must not throw the baby out with the bathwater. We must ensure that services continue to be commissioned by experts at the national level if they need to be; and that if they need to be commissioned by experts at ICB level or even more locally, it is done through the neighbourhood health schemes that the Government are pushing, which I support in principle.

For those reasons, if the Committee is minded to support the shift in responsibility, I suggest that we put in place some robust safeguards to ensure we have transparency, consultation and evidence-based justifications for decisions. Without those safeguards, there is a risk that the centralisation of power on the one hand and the devolution of specialist services on the other will unintentionally make a system that is less transparent and less robust.

That is why I support amendment 57 in the name of my hon. Friend the Member for Sleaford and North Hykeham. The powers in clause 12 need to be bounded by checks and balances, because these are not minor administrative changes, but a significant shift in responsibility. We must ensure that decisions to move service commissioning are made as transparently as possible. In those circumstances, it is entirely right that Parliament should be able to scrutinise those decisions.

The amendment would achieve that. Subsection (4A) would require the Secretary of State, before making regulations, to prepare and publish a commissioning transition plan and to lay that before Parliament. Subsection (4B) would require the plan to set out, in detail, the services being changed and the reasons for the changes. It would also require clarity on which bodies will assume the responsibility and why they are considered capable of doing so. That level of transparency is essential if Parliament is to exercise meaningful oversight. Subsection (4C) would establish a formal consultation requirement, and subsection (4E) would require the Secretary of State to publish a response to that consultation, setting out how concerns have been addressed. That is vital, because there is no point having a consultation if the Government just ignore it. Finally, subsection (4F) would ensure that no regulations can be made until a defined period has elapsed after that response, thereby providing a time for proper parliamentary and public scrutiny.

Those of us who sit on Select Committees, especially the Health and Social Care Committee, often receive responses to our recommendations from the Department that, as my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) said in evidence, give the veneer of acceptance, but then no meaningful action is taken. The amendment would allow meaningful scrutiny and ensure that the Government actually respond to that request.

Taken together, the provisions would ensure that decisions are not only made, but made openly, transparently and accountably to those who are elected in this place to represent our constituents.

[Liz Twist (Blaydon and Consett) (Lab)]

I wish to speak on clause 12 in the context of specialised commissioning. In my parliamentary work, I deal with a great number of rare disease communities and other specialised groups. Specialised commissioning is important to them to ensure that they get the service they need and deserve. Will the Minister explain how we can ensure that there is patient involvement in a more dispersed system of commissioning, and that there is national oversight and clinical leadership for all these things? How will she ensure that specialised commissioning groups are monitored and that effective services are being provided to those in the communities who need them?

--- Later in debate ---

[Dr Johnson]

Clause 14 is very straightforward: it states that schedule 1

“confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”—

perhaps most interestingly—

“contains other amendments relating to primary care services.”

Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services.

Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased,

“the whole or part of the ICB’s area”,

does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for example, an area that I represent part of, the local medical committee could not work in conjunction with the mayoral authority under this legislation, as far as I read it, because it essentially covers two ICB areas and two regions.

The mayoral authority is the Greater Lincolnshire mayoral authority. That includes Lincolnshire’s upper-tier area, the Lincolnshire county council area. It also includes the areas around Scunthorpe, Grimsby and Immingham, which fall into the Yorkshire region as opposed to the midlands region, and therefore not a whole or part of any given ICB area. I wonder whether the Minister has any comment on whether that was the intention, because it is also the case with paragraph 24(2) of schedule 1, which amends section 113 of the 2006 Act on local dental committees. Again, although the ambition stated and discussed in the Health and Social Care Committee yesterday by the Minister for Care, who is responsible for primary care, was that ICBs were to be covered at strategic level, that would not be possible for local medical committees or local dental committees under my reading of paragraph 12(2).

[Gregory Stafford]

Does my hon. Friend agree that this Bill would have been the perfect time to align health commissioning services with local government structures and that the fact that these structures are being created totally without the new local government structures is not just an oversight, but a potential problem with the whole Bill? Does she also agree—I think that she was outlining this already, but I want to ensure that the Minister is clear on it—that the Government still have a chance to amend the Bill to ensure that the commissioning structures and commissioning areas outlined in the Bill neatly map out to the new local government areas? In relation to, for example, the current Hampshire and Isle of Wight ICB, Hampshire is potentially being split up into a number of local government areas. I am against the way it is being split up, but if the Government are pressing ahead with it, this would have been the perfect opportunity to align commissioning with those areas. The problem is that we will now have a situation in which they do not match up, and the problems that my hon. Friend has outlined in her speech thus far will come to the fore.

[Dr Johnson]

Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation.

Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty—which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice—being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and bring things back into line with the new local authorities as and when it is decided what they will be.

Going on to the pharmaceutical arrangements—I should probably declare at this point that my brother is a rural dispensing GP—I share the concerns raised by the hon. Member for Bury St Edmunds and Stowmarket in relation to rural dispensing GPs. Let me give the Minister an example from my constituency. The Cliff Villages medical practice was an excellent medical practice. However, there was a doctor retirement and the illness of a doctor, and as a result the service reduced in quality quite substantially.

The ICB was working alongside the surgery and the one remaining practice doctor—not swiftly enough, it must be said. What happened in the end was that the Care Quality Commission came in, found that the service was really not good enough and closed the surgery down overnight, in the middle of the week. It was closed with immediate effect and there were no appointments for any patients in my constituency. Then, because the surgery had been closed, the ICB worked very hard to get a new practice in straightaway, and it got that opened on the Monday, which was pretty quick in the circumstances; but people lost their dispensing GP.

Living in a rural area—I have a dispensing GP myself, living in a rural area—people can go to the doctor’s, see the doctor and, if the doctor perhaps says, “You need some antibiotics,” they can go back to the waiting room and sit there for 10 minutes, be given the antibiotics and then leave. That is significantly more helpful to a rural constituent than having to drive eight or nine miles into the centre of town, park the car, find somewhere to get the prescription and then go all the way home again, which would take much longer. People really value that service—I saw how much when I held a public meeting with the ICB and the new provider to talk about what had happened at the surgery, and 250 people turned up to an evening event in the village hall at short notice. It is hugely important to people.

Will the changes allow the Secretary of State to step in in such circumstances, where the medical contract has been lost due to that cut-off by the CQC? Will that sudden loss of service be able to be replaced with a new dispensing service? Could Ministers have therefore given dispensing rights to the new provider? At the moment, those rights are not transferable, and it means that the only way that my constituents who live in that area and attend that practice can maintain dispensing rights is either to move house—perhaps to next door and back again, but they have to move house—or to change practice immediately, that same day, to another dispensing practice. To be honest, that seems ridiculous. Could the Minister make any comment on how the provisions in the Bill will help that situation and what her views are?

I am confused by new clause 23 and new schedule 1; the Minister has introduced them later than the rest of the Bill, but they seem quite significant. They would move pharmacy appeals from the first-tier tribunal to an NHS body specified by regulations made by the Secretary of State. I presume the regulations are not yet written, so we do not know what form that would take, but the first-tier tribunal is part of an independent judicial system and the appeals will now be under political control, within the Department.

Could the Minister explain why they think that is fair? Why do the Government want to do that? Is it just about saving money? How will the judgments made by that new authority be properly enforceable and give people confidence, given the change from the first-tier tribunal in the judicial system to something more politically controlled?

I move on to new clause 2, which would require the Secretary of State to establish within six months a scheme to give patients the right to a GP appointment within seven days of seeking one, or 24 hours if urgent. I would be interested to hear the Minister’s comments on that and how she thinks it could be achieved.

Modelling by the Health Foundation suggests that 6,500 full-time equivalent GPs—37,800 in total—will be needed by 2030-31 to meet greater clinical need. We have already talked about the doubling of medical school places; I presume the Minister has sought correction since we last spoke on whether the Government have a plan to double those places or not, but the Government are not on track to have that number of GPs. Is it simply that they do not have the resources to deliver it? I would be interested to hear the Minister’s comments.

--- Later in debate ---

[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.

[Gregory Stafford]

Will the hon. Lady give way?

[Helen Morgan]

I am going to make some progress, actually, because I think I am going to be asked the same questions.

[Gregory Stafford]

I wanted to ask a different question, but okay.

[Helen Morgan]

Well, I will just move on a little bit. The important question is: can this be achieved this overnight? Clearly not; we need additional clinicians in the service. The Liberal Democrat view is that the extra—I think 1,000 or 1,500—GPs that the Government have recruited so far is a welcome step forward, but that does not go far enough over the course of a Parliament.

As I was saying earlier, when patients cannot access their GP surgery, they end up, more often than not, in accident and emergency departments. That is no good for anybody. It overburdens the A&E department, leaves people who genuinely need urgent care getting a substandard level of care, and costs the NHS far more. We think it is really important that we put the resource in the right place.

--- Later in debate ---

[Helen Morgan]

Yes, I have thought about where that responsibility lies. It clearly lies with the triaging process within the GP surgery. I do not think any of us envisage somebody phoning up about a child with a cold and saying, “I consider this to be urgent,” and getting an appointment within 24 hours, but I would imagine somebody from the surgery saying, “Please describe the symptoms to me,” and then, if they detected something more serious, saying, “That is urgent and you do need to come in within 24 hours.” The point of new clause 2 is to clarify in the NHS constitution that some services require parity with others. We have already established legal rights under the NHS constitution for certain types of treatment, and this puts GP access on the same level. We think that that is important.

I am conscious of time, so I will move on to new clause 52, which is about dental deserts. Everyone is horrified by dental deserts and by “DIY dentistry”, a phrase that means—let us face it—people using pliers to extract their teeth and super glue to reattach crowns, and cavities filled with household adhesives. More than 5 million children did not see a dentist at all in 2025. That is a stark failure. Dental care is as important as care for other parts of the body, in particular when most of what goes wrong in dentistry is preventable. We should absolutely focus on prevention, and that is in line with the Government’s aims to move from sickness to prevention.

New clause 52 is about our £750 million dental rescue plan to guarantee access to an NHS dentist for anyone needing an urgent or emergency appointment, which I hope would end that awful DIY dentistry. The plan needs to be achieved through bringing dentists back from the private sector, fixing the contract, using flexible commissioning wherever necessary and introducing an emergency scheme. For example, the emergency dental scheme in Shropshire, operated by the community dental practice, enables people who have urgent need and cannot register with an NHS dentist to get the care that they need when they need it. I urge the Minister to take our new clauses on board and to ensure that people get the care they need when they need it.

[Gregory Stafford]

I will start where the Liberal Democrat spokesman, left off, with new clause 52 on dental provision. I have a lot of sympathy for what she is trying to achieve with the new clause. In my own constituency, as far as I can tell, looking earlier today, not a single dental practice is taking new NHS patients for dentistry, whether that be children or adults, and that is extraordinarily concerning.

Even more concerning—this somewhat relates to the changes that the Government are making in the clause through bringing the commissioning of dental services to ICBs—I have a fully equipped and fully functional dental surgery in Haslemere hospital in my constituency, but it has remained entirely unused for a number of years, because it sits within the hospital, which is run by the Royal Surrey NHS trust, but is commissioned by the ICB. That seems like an utter waste of resources. That is something that could be clarified through new clause 52 and, I hope, through the clauses tabled by the Government.

On new clause 2, about GP practices, I am disappointed that the hon. Member for North Shropshire did not want to take my intervention because she will not be able to answer my questions, unless she intervenes on me now, which I hope she will. Again, I sympathise entirely with what she is trying to achieve. We want to ensure that people have timely access to their GPs. I am sure that, like me, she has constituents who cannot get a GP appointment in any reasonable time. They can wait numerous weeks, upwards of five or six weeks, for something that they should be seen about.

A lot of questions are unanswered by new clause 2, however. I will not repeat the questions asked by my right hon. Friend the Member for Melton and Syston and by my hon. Friend the Member for Sleaford and North Hykeham, but I have some others. For example, the new clause states that the Government must

“establish a scheme to provide every patient with the right to a GP appointment”.

Although the hon. Lady clarified that that could be a telephone consultation, what is not clear is whether that is an appointment at the named GP practice at which the patient is registered, or is just with any GP, through something such as the NHS 111 service.

[Helen Morgan]

I would like to clarify that point. We envisage that being at the GP with whom the patient is registered. Our broader policy, which is not included in new clause 2, is to have named GPs for people with complex conditions and complex comorbidities. Absolutely, we would envisage that as being a part of the continuity of care, which is so crucial.

[Gregory Stafford]

That is a helpful clarification, but it raises a number of other questions. I entirely agree with the hon. Lady that named GPs are most appropriate; all the clinical evidence suggests that even for people with non-complex needs, having a named GP whom they can see regularly improves patient outcomes. I therefore support her on that, but does she believe that we currently have sufficient GPs for that to go ahead? Even the six-month lag in her new clause would not be enough time to recruit thousands more GPs. If she does not believe that there are enough GPs at the moment, when does she envisage that they would be in post? How much would that cost? Where would she get the money to fund those extra GPs? Rather than just expressing what I would call “motherhood and apple pie” statements about things that we all want, we in this House have a duty to be honest with our constituents about how we would achieve them—and, if we have to achieve them within six months, what funding and impetus will have to be put in place.

[Helen Morgan]

Let me clarify. The new clause is about conferring a duty on the Secretary of State to provide that level of care. It would require a significant number of additional GPs, and that would cost a lot of money. The Liberal Democrats’ 2024 manifesto had a fully costed pledge to recruit and retain an additional 8,000 GPs within the course of a Parliament. I think we can all agree that the world has moved on since then, but the hon. Gentleman will be aware that this week we proposed a significantly closer relationship with the European Union, which would grow our economy, increase our tax base and pay for a number of these things without having to subject people to additional, onerous tax hikes.

[Gregory Stafford]

I think that clarifies that there is no real concrete plan for how to fund this new clause. I do not mean in any way to demean what the hon. Lady is trying to achieve, because she is trying to achieve something important, and which we all want, but we have to be honest with our constituents about how we can do that, and some ethereal money to come through some ethereal plan at some point in the future—

[Helen Morgan]

Will the hon. Gentleman give way again?

[Gregory Stafford]

Let me finish this point. I am not in the mind of the current Prime Minister, and I am certainly not in the mind of the potential next Prime Minister, but even if the hon. Lady is right my understanding is that he—either is probably a he—is unlikely to have changed our relationship with Europe within six months.

[The Chair]

Order. We are straying slightly into a debate about European matters. Can we stick to the amendments before us, please?

[Gregory Stafford]

Thank you, Ms Lewell. You have certainly saved me from myself, if not anybody else. I think I have belaboured the point; I will leave it there. I sympathise with and indeed support the ambition of new clause 2, but I have a real problem with the lack of detail on how it would be achieved.

I turn quickly to clause 14. As my hon. Friend the Member for Sleaford and North Hykeham said, it has bits that we welcome, but there are some concerns about how the ICB structures fit over the local government structures, and cutting ICB administrative budgets by 50%, while asking them to take on more power and responsibility for commissioning services and many other things, is a real problem.

Likewise, we have welcomed, and I think both sides of the Committee agree, having neighbourhood health—however we want to describe it—and care closer to home, and having commissioning closer to home. It is therefore strange that my best performing ICB, Frimley ICB, has been abolished or merged with a number of other ICBs that have been performing far less well.

If the Government want to have the principle of place-based, locally responsive commissioning, they have to have a real focus on, actually look at, what fits with the current structures and to ensure that those ICBs that are performing best are encouraged and kept and that those that are not are dealt with. I have real concerns about, for example, the superstructure of the new Surrey and Sussex ICB. It is huge and, essentially, entirely antithetical to what the Government were trying to achieve by making stuff local—closer to home.

[Dr Johnson]

One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.

[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.

Health Bill (Fifth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Sir Roger. I agree heartily with the shadow Minister, and a couple of other things concern me about clause 8.

On the one hand, the clause appears to bring more centralisation, but on the other hand it pushes things down to an ICB level at the same time. I am worried that if we have individualisation of ICBs, we will only exacerbate the disparity of services across regions. I would be interested to understand from the Minister how the Secretary of State’s functions will allow the independence of ICBs and, where an ICB understands its local population well, ensure that patients do not end up in a postcode lottery based on which ICB area they happen to live in.

The danger here is that if the Bill does not deal with those problems and close regional gaps, it is not immediately clear from the clause how the Secretary of State could intervene to ensure that ICBs have the autonomy to make decisions based on their local populations and ensure at the same time that patients do not receive a worse service just because they happen to live in one ICB area rather than another.

[Karin Smyth]

I recognise that this is a subject of some debate; we may discuss it further when we come to the part of the Bill on ICBs. The abolition of NHS England and transferring all its functions to one body has a consequence, which is that the Secretary of State retains that accountability and power. We are keen to have that power clear but flexible in order to empower local systems. That remains the intent.

The power is necessary for the Secretary of State to update national commissioning standards, for example. The ICBs will have wider roles as strategic commissioners. We expect them to take on formal responsibility for a number of services delegated by NHS England. That allows us to issue a common set of commissioning standards, on the point made by the hon. Member for Farnham and Bordon about variability in different places. There need to be common standards across the piece: eligibility criteria, the treatments the provider should use, and national reporting requirements. ICBs having those standards means that there will be a reduction in unwarranted variation in some of these events.

The shadow Minister raised the timetable. The Opposition will recognise that there needs to be flexibility for the Secretary of State and Ministers to respond to unforeseen or changing events. That is why it is purposely broad, because the range of events that can impact the NHS is clearly very broad. We cannot predict the future.

The hon. Member for Farnham and Bordon said that the Bill needs to deal with all these problems. The Bill needs to give enough flexibility to the system and devolve as much power to the system. The Bill needs to make sure that the powers are in the right place, but it is for the local systems to respond to their local needs within that framework. They will be held accountable, for example through the NHS oversight framework and through ICBs’ normal accountability frameworks.

--- Later in debate ---

[Dr Johnson]

In a system as large as the NHS, covering an area as diverse as England, it is necessary that the Government be able to deal with unexpected situations. The pandemic may be half a decade behind us already, but the Committee will remember that the previous Government had to act quickly and part with a lot of money in a short time. In such instances, it is essential that Ministers have the power to provide financial assistance. It is not only about crises, however; ordinarily, there are occasions when a Government will want to roll out a new prevention programme or address deficiencies in care in particular areas. I know that health policy is always evolving, and the case for flexibility is clear. The Health Secretary may need to be able to provide financial assistance in pursuit of supporting the health service.

I am sure that hon. Members are familiar with the existing legislation. Section 12D of the National Health Service Act 2006 gives the Secretary of State, NHS England, an ICB or the local authority the ability to make direct financial payments as an assistance to persons or bodies. Clause 9 would new section 12DA of the Act, under which the Secretary of State would be empowered to provide assistance to any person or body carrying out, or proposing to carry out, activities that they deem beneficial to the service.

This is where semantics are important. The existing legislation allows the Secretary of State to make payments, but clause 9 is different: it would allow the Secretary of State to provide financial assistance and to make available persons employed by the civil service or any other resources that the Secretary of State has. This is a remarkably open-ended power that would allow the Secretary of State to spend taxpayers’ money while bypassing standard scrutiny. When NHS England spends money, there is transparency: the public can see how much has been spent on different types of care, ranging from hospitals to public health programmes. The public can see how much money has gone into trusts, into the independent sector and into procurement.

Transparency builds trust in the system and disincentivises wasteful spending. Where will parliamentarians or the public be able to see the financial expense of civil servants, or literally any other resource that the Secretary of State may offer in support? For the first time, the Health Secretary will have the power to insert politically directed civil servants into elements of the health service that are not under public ownership.

As clause 9 is drafted, the Secretary of State could provide civil service labour to private or mutual health providers that work within the NHS. Will the Minister elaborate on how that would be used, and how it would be beneficial to the taxpayer and the health service? The number of civil servants taking home more than six figures has increased under this Government. Their time should be focused on delivering public services, not propping up providers, especially ones that are private businesses.

It is also unclear where the legal liability lies under such arrangements. If something goes wrong and the human resources provided by the Secretary of State are responsible, is the Secretary of State responsible or the entity into which those staff have been inserted? Can the Minister clarify that?

It may be politically beneficial in the short term to provide state support, but it can be costly to the public purse and damaging to markets in the long term. By allowing the Health Secretary to issue assistance in the form of free civil servant labour, clause 9 effectively creates a new type of off-the-books subsidy. How can Members of the House or NHS providers tell whether assistance is operational support or a de facto subsidy? It could undermine the idea of a level playing field for firms contracted to deliver NHS services.

There is also the question of when assistance crosses from operational support into running a provider or firm. We do not necessarily want to be in a position where the Bill is used to bail out failing private firms with NHS contracts. I return to the phrase

“any other resources of the Secretary of State”.

It is difficult to understand why the legislation was written in this way, allowing financial assistance, the provision of labour, and then the use of absolutely any other resource at the Health Secretary’s disposal. As with several other provisions in the Bill, it seems another sign that the legislation was rushed. Instead of circumscribing power tightly where it is needed, the Bill gives huge sweeping powers while claiming that it decentralises.

The Minister has described clause 9 as a discretionary power intended to support the effective functioning of the health service and its workforce. Although that may be what she sought to achieve, that is not the reality. The clause paves the way for arbitrary and unaccountable deployments of state resources, and that should concern all hon. Members.

[Gregory Stafford]

I endorse the comments made by my hon. Friend the Member for Sleaford and North Hykeham.

I am particularly concerned about subsection (2)(a) of proposed new section 12DA. On examination, this provision raises significant concerns about the control of public expenditure and the efficient use of resources within the health service, and I find it rather vague. There is no definition of the terms used, no indication of scope and no express limitation on how the power is to be exercised.

When read together with subsection (1) of proposed new section 12DA, the effect, as I read it, is to allow the Secretary of State to provide funding to an extremely wide category of recipients. That includes not only public bodies and established NHS providers but, as my hon. Friend the Member for Sleaford and North Hykeham has said, private entities, charities, individuals and any person engaged in activities that the Secretary of State considers to be beneficial to the health service.

That breadth is not accompanied by a corresponding statutory safeguard. The clause does not set out criteria for eligibility, priorities for funding or principles to guide decision making. It does not impose limits on the sums that may be disbursed, nor does it require any structured process for allocating funds. There is no express provision for transparency, such as publication of decisions or reporting obligations to another body such as Parliament. That absence is significant.

Control over public expenditure ultimately lies with Parliament, yet the clause delegates a wide and flexible spending power to the Executive with little direction as to how that power is to be exercised. While it may be said that Treasury rules, audit requirements and general public law principles continue to apply, those are external controls and they do not substitute for clear statutory discipline within the provision itself.

The practical consequences of such a broad power need to be considered. The NHS is already under considerable financial strain; as we all know, demand is rising and resources are constrained, and there is a continuing need to ensure that funding is allocated in a way that delivers measurable improvements in outcomes. In that context, certainty, prioritisation and efficiency are essential. By framing this power in such open terms, the clause risks undermining those objectives. It will create the possibility of fragmented funding decisions, with resources distributed across a wide range of initiatives without clear and consistent frameworks, and it may lead to duplication of effort or to supporting projects with benefits that are uncertain or difficult to evaluate. Without clear criteria or structured oversight, it will become more difficult to ensure that funding is directed to the areas of greatest need.

--- Later in debate ---

[Dr Johnson]

This is perhaps the oddest provision in the Bill. Since time immemorial, the Labour party has accused its political rivals of wanting to privatise the health service. In the early 2010s, the then shadow Ministers indulged the idea that the Health and Social Care Act 2012 was a Trojan horse for privatisation. Several years later, after the Minister had herself joined the House, claims continued. The then leader of the Labour party urged the previous Government to

“undo the very damaging privatisation of so much of our NHS”. —[Official Report, 23 October 2019; Vol. 666, c. 960.]

In the 2019 election, the public were even presented with a dodgy dossier—not Labour’s first—that purported to show that the NHS was on the table in negotiations for a trade deal. We now have a trade deal and the NHS is still intact.

Even though Members know full well that no sensible opposition party is advocating for abandoning our NHS system, they keep saying that Governments have been selling off the health service through the back door. Today, private providers deliver only about 10% of NHS care and the system continues to be free at the point of use.

That brings us to the deep irony of today’s debate. After years of peddling the NHS privatisation myth, the Labour party has introduced legislation to make privatisation possible. The Health and Social Care Act 2012 inserted a safeguard against privatisation, section 12E, into the NHS Act 2006. That section prohibits the Secretary of State from exercising his functions for the purpose of “causing a variation” in the proportion of services provided by the public or the private sector.

Clause 10 substitutes the text in that section and makes two small but significant changes. The first change is to expand the type of providers beyond public and private to

“different kinds of legal entity”.

That is probably a good change, because it encompasses the mutual and voluntary sectors, which do have an important role to play in health provision going forward.

The second change is what has caused alarm. The Secretary of State cannot alter the provider mix unless they deem it to be

“in the interests of the health service.”

Could the Minister set out some scenarios when it would be deliberately beneficial to privatise provision or, indeed, when it would be beneficial to deliberately nationalise provision? I cannot recall an instance where Ministers needed to privatise an entire service to ensure patients did not lose access to care.

In February, the Minister of State for Secondary Care told the House that lessons had been learned from private finance initiatives. Yet the Government announced that 80% of neighbourhood health centres will be privatised through public private partnerships. The Government are able to use these partnerships to loan money outside their limits, but it tends to be more costly than public sector borrowing. Essentially, it is borrowing, but not borrowing on the balance sheet.

What is the effect of these private initiatives? I remember receiving my own office on being promoted as a doctor to consultant. It is quite an exciting moment; before that, resident doctors share an office. I had my own space, my own desk, my own computer and a big whiteboard for notes. When I asked whether I could place the whiteboard on the wall, I was told I could not—it was £800 to stick it on the wall under the private finance initiative contract.

So my great big whiteboard sat there, propped against the wall. Periodically, I would move a piece of paper, knock the bottom of the whiteboard and it would tip and fall on me when I was sat at my desk. I did suggest putting it up myself, but that would also incur a charge through the PFI contract—for modifying things without getting them to do the modifications—so I just had to sit there with it propped up against the wall, ad infinitum.

The Government are on the hook for more than £100 billion of payouts, simply for the use and maintenance of PFI facilities. The Labour scheme was a shambolic waste of taxpayers’ money that could have been spent on improving care. When my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) asked the Minister about public private partnerships, she told him she was

“very proud of the capital investment under the last Labour Government”.—[Official Report, 4 March 2026; Vol. 781, c. 386WH.]

But is clause 10 simply a mechanism for Ministers to develop further private finance initiatives? If Government spending is under pressure, may Ministers seek to shift provision even if it proves more costly in the long run?

There is another side to the conundrum of clause 10. Instead of a Health Secretary intent on privatisation, what if we get one intent on squeezing out private sector provision? Who our new Prime Minister will be, we do not know, but one of the candidates has called for the country to abandon 40 years of neoliberalism. Perhaps the Minister could elaborate on what that means, since the tax take as a percentage of GDP is the highest it has been in 40 years. To me, it signals a potential hostility towards choice and competition. We do not want to be in a situation in which the decision is made to alter the provider mix in service of ideology, rather than in the best interests of patients.

I am aware of several private firms that provide services to the NHS and are concerned that clause 10 could be wielded against them. If a future Health Secretary decided to reduce private provision on the basis of ideology, what would happen to the 10% of planned activity that is currently delivered by for-profit entities? NHS providers could not feasibly handle such a surge in demand, waiting lists would increase further, and patient choice would suffer. It would also be expensive. If private providers fear that the NHS is no longer a reliable customer, and that they may suddenly lose their contract if this clause is invoked, they will charge a risk premium on their services—that is what firms do when they face shifting regulatory goalposts. That would only damage the public purse.

Under clause 10, it would be legally possible for the Health Secretary to alter the provider mix. As a result, it would be worth it for several types of providers and ideologically motivated groups to spend vast sums of money hiring lobbyists to convince Ministers that their sector deserves favourable treatment and that they serve the interests of the NHS. Organisations would invest less in resources and more in influencing the rules, which is not a good outcome either.

All those issues are compounded by the fact that clause 10 is imprecise. What does the Minister define as

“the interests of the health service”?

I am not trying to catch the Minister out; I just want to illustrate the problem with legislation drafted in such terms. It is difficult to prove that the Health Secretary has not acted in what they thought were the best interests of the health service. What could that refer to? It could refer to the interests of patients, to the interests of NHS staff or to the financial stability of the health service—it is entirely subjective. What is the health service there for? It is there for patients, which is why I tabled amendment 53.

Amendment 53 would revise clause 10 to specify that the Secretary of State must not alter the provider mix unless doing so is in the interests of patients. I would like to place patients at the centre of the Bill’s changes, in recognition that we do not have the numbers on the Committee to change the clause altogether. My revision would make it harder for the Health Secretary to justify altering the provider mix if it harms patient access or reduces their choice. It would make NHS providers less fearful to know that the Health Secretary would be subjected to a better defined legal threshold.

[Gregory Stafford]

The shadow Minister has outlined a couple of hypotheticals for the future, when we have a different Prime Minister and a different Secretary of State. One might go down a route of more privatisation, another down a route of removing the private sector from health service provision. My concern is more practical and for the here and now: if the clause stands part of the Bill, it must be because the Government have some desire to do one of those two things now. Would it not be a good idea to hear from the Minister which of those two options it is?

[Dr Johnson]

It does raise questions about the point of new section 12E. That provision was not there before; there must be a reason for adding it. Either the Government want ideologically to reduce the amount of private provision in the NHS, or they want to increase it. The clause gives them the power to do both.

Labour politicians very often tell the public that the NHS is being privatised. Data has shown that that is not happening, but that did not matter; they found the myth politically advantageous and repeated it ad nauseam. Now, the Minister and her colleagues are in office—they have the levers of power—and are proposing to change the law to make it easier to change the provider mix. That is not only ironic but deeply misguided.

I tabled amendment 53 to require any changes to the provider mix to be in the interests of patients. If the Minister is unwilling to support that, will she offer a compelling explanation why? Clause 10 has alarmed stakeholders across the health sector and the political spectrum. That really ought to tell us something. I look forward to her response.

--- Later in debate ---

[Gregory Stafford]

I want to take the Minister back to her rejection of the amendment of my hon. Friend the Member for Sleaford and North Hykeham on the basis that—I paraphrase—she felt the definition of “patients” was too limiting because it would not count people who had not entered the health system at that point. The clause itself, however, refers to the benefit for the health service. Is the Minister suggesting that the health service, as defined in the Bill, includes what happens before people enter what I would describe as the health service? Is it something before that point? She seems to be saying that our definition is too narrow, but her definition in the Bill must apply to those who have entered some kind of formal setting. Or is the health service wider than that?

[Karin Smyth]

I refer the hon. Gentleman back to my comments. The health service is defined under section 1 of the NHS Act 2006 as not being separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness—so, yes.

At this juncture, I will explain a number of other features of the clause. In particular, I draw the Committee’s attention to the fact that it builds on section 12E of the 2006 Act to cover the Secretary of State’s health functions, powers and duties. It recognises that, with the abolition of NHS England, the Secretary of State has a far more substantial role to play—as a commissioner of services, for example—than previously. I also put on the record that whenever the Secretary of State takes a decision in this space, the general NHS procurement requirements and other statutory duties will continue to apply.

Finally, the NHS relies on privately owned providers, as well as charities and community organisations, to provide a range of important NHS-funded services across the country. As such, it is important to ensure that, where there is a mixed-market provision between public and private for providers of a particular service, the Government’s powers are not used to distort the provision and potentially discourage important investment from outside the NHS. Conversely, they should not be used purposefully to favour independent providers over NHS providers for reasons unrelated to the quality or efficiency of NHS-funded healthcare.

--- Later in debate ---

[Gregory Stafford]

I rise to support amendment 47, tabled by my hon. Friend the Member for Sleaford and North Hykeham, and to ask a few questions about clause 11. I completely understand the thinking behind the clause. The Secretary of State for Health and Social Care is probably the most politically impotent of all Secretaries of State: as my hon. Friend said, they pull levers and not much seems to happen, because they do not have the control over the health service that the public think they do—or indeed, that Members of Parliament think they do, judging by the number of us who stand up and demand that the Secretary of State do things in our local areas.

I understand the Government and the Secretary of State’s desire to change some of that, but there is concern about the potential politicisation of NHS leadership. Integrated care boards were established in various forms under the Health and Social Care Act 2012 precisely to remove politicisation to ensure that decisions in our healthcare service were made for the benefit of patients on the basis of clinical evidence and the needs of the local population, not on the whim of any Secretary of State or Minister. More importantly, ICBs were brought in to make sure that local health systems, local authorities, clinicians and communities made decisions based on local need.

Those politically independent ICB chief executives were expected to exercise professional judgment, make difficult decisions about priorities and resources and sometimes deliver messages that Ministers, and indeed local Members of Parliament, found uncomfortable. If those leaders know that their continued employment ultimately depends on the confidence of the Secretary of State, there is a real risk that the independence of their judgment will be weakened and that patient safety will diminish.

The amendment tabled by my hon. Friend the Member for Sleaford and North Hykeham tackles a core question: should an ICB chief executive focus solely on what is best for patients and the local health economy, or should they have to consider whether their decisions may attract ministerial displeasure? Even if the power is rarely used, and even if, as my hon. Friend said, there are currently some guardrails in the clause, its existence will change behaviour—it must do. Leaders will become more cautious, perhaps more risk-averse and potentially less willing to challenge national policy when local evidence points in a different direction.

ICBs have benefited from the ability to speak truth to power. A system in which senior NHS leaders fear dismissal by Ministers risks discouraging precisely that kind of honesty. Do not get me wrong: there are good ICB chief executives and bad ICB chief executives, ones who understand their role well and ones who feel that they do not need to engage at all with their local communities. I have a very good ICB in what is currently Surrey Heartlands, soon to be a larger organisation, and an ICB that does not do the job as well—I will not name it, but any student of geography will be able to work out which one it is.

Secondly, excessive ministerial power blurs the lines of accountability. The Minister, in her defence, has argued that Ministers need powers because Ministers are accountable. I get that argument, but one of the most important principles of effective public administration is clarity of responsibility. If the Secretary of State gains extensive powers to appoint and dismiss local NHS leaders, it will become increasingly difficult to know who is actually responsible for outcomes. When performance improves, Ministers will claim credit; when performance deteriorates, local leaders may be blamed. If Ministers possess the power to select and remove those leaders, they will inevitably become more directly responsible for those management decisions, so far from increasing accountability, this might dilute it by creating uncertainty about where true authority lies.

Thirdly, there is a constitutional concern. Whether one likes it or not, the previous Act created a balance between democratic accountability and operational independence. Parliament rightly determines the funding, priorities and legislative frameworks, and Ministers rightly set national policy, but operational decisions have been made by healthcare professionals and the statutory bodies established for that purpose. That distinction exists for a good reason. No Secretary of State, regardless of ability or commitment, or indeed their own background in the health service, can personally manage every NHS organisation in England, and I do not think they should. The more powers we concentrate at the centre, the greater the temptation for Ministers to become involved in operational matters that are better addressed through professional expertise and local knowledge. My hon. Friend’s amendment seeks to preserve that distinction in a singular and precise way. It recognises that Ministers should govern the NHS and be held accountable at the top by us as Members of Parliament and our constituents, but should not seek to manage every aspect of it.

Fourthly, there is a practical problem. Supporters of ministerial intervention often point to examples of failure and ask what should happen when an ICB is underperforming. That is a fair question, but the answer is not that the Secretary of State must personally possess dismissal powers. A range of mechanisms already exist: ICB boards have governance responsibilities; NHS England has oversight powers; professional regulators oversee the conduct of clinicians; there are provisions in employment law for procedures when it comes to misconduct and capability issues; and auditors and inspectors can identify failings. It would be far better if the Bill strengthened those provisions to ensure that accountability was brought forward, rather than giving the Secretary of State the ability to fire and hire as he or she sees fit.

Of course, none of those mechanisms of accountability will disappear if amendment 47 is adopted. The amendment would not create any kind of immunity from accountability; it would simply ensure that accountability is exercised through the established governance structures, rather than through direct ministerial intervention on a chief executive. Indeed, one might ask whether a Secretary of State is really the best person to assess the performance of an individual ICB chief executive. Such judgments often require detailed understanding of local service pressures, workforce challenges, demographic factors, financial constraints and so on. Those are matters better evaluated by individual organisations with operational expertise than by politicians operating at national level.

Fifthly, I think the clause as drafted would present a risk to recruitment and retention. The NHS already faces significant leadership challenges. Senior leaders are expected to manage enormous budgets, oversee complex organisations and make difficult decisions under intense public scrutiny. If we create a system in which their tenure can ultimately depend upon ministerial whim, we may deter talented individuals from seeking those positions. As my hon. Friend said, the NHS needs leaders who are willing to innovate, take calculated risks and make difficult long-term decisions. It does not need a culture in which leaders are constantly looking over their shoulder, wondering whether a politically controversial but clinically necessary decision could threaten their position. Strong organisations attract strong leaders when governance arrangements are stable, predictable and professionally driven. They do not attract them through uncertainty and political intervention.

Sixthly, we need to consider the precedent being established. Powers granted to one Secretary of State are inherited by the next, as the hon. Member for North Shropshire said. Members may trust the intentions of the current Minister—I certainly do. They may also believe that these powers would be exercised responsibly—and at the moment I think they would be. However, legislation must be judged not on how it is going to be used by one individual, but on how it could be used by any future holder of the office. Therefore, the question is not whether the current Secretary of State or Minister would misuse the power, but whether Parliament wishes to establish a framework in which future Secretaries of State possess the ability to remove local NHS leaders whose decisions, views or priorities may conflict with their political objectives. That is a much more serious question.

Finally, we must remember what ICBs were trying to achieve, even if we do not think that they have achieved it or performed in the way that we wanted them to. If we go back to the principle of why they were set up, they were designed to encourage collaboration rather than some sort of command-and-control structure. They were intended to bring decision making closer to patients and communities. They were established to support long-term planning across local health systems. Those objectives, I am afraid, are very difficult to reconcile with a model in which local leaders remain subject to direct ministerial dismissal. Partnership working flourishes when organisations have confidence in their independence and responsibilities. It is weakened when authority is increasingly concentrated at the centre.

For all those reasons, I believe that amendment 47 in the name my hon. Friend the Member for Sleaford and North Hykeham raises an important principle. It is not about protecting poor performance or shielding individuals from accountability; it is about ensuring that accountability is exercised through proper governance structures rather than political control. Expanding ministerial powers to hire and fire local NHS leaders risks undermining all of those principles.

[Karin Smyth]

We have a clear political and—as I think the hon. Member for Sleaford and North Hykeham said—philosophical division here. This Government believe in democratic accountability, in politics and in good government. I understand that both Opposition parties were architects of the 2012 Act, which created this huge, independent body to run what has become a £200 billion service that clearly has not worked, and that they want to hold on to some of that, despite not opposing the Bill on Second Reading and, actually, not really opposing the abolition of NHS England—I think we will keep returning to that—but we believe that, ultimately, the Secretary of State needs to be accountable for the service, which is not working as the British public deserve or expect.

The hon. Lady asked me to go into good variation and bad variation. Our drive has been to understand the variation. I know from Members of Parliament who have come to me in the past two years, and we understand from looking in detail at the variation across the service, that there is often no rationale for the variation. Local people do not understand why services work better in one part of their county, even, than in another. The hon. Member for Farnham and Bordon alluded to that when he mentioned some places in his area that are working better than others. That is why—and I personally wanted to drive this very strongly—we are getting more information out, releasing the outcomes framework and releasing information to all Members of Parliament about where and how the current data shows their local systems are performing. That is what local people need, and in my view good local parliamentarians, of whom there are very many, should be able to go back to talk to their local systems and chief executives about why that is—not to berate them, but to understand it. There might be a very good cause for the variation; there might be structural reasons or geographical reasons, and they might be long-standing reasons. That is what we seek to do in order to regain the trust and confidence of the British public, and that is why we are publishing those documents.

I stand by my comments that my approach is more local than centralised. This is about changing the culture, which we seek to do by making that happen more locally. I absolutely get the points about operational freedom and the balance that we will seek when we release the operating model, which is being worked on in the Department, as we bring the new system into being, alongside the Bill.

However, we want to be very clear that when an ICB has failed or is at risk of failure, and that failure is significant, it is right that the Secretary of State has the tools to minimise the impact on patients and the public and to act swiftly to put things right. The public rightly expect that, in such circumstances, Ministers will take the necessary steps to protect patients, taxpayers and the public. In some cases of significant failure, that may include directing an ICB and removing the chief executive.

I am sure that all Members here today will agree that effective performance management of ICBs will continue to be essential once NHS England is abolished, not only to support the provision of a quality service, but to reassure the people served by ICBs that when things go wrong, they will be put right.