Health Bill (Fifth sitting)

Helen Morgan Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason.

As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences—a bit like the deregulation of buses. In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers—that has worked well to bring down elective waiting lists, for example—the provisions to protect the mix are important.

I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.

[Peter Prinsley]

It is true that the situation in ophthalmology is now quite serious, but is the hon. Lady aware of the problems in radiology and pathology? Some hospitals are unable to recruit histopathologists or significant numbers of radiologists, who provide key services, because the personnel necessary to run those services have been attracted into a private system, although they are contracted to the NHS. That jeopardises the ongoing services for urgent and emergency care.

[Helen Morgan]

The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence.

Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?

[Karin Smyth]

I will respond to that question before picking up the other comments. If I do not address all the Committee’s comments, I will come back to Members.

Everyone would expect this, but let me be clear: this Government are absolutely committed to a free-at-the-point-of-use, taxpayer-funded service. We also think that unless it is reformed and changed, it is an existential problem for the British public, who will not continue to support the service. As Members know, one Parliament can never bind another one, so I cannot predict what a future Government will do. There is talk from some of our Reform colleagues about an insurance-based system. There are people who were in the Conservative party but have moved over who think that, so obviously I cannot—

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The gap between what was promised and what is being offered has left the British public wondering: did the Labour Government really believe that power was too concentrated, or that power was concentrated in the wrong hands? I hope the Minister will enlighten us.

[Helen Morgan]

I mentioned in Committee last Thursday that the Liberal Democrats are worried about the risk in the Bill of political capture and the Secretary of State’s ability to meddle in day-to-day operations. As I am sure the Minister is aware, speaking at the NHS ConfedExpo this month, Sir Jim Mackey, the chief executive officer of NHS England, warned that the Bill may give Ministers too much control and that there has to be operational freedom; otherwise we will grind to a halt.

I want to probe the process by which we got to this point. Originally, there was discussion about whether the seven NHS regional teams should become independent arm’s length bodies to mitigate such a risk. NHS leaders argued that this would mitigate the risk of direct political control of the service and pointed out that the 10 regional strategic health authorities had played a useful role in running the service efficiently before the creation of NHSE. That proposal was rejected by Ministers, and it is not entirely clear why. I am interested to hear the Minister’s view on that.

It is now being reported that a fresh attempt is being made to argue that regional teams should be hosted by an NHS organisation—probably an ICB—to protect their employment terms and, as staff would remain public rather than civil servants, provide some brake on political control. Can the Minister shed any light on all this? Does she recognise the importance of maintaining operational freedom in NHS decision making?

We have discussed the reality that current Parliaments cannot bind future ones, and I take that point on board. However, current Parliaments do set precedents and establish the legal frameworks within which future Governments initially operate until they change the law. With the potential for more extreme Governments, there is a risk of discrimination and political considerations entering what should be clinical decision making—for example, decisions on whether to place a trust into special measures or what services are offered, such as sexual health, IVF, outreach to migrant communities and so on.

We are concerned not about the current Secretary of State, or indeed the shadow Secretary of State, but about the risk of those sweeping powers being placed in the hands of an extreme Government. If we imagine for a moment that an incoming Government decided that they did not approve of diversity on an NHS board, for example, and replaced an executive with their own candidate, that would be a horrifying situation. I think we would all agree on that. It would be useful to include safeguards now and set a precedent that such action would not be acceptable under this Bill. Notwithstanding the fact that a future Government could come along and change that, they would have to be transparent about their reasons for doing so.

The former Health Secretary, the right hon. Member for Ilford North, claimed that he was taking powers back into DHSC in order to give them away to the system, but this Bill has a lot on taking those powers and very little on giving them to the system. How can we be sure that that will actually happen on the ground, and that ICBs, hospital trusts and other health trusts will have the opportunity to flex their local muscle and ensure that services are best shaped for the local population? The NHS Alliance has called for an operationally independent regulatory function in DHSC to oversee NHS organisations, or for an independent panel to make appointments. Will the Minister consider such practical changes to ensure that political capture is not an unintended consequence of the Bill?

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[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.

[Helen Morgan]

I could not agree more with the Minister that when there is an obvious failure, either in a local system or in a trust, we would hope that the Secretary of State will intervene. She will know from our experience in Shropshire that, when a system is failing or underperforming, that intervention is welcome. But the Bill gives the Secretary of State power to intervene even when things are going well, which is quite an extension of power. Will the Minister comment on that?

[Karin Smyth]

I thank the hon. Lady for that intervention, and I will come on to the power.

As hon. Members are aware, NHS England currently holds similar powers, so it makes sense for these powers to be held by the Secretary of State once NHS England is abolished. I want to be clear—I hope that this will address the hon. Lady’s point—that our intention is to use these significant failure powers rarely and not as a first port of call. It is far better to work closely with ICBs and their leaders to spot issues and work collaboratively to resolve them before they have the opportunity to become significant, but it would be irresponsible not to have the power to intervene as a last resort.

I want to address the other elements of clause 11. The first part of the clause establishes a general power for the Secretary of State to direct integrated care boards about the exercise of their functions. Using that power, the Secretary of State could direct a singular ICB, a group of ICBs or all ICBs, depending on the scope of the direction. This power is a necessary step in restoring democratic control over the NHS. The public rightly expect Ministers to be able to set priorities, drive improvements and set out how they expect the NHS to operate. For example, we expect to use the power to set up and update national commissioning standards.

The power is particularly relevant given the wider commissioning responsibilities ICBs will have in their role as strategic commissioners following the abolition of NHS England. By setting standards for all ICBs, the power will help reduce the unwarranted variation in the way that ICBs discharge their functions. It is also an important tool for enabling Ministers to respond to changing events. The lack of such a power has slowed the ability of NHS England to respond to unforeseen challenges within the health system.

I can also give the Committee an assurance that the clause includes a considered set of limits on the scope of the power. The Secretary of State will not be able to direct ICBs to appoint a particular individual, issue a direction about the services to be provided to an individual, or direct the use of a drug treatment or diagnostic technique where that is inconsistent with NICE guidance or recommendations. Equally, to maintain transparency in the health system, directions made under the general power to direct ICBs as to the exercise of their functions will be required to be made in writing and to be published as soon as reasonably practical. The power will enable the Secretary of State to uphold the standards that patients expect and deserve, while also protecting the principles of fairness and impartiality at the heart of the NHS.

We have already addressed much of the second part of the clause, but I should note that we have purposely placed the powers to intervene in cases of significant failure outside the general power of direction over ICBs. That is because it is important to be clear that those powers are expected to be used only rarely and in situations where an ICB is failing or at risk of failing.

I hope the hon. Member for Sleaford and North Hykeham feels able to withdraw her amendment. I commend the clause to the Committee.

Question put, That the amendment be made.