Health Bill (Thirteenth sitting)
Helen Morgan Excerpts(2 months, 1 week ago)
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Dave Robertson (Lichfield) (Lab)
It is, as ever, a pleasure to see you in the Chair, Ms Lewell.
Healthwatch was established, at least in part, as a response to the Mid Staffs scandal. Mid Staffs came up three times in our evidence sessions, and the hon. Member for Winchester mentioned it just now. That scandal matters to everyone, but it has a particular resonance for my role in Parliament. Many of my constituents were harmed by the failing at Mid Staffs. I was born in that hospital, and I speak as a Staffordshire MP. None of us should ever forget what happened or allow it to be swept aside without examining it. There were a great many failings at Mid Staffs over a long period. Oversight was just not in the room when decisions were being made.
Staffordshire county council’s health and care overview and scrutiny committee clearly did not do that job. The Francis report stated:
“The arrangements for public and patient involvement, and for local government scrutiny in Stafford, were a conspicuous failure.”
The report recommended some changes to ensure that Healthwatch, which was in the process of being set up at the time, was funded properly. In that light, the framing of this debate is important and timely. Healthwatch has been going for well over a decade. It is right that we now examine its impact, as it is a significant part of patient voice within the NHS.
Despite the very best efforts of a great many hard-working staff and an army of committed volunteers across the country, the quality of local healthwatch organisations is pretty changeable. Over the past few weeks, I have spoken with right hon. and hon. Members from across the House. The feedback that I have received has ranged from, “My local healthwatch team is brilliant— I work with them really closely and they have really helped out with a huge amount; they deliver great things in my constituency” all the way to, “I have some pretty significant concerns about their impact.” In a couple of cases I heard, “What is Healthwatch? I have never heard of it.”
Helen Morgan (North Shropshire) (LD)
We heard in evidence that the reason for that variability was a lack of funding. Would the hon. Gentleman support our new clause 78, which tries to deal with the lack of funding and ensure a consistent service from Healthwatch across the country?
Dave Robertson
Funding Healthwatch is really important, but to address the issue properly, we must make sure that Healthwatch is in the rooms it needs to be in. Funding needs to be part of the process that ICBs follow. I will touch on that later, so the hon. Member will hear further thoughts on the matter.
Local healthwatch organisations across all our constituencies have an important role. At the local level, they are geographically bound to counties. In constituencies like mine and that of the hon. Member for North Shropshire, those geographical areas are huge. The health disparities within my constituency, with two towns that are 4 miles apart, one with a significant mining—
Dave Robertson
I will make some progress. There are concerns that if we roll some responsibilities into ICBs or councils, the Department needs to make sure that the issue does not get pushed to the side and that the funding does genuinely remain for patient voice. I am reassured that there will be a patient experience directorate within the Department. That will bring decision making and the patient voice into the Department while also keeping an eye on what is happening with those ICBs and ensuring that they have standards to hit.
The Department needs to ensure that it is sharing good practice and keeping oversight of local authority commissioning of social care. The CQC is starting to do that, and there are some positive indicators. There is obviously more work to do, and we need to stay on top of it because, as I said earlier, there are risks whenever there are changes to healthcare. I am reassured that bringing the patient voice into the room with decision makers is the right way to enact change.
Karin Smyth
I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important.
At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable.
I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.
Helen Morgan
For the record, I tabled amendments to delete those clauses, so there was consistency of intention.
Karin Smyth
I am just computing that in my brain. Can I seek clarification on that?
Helen Morgan
I tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.
Karin Smyth
I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.
Dr Johnson
As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.
There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?
The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?
The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.
The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?
The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?
Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.
Helen Morgan
I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring.
I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch.
The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try the local services is, I think, missing the point.
With the Ockenden report on Nottinghamshire a couple of weeks ago, we also saw that the hospital trust commissioned several reports into its own maternity services, which found that it was failing. Instead of acting on them, it brushed them under the carpet and commissioned another. The suggestion that providers are capable in the current culture of dealing with those issues does not, I am afraid, hold true in the way it should across every trust.
Dr Prinsley
Is it the hon. Member’s belief that that is something that Healthwatch would have been able to deal with, support and prevent?
Helen Morgan
The hon. Member will know that Healthwatch was introduced almost as a direct consequence of the Francis review of Mid Staffordshire, so that was certainly the intention. I have discussed the variability of healthwatch organisations across the country and the fact that they are not as well funded as was originally intended. Although I take the point that they have not effectively delivered that alarm-raising service in every case, if they were properly funded and used in the way that they were envisaged to operate, they would be able to spot such issues.
Helen Morgan
I am going to go on and give some examples. Central to the value and success of the Healthwatch network is its local focus and the fact it is centred in communities. Where it has worked well, that has allowed Healthwatch to earn trust and build relationships, especially with harder-to-reach communities, as we have discussed. I take the Minister’s point that we know about those harder-to-reach communities, but the reality is that we are not engaging with them, and that is important.
Dr Johnson
Is there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?
Helen Morgan
The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.
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.
Karin Smyth
I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.
Question put and agreed to.
New clause 91 accordingly read a Second time, and added to the Bill.
New Clause 92
Medical Devices Regulations 2002: mutual recognition agreements
“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.
(2) For regulation 1A (Schedules) substitute—
‘1A Schedule
Schedule 2A has effect.’
(3) In regulation 2 (interpretation), in paragraph (1)—
(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;
(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.
(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)
This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.
Brought up, read the First and Second time, and added to the Bill.
New Clause 93
Consultation about medicines and medical devices regulations
‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.
(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.
(3) After subsection (1) insert—
“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—
(a) carry out a public consultation, or
(b) consult such persons as it considers appropriate.”
(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.
(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)
This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.
Brought up, read the First and Second time, and added to the Bill.
New Clause 94
Medicines and medical devices regulations: parliamentary procedure
‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—
“(3) Regulations under Part 1 are subject to the draft affirmative procedure.
(3A) Regulations under Part 2—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on section 6(1)(a) (fees);
(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);
(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—
• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),
• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),
• Schedule 15 (requirements for specific products subject to general sale),
• Schedule 16 (patient group directions and vaccine group directions),
• Schedule 17 (exemption for sale, supply or administration by certain persons),
• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),
• Schedule 19 (medicinal products for parenteral administration in an emergency), or
• Schedule 21 (medicinal products at high dilutions);
(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;
(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);
(b) are subject to the made affirmative procedure if they—
(i) contain only provision that is made in reliance on section 7 (emergencies),
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and
(iii) are not within paragraph (a);
(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).
(3B) Regulations under Part 3—
(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and
(b) are subject to the draft affirmative procedure if they are not within paragraph (a).
(3C) Regulations under Part 4—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on—
• section 17(1)(a) (fees), or
• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);
(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;
(b) are subject to the made affirmative procedure if they—
(i) contain only provision made in reliance on section 18 (emergencies), and
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;
(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)
This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).
Brought up, read the First and Second time, and added to the Bill.
New Clause 95
Medical devices etc: parliamentary procedure for certain fees regulations
‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—
(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.
(b) after sub-paragraph (1) insert—
“(1A) Provision falls within this sub-paragraph if it relates to—
(a) altering the amount of a fee or charge to reflect changes in the value of money,
(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or
(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).
(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—
(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or
(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,
as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)
This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.
Brought up, read the First and Second time, and added to the Bill.
New Clause 1
National Maternity Commissioner
“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.
(2) The functions of the National Maternity Commissioner are to—
(a) oversee NHS maternity services;
(b) act as an independent voice for women and families;
(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;
(d) promote consistency, safety and accountability across NHS maternity services; and
(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.
(3) The person appointed as Commissioner must—
(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;
(b) have first-hand experience of working in maternity services, so far as reasonably possible; and
(c) not be a sitting Member of Parliament.”—(Helen Morgan.)
This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss new clause 13—Maternity Safety—
“(1) The Secretary of State must ensure that every NHS maternity unit is rated ‘good’ or ‘outstanding’ by the CQC.
(2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes—
(a) 24/7 consultant obstetrician cover on every labour ward,
(b) one-to-one midwifery care,
(c) a Director of Midwifery in every maternity service,
(d) ringfenced maternity service development funding, and
(e) a dedicated neonatal workforce plan.
(3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.”
This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.
Helen Morgan
New clause 1, which I tabled, would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise in maternity services, and not a political appointment.
It is important to start by saying that I tabled the new clause before we had the report from Donna Ockenden on the Nottingham review, and last week’s report from Baroness Amos on her national review, both of which recommended the appointment of a maternity commissioner. Obviously, since then, the Secretary of State has announced that he will appoint a maternity commissioner. None the less, I will state the arguments for having one, and if the Minister can give us some assurances today, I will not press the new clause to a vote.
Just to set the scene, which I think we all know too well, maternity services in England have suffered a series of high-profile scandals. The cost of political neglect has been paid by families in terms of trauma, injury and lost lives. We have known for a long time that maternity services in this country have been failing. Numerous recommendations have been made over that period, but they have not been effectively acted on in a consistent way, and Baroness Amos’s inquiry finally confirms that.
It is important to say that the vast majority of births take place safely, successfully and happily. However, where things go wrong, having a baby safely has become a postcode lottery. Women are being routinely silenced, and staff who raise the alarm on unsafe care or systemic discrimination have been put off or crushed by a culture of fear. We therefore need to make England the safest country in the world to have a baby.
The Liberal Democrats have been campaigning on that for a long time, and following the Ockenden and Amos reviews it genuinely feels that there is now the will and focus to deal with the problem once and for all. This issue has been going on for far too long. We thank the Secretary of State for hearing our campaign and Baroness Amos’s calls for a national maternity commissioner to oversee national standards and drive change. We also pay tribute to campaigners such as Louise Thompson and the former MP for Stafford, Theo Clarke; without their advocacy, and without so many women sharing their stories, we would not be moving forward.
It is important to say that one individual—one maternity commissioner—will not solve all the issues in maternity by themselves, but they can help drive change and address recurrent issues, whether those are cultural or about safe staffing. They can hold Ministers to account, help restore public confidence in NHS maternity service and ensure that accountability exists. But I want to be clear that the buck should always stop with the Secretary of State; they hold the power and the purse strings, and this role cannot be used by Ministers as a way to shirk that responsibility.
I hope the Minister will clarify a few key points. First, can she reassure us that the commissioner will be independent and not a political appointee? It is essential that this individual feels confident to hold the Government to account and have those difficult conversations. That is far less likely if they are a political appointee.
Secondly, women have made it clear that for them to be reassured that this change will happen and happen meaningfully, they need a clear timetable for when the maternity commissioner will be in place and operating. Understandably, the Secretary of State has not been able to provide that yet, given the need for this Bill to pass through Parliament and for the statutory role to be on the books, and given the time it will take his maternity taskforce to define what it wants the role to look like and for the appropriate legislation to be written and put in place. However, we hope we can get a firm commitment to a timetable from the Minister today or, if not today, then on Report.
We think the commissioner should be involved in the establishment of the taskforce, because it is important that it does not develop a plan that they are required to implement, despite it being something they personally would not have approved. I therefore hope the commissioner will be in place very quickly, even if only on a temporary basis, so that they are working to get the taskforce plan into place.
We heard from the Secretary of State that the commissioner will co-chair the taskforce alongside him. That seems to be the right move, and I welcome it, but, as I said, it is important that they have some role in shaping its action plan, so that they can feel responsibility for it and be fully behind its implementation. Will the Minister commit to introducing a temporary maternity commissioner so that that can happen?
Finally, we have heard reports that the taskforce is not meeting very regularly. I hope the Minister can reassure me that it is now meeting much more regularly and getting that plan into place as quickly as possible, and that the Secretary of State is fully on board in driving forward the commissioner’s role as soon as possible.
New clause 13, which is also in my name, is about putting a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a good or outstanding rating from the CQC. I will not repeat some of the points I have just outlined about failing maternity services, but the first quarter of 2026 saw the worst ever recorded rate for maternity injuries. Four years ago, the Ockenden review into the Shrewsbury and Telford hospital NHS trust, which is in my area, found that over 200 babies had died unnecessarily in Shropshire. Yet, despite several immediate and essential actions being put in place, a subsequent CQC review found that the majority of maternity units in this country did not achieve a good rating for safety—they were inadequate in some way. That is just not acceptable.
Our package of measures includes the maternity commissioner, which the Government are obviously progressing with, and we are very pleased about that. However, we also need investment in the service to ensure that that maternity commissioner has the resources they need to make the changes required. We therefore call for one-to-one midwifery care for every woman in labour; a consultant on every labour ward 24 hours a day, seven days a week; a director of midwifery—a senior, experienced midwife—in every maternity service to ensure that more junior midwives on that ward are suitably supervised; the restoration of ringfenced service development funding; and a dedicated neonatal workforce plan.
New clause 13 also requires an annual report to be laid before the House on the “effectiveness of the scheme”. That would allow Parliament to track progress and hold the Government’s feet to the fire on it. Baroness Amos has also called for regular reporting to Parliament to maintain accountability, albeit through the maternity commissioner.
There seems to be consensus, here and across the NHS, on the need for meaningful and decisive action on maternity. There is a great deal of overlap between our plan and the recommendations Baroness Amos has made, and I hope the Minister will be able to take some of these points on board and incorporate them into the Bill.
Dr Johnson
As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.
New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012 and 2013.
I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.
The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.
My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.
I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.
Helen Morgan
I thank the Minister for her response. Given the commitments that she has made, I do not intend to press the new clauses, but I hope she will be able to come back to us on Report with some more concrete progress. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 3
Assessment of risks posed by contracts with non-UK based suppliers
“(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.
(2) In conducting an assessment under this section the Secretary of State must—
(a) pay particular regard to contracts which provide technology companies with access to confidential patient data;
(b) consult national security experts on the risks posed to UK sovereignty by such contracts;
(c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK;
(d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and
(e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations.
(3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.”—(Dr Chambers.)
This new clause would require the Government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK.
Brought up, and read the First time.
Health Bill (Twelfth sitting)
Helen Morgan ExcerptsTuesday 7th July 2026
(2 months, 1 week ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 July 2026 - (7 Jul 2026)
The Chair
Good morning, ladies and gentlemen. Electronic devices switched off, please, and no teas or coffee in the Committee Room. Members may remove their jackets if they wish to do so and, exceptionally, if any Members wish to remove ties, because of the weather I am prepared to permit that as well.
Clause 58
NICE recommendations: decisions about time for compliance
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 78, in clause 58, page 43, line 40, at end insert—
“1. (8B) Regulations under subsection (8A) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.
2. (8D) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.”
The amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.
Helen Morgan
The amendment was tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) on behalf of the approximately 1.2 million people in England who live with myalgic encephalomyelitis, because five years after the introduction of National Institute for Health and Care Excellence guideline NG206, little has changed. Service provision according to NG206 remains patchy and poor, with many patients having traumatic experiences. The amendment would require a period to be set in which integrated care boards and other health bodies must comply with the guideline, and the Secretary of State must publish an annual statement on compliance with NG206 across the NHS in England.
The introduction of the guideline after sustained campaigning represented a major reform after years in which ME was treated as a psychiatric condition and patients were pushed to follow graduated exercise therapy. Often, GET had disastrous consequences, precipitating serious deteriorations that patients never recovered from. Credit is due to the hon. Member for Washington and Gateshead South (Mrs Hodgson), the current Minister for Public Health and Prevention, for her determination when in opposition to bring about the change.
In a written answer published last week, the Minister for Public Health and Prevention confirmed that all ICBs have a statutory obligation to ensure sufficient care provision for their population, but the experience of those with ME is that that obligation is far from being fulfilled. In some ICBs, no services for ME are commissioned; in others, the provider has a history of providing services that reflect not NG206, but the old and condemned approach of GET. Some services are provided out of psychiatry departments, which is a huge red flag for those with ME, and information on the quality of services is patchy. Results from a big survey of more than 5,000 people with ME or long covid in late 2025 painted a bleak picture: more than half said that they had been disbelieved by an NHS healthcare official, one in three had been made to feel that their ME was their own fault, and almost two in five had had an encounter with a clinician that was traumatic or traumatising.
Five years after its introduction, NG206 is far from being complied with, and so members of the ME community—approximately 1.2 million people, as I said—are desperately asking that something be done to address the situation. The amendment represents a route that offers hope for many long-neglected and mistreated people. I do not intend to press the amendment to a vote, but I hope that the Minister will be able to reassure us about improving the consistency of provision for people with ME.
Moving to the clause generally, we broadly support the intention, but think that more safeguards need to be built into the principle, given the powers that are being handed to the Secretary of State. The clause makes provision for the period for compliance with a NICE recommendation, but gives no detail of how that will work in practice or how often the Secretary of State will change the standard three-month rule that NICE requires. No ceiling is put on the compliance period, no criteria govern when the period may be extended, and there is no duty to consult or set out reasoning.
What will the process be when the Secretary of State intervenes in the period of time for compliance with a NICE recommendation? We thought that there would be some mix of evidence requirements, consultation, statement of reasons, impact assessment and some kind of parliamentary scrutiny. The Secretary of State should at least have to set out their reasoning why the new power has been used. The value of the current requirement is almost entirely due to the compliance period being short and fixed. The three-month rule gives a positive NICE recommendation practical force. A power to lengthen or vary that period without constraint weakens the requirement in substance while leaving it formally intact. The right is not removed but its timing is made discretionary. For a patient awaiting treatment, that does not amount to the same thing.
A variation power is not new. Since the introduction of the budget impact test in 2017, NHS England has been able to apply to NICE to extend the funding period for medicines with a budget impact above a defined threshold, but, importantly, that period is criteria-based, triggered by a defined financial threshold, subject to a defined process and time-limited in effect. We are not overtly opposed to the power in principle, but more safeguards should be built into the criteria for its application. I would be grateful for some guidance from the Minister on that.
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?
The Minister for Secondary Care (Karin Smyth)
Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State.
NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment.
That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals.
I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which.
To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures.
I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it.
To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations.
The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that.
Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.
Helen Morgan
I thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 58 ordered to stand part of the Bill.
Clause 59
Transfer of HSSIB’s functions to CQC
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Amendment 55, in schedule 8, page 110, line 23, at end insert—
“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—
(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or
(b) should not be exercisable in relation to certain specified premises for other purposes,
those powers are not exercisable in relation to those specified premises.
(7) In this section, ‘Crown interest’ means—
(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;
(b) an interest belonging to His Majesty in right of the Crown;
(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;
(d) an interest belonging to the Duchy of Cornwall.”
This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.
Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).
This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.
Amendment 5, in schedule 8, page 120, line 16, at end insert—
“(2A) After paragraph 6(8) insert—
‘(9) A committee of the Commission is to be appointed in accordance with regulations.
(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.
(11) The committee is to be operationally independent from the Care Quality Commission.
(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.
(13) A majority of the members of the committee must not be members of the Care Quality Commission.
(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.’”
This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.
Schedule 8.
Clauses 60 and 61 stand part.
New clause 42—Funding for Care Quality Commission (CQC) investigations—
“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”
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.
Edward Argar
I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its
“scope of work beyond the original remit.”
It goes on to say:
“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”
I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.
Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:
“Most investigations into safety incidents should continue to be managed within provider organisations”.
That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.
Helen Morgan
I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?
Edward Argar
The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.
Health Bill (Eleventh sitting)
Helen Morgan ExcerptsThursday 2nd July 2026
(2 months, 1 week ago)
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Dr Chambers
I thank all hon. Members for their input, and the Minister for her insights. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 70, in clause 47, page 34, line 38, at end insert—
“(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.
(6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups.
(6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for—
(a) those without access to a suitable electronic device,
(b) those without access to suitable broadband connectivity,
(c) those with physical and/or mental disabilities,
(d) those belonging to groups considered socially excluded, and
(e) those considered lacking digital skills.
(6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.”
This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.
The Chair
With this it will be convenient to discuss amendment 49, in clause 47, page 36, line 1, at end insert—
“(4A) Regulations may not be laid under this section unless the Secretary of State has published a plan for a public awareness campaign to be conducted before the system established under section 250E(1) is made available to patients (a ‘public awareness plan’).
(4B) The public awareness plan must include—
(a) a description of the information to be communicated to members of the public through the campaign, which must include information about—
(i) what the single patient record is and what patient information it will contain;
(ii) who will be able to access patient information through the system and for what purposes;
(iii) the rights of patients in relation to their patient information, including any right to object to or restrict access;
(iv) how patients will be able to view a record of access to their patient information; and
(v) how patients can raise concerns or make complaints;
(b) the steps to be taken to ensure that the campaign reaches groups who may face barriers to accessing information, including people with disabilities, and people with limited digital access or literacy;
(c) the proposed timetable for the campaign, including the date on which the campaign is to commence and the minimum period during which it will run before the system is made available to patients; and
(d) a description of how the effectiveness of the campaign will be evaluated.
(4C) The minimum period referred to in subsection (4B)(c) must be not less than three months before the date on which the system is first made available to patients under subsection (1)(a).
(4D) The Secretary of State must lay the public awareness plan before both Houses of Parliament.”
This amendment prevents the Secretary of State from making regulations to establish the single patient record unless a public awareness plan has first been published, laid before Parliament, and a minimum three-month public information campaign has been conducted before the system goes live.
Helen Morgan
Amendment 70, tabled by my hon. Friend the Member for Epsom and Ewell, would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record. I declare an interest as the current chair of the all-party parliamentary group on digital communities.
I hope that we Liberal Democrats have been clear that overall, we are supportive of the single patient record; it is important that every patient can access their own health records. Under the SPR, however there is a risk that people belonging to already vulnerable groups will be digitally excluded from accessing their health information. Research commissioned by Ofcom suggests that 2.8 million people—5% of the UK population—do not have access to the internet at all. Although age is a predictor for a person not having access to the internet at home, especially if they are over 85, more than half of such people are younger than 75.
Amendment 70 would ensure that the Secretary of State assesses the potential for digital exclusion with relevant stakeholders, including patient groups, and that the assessment is laid before Parliament. It would also ensure that the Secretary of State takes into consideration the risk of exclusion for those lacking access to a suitable electronic device or suitable broadband connectivity, including people who have disabilities, who belong to socially excluded groups or who lack digital skills.
Dr Johnson
Amendment 70, as the hon. Member for North Shropshire said, would require the Secretary of State to publish a risk assessment on the potential for digital exclusion in the single patient record. That is important because, as our lives become more electronic and online, there are people who are getting left behind. That could be because they have a disability that prevents or makes it more difficult for them to access online facilities, because they do not have the resources, because they live an area of the country that is less well served by digital or broadband provision, or because they are elderly and have decided that they will not get involved in the digital world.
In fact, according to the Good Things Foundation, 7.9 million people in the UK lack basic digital skills and 1.6 million adults do not have a smartphone, tablet or laptop. Of those with no basic digital skills, 77% are over 65. People need more healthcare as they get older, yet those individuals have fewer digital skills, so this issue needs to be addressed. The NHS Alliance published a report on digital inclusion in March 2026, which found that rural and coastal areas typically have higher levels of digital exclusion than urban areas.
Lincolnshire ICB, which covers the area that I represent, estimates that 21.3% of Lincolnshire’s population live in the most digitally deprived areas. The ICB has a digital inclusion strategy for 2025 to 2028, which includes efforts to try to reduce digital exclusion; I am interested in the Minister’s thoughts on how she might expand that sort of initiative across the country.
The Government’s equality impact assessment for the single patient record recognises that digital exclusion is a significant challenge in several groups with particular protected characteristics and other characteristics. I am interested in learning more from the Minister about how she intends to mitigate that challenge. In many ways, digital availability is a good thing, and it makes things much easier for many people—I am not knocking it in any way—but we need to ensure that people do not get left behind.
I understand that NHS England is supporting public libraries to signpost users to the NHS website and help them navigate it. What will happen to that support as NHS England gets abolished? Does the Minister intend the Department of Health and Social Care to provide something similar?
Amendment 49, tabled in my name, is basically about public awareness. Although we get immersed in what we are doing here, the public are not necessarily following every word that is said in Committee or in this House—or even necessarily every word that appears in the press—so when the single patient record is launched, it is important that they are aware of it, and in particular, aware of their rights.
We have talked about whether a person might want to let a carer see the single patient record or whether they might want to let someone see part but not all of the record. If the record goes live before people are aware of their rights and abilities in relation to it, they might find that things are available to people, or can be viewed by people, who they would not have wished to see them, which could lead to a number of problems. The amendment would allow people to be more aware of the single patient record for a period of time before it is brought in to try to make sure that that sort of problem is mitigated, and I am interested to understand the Minister’s view on it.
Helen Morgan
We have not seen a full design of the single patient record yet, but it is difficult to envisage what it would looks like for somebody who does not have access to the internet. It is not just older people; it is obviously a significant problem in deprived areas as well. Can the Minister elaborate on what that might look like for somebody who does not have a device or does not have broadband or mobile access? How will they be able to access their medical record? We might need to understand that before we move forward.
Karin Smyth
The hon. Lady makes an excellent point. Part the difficulty is that the powers in the Bill that enable the Government to bring forward a single patient record are separate from the secondary routes whereby we describe and work through the detail of regulation. All those considerations have to be very clear. The hon. Lady and I have spoken regularly about the lack of broadband access in her community, which remains a huge problem. All those considerations need to be worked through with the team. They are varied and multiple, and we need to bring parliamentarians and the public with us in doing that, as we bring forward secondary regulations.
NHS England’s digital inclusion framework, as currently, supports the delivery of the 10-year plan by addressing those particular connectivity and skills issues, as well as confidence and accessibility. That work is already partly in train through NHS England. We need to build on that and bring it forward as we come forward with the regulations. I visited the team up in Leeds around some of the digital inclusion they have already been doing from the app. It is very impressive how much they are doing with people to develop the app. I think people would agree that we can take some of that learning forward, because it is about making sure that digital transformation is inclusive and aligned with the ambition in the 10-year plan to personalise care, reduce inequalities and create a health system that works for everyone.
In addition, as set out in the “Managing health services for others” guidance, since February 2026 the NHS has had a process to allow proxy access to the app, which should also support people who, for example, do not have the skills to do it for themselves. Alongside those improvements, it is policy to undertake an inequality and health inequalities assessment prior to hosting anything new on the app. Again, that helps to identify, mitigate and monitor unintended negative impacts on vulnerable and marginalised populations before implementing new policy, services and procedures, as raised by the hon. Member for North Shropshire. That process should identify and consider the mitigations for the groups identified in the amendment.
I hope that Members can see how seriously the Government have taken the development of digital access so far. We absolutely recognise that we have to get it right to enable this record, which the public and population so desperately want to see. That work has already been undertaken and it will continue. For those reasons, I ask that the amendment be withdrawn.
Helen Morgan
The importance of the amendment is that it requires this problem to be monitored in an ongoing way. Monitoring something usually makes the situation improve, so I will not withdraw the amendment.
Question put, That the amendment be made.
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—
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
I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary?
Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception. Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?
Helen Morgan
I want to speak to amendment 6, which is tabled in my name, and amendment 7, which is consequential upon it. Amendment 6 would ensure that the CQC and NICE can
“continue to make mandatory requests to the Secretary of State to establish an information system”,
as they currently can with NHS England. At the moment, NHS England has a duty to co-operate with the CQC and NICE, and that is often enough for a collaborative approach that allows the CQC to access the data it needs.
But the duty that applies to NHS England is not being passed on to the Department of Health and Social Care. The CQC raised the issue in written evidence to the Committee, saying that the duty
“has been an important mechanism”
that has
“supported receipt of patient safety incident reports…information sharing between regional teams, and the development of central data sharing solutions.”
The CQC went on:
“Without an equivalent duty, we would be reliant on there being sufficient capacity and willingness within DHSC to share information, with no statutory backstop. This could inhibit our ability to receive the information”
needed
“to keep people who use services safe. Challenges in this area are often cultural and rely on the subjective judgment of individual data controllers as to whether particular data sets can be shared, how these should be used and what the timeliness of sharing should be, leading to protracted piecemeal conversations and delays.”
As we have harrowingly heard over the past week, there is often reluctance to share data, particularly when there is a defensive culture in certain NHS institutions. Our amendment seeks to address the gap. I hope that what I have outlined is an oversight from the Government, not a deliberate attempt to reduce transparency or reduce regulator access to key data. The wider changes in schedule 11 will omit section 288 of the Health and Social Care Act 2012. The Government are dropping this key wider duty in a schedule entitled “Minor and consequential amendments”. We do not think it is minor. It holds major implications for patient safety and transparency.
On a wider note, it seems counterintuitive that the CQC, as regulator, does not have easy access to the data collected nationally in the health service.
Karin Smyth
Let me respond to the hon. Member for North Shropshire on amendments 6 and 7. As she said, amendment 7 is consequential on amendment 6, so I will take them together.
I think we can all agree that the CQC and NICE should have access to the information they need to undertake their important work. Amendment 6 is not required to ensure that. Clause 50, and the associated changes in schedule 7, maintain the current ability for any person, including NICE and the CQC, to request the establishment and operation of an information system. However, NICE and the CQC will not be able to make the equivalent mandatory request they used to be able to make to NHS England because NHS England is to be abolished.
Amendment 6 seeks to maintain the current position when, in reality, mandatory requests were practically never made under the current arrangements. They were thought necessary when a separate arm’s length body had responsibility for collecting data about healthcare. There is no need for the Secretary of State to be subject to the same mandatory requirement as they are responsible for oversight of the entirety of the NHS and the adult social care system, and for its effective regulation.
Furthermore, the CQC has a statutory power, under section 64 of the Health and Social Care Act 2008, to require the provision of
“documents, records (including personal and medical records) or other items”
the CQC considers “necessary or expedient” for the purposes of its regulatory functions, from a range of health and social care commissioners and providers.
On amendment 7, the Government agree that a code of practice setting out strict standards for how health and care organisations must handle confidential patient information is an important component of a healthcare system that uses data safely and effectively. That is why clause 50 allows for the insertion of new section 252ZA into the National Health Service Act 2006, to transfer to the Secretary of State the duty to publish a code of practice on confidential patient information. For those reasons, I ask the hon. Member for North Shropshire not to press amendments 6 and 7 to a vote.
The hon. Member for Sleaford and North Hykeham asked about duplication. I think the answer to her question is yes, but if that is not correct, I will make sure that I respond to her accordingly.
Question put and agreed to.
Clause 49 accordingly ordered to stand part of the Bill.
Clause 50 ordered to stand part of the Bill.
Schedule 7
Health and social care information systems etc
Amendment proposed: 6, in schedule 7, page 96, leave out lines 38 and 39 and insert—
“For section 255 (power to request NHS England to establish information systems), substitute—
‘255 Powers to request the Secretary of State to establish information systems
(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.
(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.
(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.
(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—
(a) it is made by a principal body, and
(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.
(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—
(a) a mandatory request, or
(b) any other request under subsection (1).
(6) In deciding whether to comply with the request, the Secretary of State —
(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and
(b) may take into account the extent to which the principal body or other person making the request has had regard to—
(i) the code of practice prepared and published by the Secretary of State under section 263, and
(ii) advice or guidance given by the Secretary of State under section 265.
(7) In this section “principal body” means—
(a) the Care Quality Commission,
(b) the National Institute for Health and Care Excellence, and
(c) such other persons as may be prescribed in regulations.
(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.’”—(Helen Morgan.)
This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.
Question put, That the amendment be made.
Health Bill (Eighth sitting)
Helen Morgan ExcerptsTuesday 30th June 2026
(2 months, 2 weeks ago)
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Dr Johnson
My hon. Friend is, as ever, correct. The mayors are also not all responsible for health and social care—the local authorities are, in most cases. There could therefore be a mayor directing proceedings with the ICB who is a political opponent of those actually democratically elected to look after social care. ICBs are supposed to be apolitical commissioners accountable to the Secretary of State, but now, instead of working with social care directors, they will work with an elected mayor instead.
I can see a positive to that in terms of democratic accountability, but what happens if they all disagree? There is some incoherence about who is in charge. We have the local authority tasked with delivering social care, which may be led by one political party; the mayor directing the ICB, who may be of a different political party; and the Secretary of State who can also direct the ICB, who may again be of a different political persuasion. How does it work if they disagree? Does the mayor actually have authority, given that the Secretary of State can override them anyway? How does the Minister see that working in practice? It feels like some people will be in power without responsibility and others will have responsibility without the power to exercise it.
Helen Morgan (North Shropshire) (LD)
I will raise some similar concerns about the abolition of integrated care partnerships and integrated care strategies, which clause 23 brings about. Before I do, I should declare my interest as a vice-president of the Local Government Association.
The removal of integrated care partnerships, as well as the extension of ICBs to cover multiple local authorities, raises unanswered questions about the future of social care planning, which is very important to the Liberal Democrats, as the Minister knows. We feel that it removes the voice of charities and others in the voluntary sector who are crucial to meeting the range of needs in health and social care.
Throughout the Bill there is a theme of separating social care and the NHS, at a time when greater integration and closer working are clearly needed. We heard Sir Andrew Dilnot say in evidence that we cannot deal with some of the challenges that arise in the NHS—particularly around flow through hospitals and long waits in corridor care in accident and emergency—without improving the discharge of patients into social care. Separating the organisations that deliver those things is clearly problematic. If we think about it, as the shadow Minister just outlined, we have lost the local authority representative on ICBs. The Bill also changes the way the better care fund is administered. With those changes, we are really concerned about the separation of these two responsibilities.
I want to draw the Minister’s attention to an example in Shropshire. Shropshire council spends almost 80% of its budget on social care. It is an extremely challenged council because of those funding pressures. Shropshire, Telford and Wrekin ICB has also been one of the most financially challenged ICBs. That is partly because of its small scale and its merging with Staffordshire—which, for the record, is unlikely to be the combined mayoral authority that Shropshire ends up in, as is my current understanding, although we are a long way off resolving that problem.
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?
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.
Helen Morgan
I wish to speak to amendment 36 and new clause 59, which are different ways of seeking to do the same thing. They are aimed at ensuring that “civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.”
In earlier sessions, we spoke about the risk of political capture; the amendment and new clause intend to deal with that. The Government’s intention is to give providers more freedom to design services around local needs, but we are worried that giving the Secretary of State the powers to appoint trust chairs and non-executive directors will undermine that local flexibility and agency. It risks creating a bottleneck in the Department for Health and Social Care, leaving foundation trusts waiting for approval to make their arrangements. In theory, the Secretary of State will be responsible for the appointment of 143 foundation trust chairs and roughly 1,000 foundation trust non-executives, who themselves will appoint the executive directors. Clearly, there is the potential for a bottleneck there.
We also think that in the hands of the wrong Secretary of State—I cast no aspersions about the current one—there is potential for mass manipulation of the make-up of future NHS leadership. I think everybody here would agree that NHS leaders should be the best possible people for the job, not those who best fit the political agenda of the Secretary of State of the day. We are worried that future Secretary of States could abuse their power, intervening unnecessarily and for non-clinical reasons in hiring and firing decisions. Their political views could heavily influence the make-up of trust and ICB non-executives across the country—who are themselves responsible for appointing the chief executive— and lead to the firing and hiring of those who suit their personal vision of what a leader should look like.
From speaking to chief executives and other senior NHS leaders, I know that many already feel that chief executives are subject to the political whims of the day and are too easily scapegoated for wider failures. Holding poorly performing leaders to account is extremely important when there are failures, but sometimes those concerns and the blame culture that can exist in those organisations stops capable, impressive NHS leaders from taking the next step up the ladder to becoming a chief executive. We think a safeguard is necessary there.
We recognise that someone has to hold that power and appoint those people now that NHS England has gone. That is why amendment 36 proposes that in order to ensure there is not political capture of those decisions, they are taken by impartial civil servants who are given a set criteria of what a good leader looks like, rather than by Ministers or their special advisers.
As I mentioned, new clause 59 broadly seeks to do the same thing, but uses a different mechanism for getting that into the Bill.
Helen Morgan
I had finished speaking, but I will give way and think of something else to say.
Dr Johnson
The civil servants will be under the direction of the Minister, so how does the hon. Lady envisage it working? Presumably, civil servants are there to deliver for their Ministers or Secretary of State? Is she suggesting that makes the decision more impartial? Can she give us some detail on how that will work?
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.
National Maternity and Neonatal Investigation
Helen Morgan Excerpts(2 months, 2 weeks ago)
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Helen Morgan (North Shropshire) (LD)
May I also add my thanks to the Secretary of State, to Baroness Amos and her team, and to the families that have relived the pain of their experiences to bring about this report? But the Amos report tells us little that we did not already know—indeed, it confirms our worst fears. Maternity services in England are fundamentally broken with the cost of political neglect being paid in trauma, injury and lost lives. Figures revealed by the Liberal Democrats in the last week show that the first quarter of 2026 saw the worst rate ever recorded for maternity injuries. In fact, while the number of reviews into NHS maternity services has steadily ticked up, we have also seen rising maternal mortality rates.
Four years ago, I spoke in this Chamber in response to the findings of the Shrewsbury and Telford review, which were devastating for my community. Last week, I stood here really distressed, actually, as we heard further traumatic reports from the Nottingham review. But anger is not enough. The Government must meet this moment now and implement Baroness Amos’s recommendations in full and without delay, or the families simply will not forgive them. To do this, we need genuine accountability through the NHS and the Department of Health and Social Care, accompanied with the investment needed to make Britain the safest country in the world to have a baby.
I welcome the Government’s commitment to a national maternity commissioner—a long-standing Liberal Democrat campaign—and the other urgent and immediate actions that the Secretary of State has outlined in the last week. They are all urgent and are signs that this is being taken seriously. But we need to recognise that a commissioner alone cannot fix the broken system. I urge the Secretary of State to work with us and look at our maternity rescue package for inspiration for his action plan—it has a great degree of overlap with Baroness Amos’s recommendations. Our package would ensure one-to-one midwifery care for every woman in labour, additional senior midwives, an obstetrician on every ward, and mandatory updated annual training. Will the Government commit here and now to implementing all those recommendations and working with us to deliver the change we need?
James Murray
I thank the hon. Lady for her comments, and she puts it well when she talks about Baroness Amos’s investigation confirming our worst fears. I was shocked but not surprised, sadly, to read the investigation report. It was devastatingly familiar to read what it set out as being the failings across the country. The report’s recommendations will now become part of the work of the taskforce, which I chair, to produce the comprehensive action plan by the end of this year. My intention is that the taskforce will take all the national recommendations from Baroness Amos’s report, as well as the national-level recommendations from Donna Ockenden’s report last week and recommendations from any other investigations and reports, and ensure that the action plan it produces comprehensively addresses all the issues raised. I think that we would all agree that there is not—one, two, three—a small number of actions that we need to take; this has to be a comprehensive plan to truly transform the service.
Health Bill (Seventh sitting)
Helen Morgan ExcerptsThursday 25th June 2026
(2 months, 3 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
The Chair
Before we begin, I remind Members to switch electronic devices to silent. Tea and coffee are not allowed during sittings, but there are copious amounts of water—blue is still and silver is fizzy.
Clause 15
Public involvement in commissioning by Secretary of State
Helen Morgan (North Shropshire) (LD)
I beg to move amendment 28, in clause 15, page 11, line 26, at end insert—
“(d) in the design of service and arrangement for service delivery (co-production).”
The amendment would explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State.
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.
The Minister for Secondary Care (Karin Smyth)
Patients and the public have a critical role in shaping our health services. I am grateful to the hon. Member for Oxford West and Abingdon for tabling the amendment, as moved by the hon. Member for North Shropshire. I will discuss the amendment with the wider question of whether the clause should stand part of the Bill.
To be clear, the Government are committed to engaging with patients and the public about the services they use. Services shaped together with the people who rely on them are better services. We want to see deep and collaborative ways of working between patients, public and the NHS. Across the country, there are good examples of that from which we want to learn. That is why the clause requires the Secretary of State to involve patients and the public in the planning of commissioning arrangements, the development and consideration of proposals for service change, and decisions that may affect how services are delivered or the range of services available.
The clause is intended to encourage early engagement and meaningful involvement in service change, thereby helping to build legitimacy, trust and better-informed commissioning decisions. As a duty, it covers the entire end-to-end commissioning cycle. I have been a commissioner myself, so although I will not detain the Committee too much on that, it is indeed part of the job of a commissioner to do that at a very early stage.
I also draw attention to the fact that the clause places a statutory duty on the Secretary of State to make arrangements to ensure the involvement of individuals who use or may use health services, together with carers and representatives, where appropriate, in commissioning activity. That duty is purposely broad, covering both existing service users and those who may reasonably rely on services in future, and will support preventive approaches and enable the consideration of wider population health impacts.
We made the deliberate choice to include specific references to carers and representatives, recognising that some individuals may require support to participate effectively in engagement and decision-making processes. That is particularly important where barriers such as disability, communications needs, sometimes age, vulnerability or unequal access may otherwise limit participation. We are ensuring that involvement is inclusive and meaningful, which I think is what all hon. Members want to see.
Specifically on amendment 28, I gently caution against creating an implication of different approaches to patient involvement for different parts of the system, leading to a two-track approach and unnecessary confusion. Instead, we propose a Government commitment to ensure meaningful consultation. We support co-production and will continue to champion it, but we do not think it necessary to put it on the face of the Bill.
The Government support involving patients and the public at every stage, and we recognise that working closely with the people and communities affected by commissioning decisions brings valuable insight into service quality, accessibility, equity and effectiveness. We will use the duties and powers available to Ministers to ensure that that principle is embedded across the work of the NHS. I hope, therefore, that the hon. Member for North Shropshire has some reassurance and will withdraw her amendment. I commend the clause to the Committee.
Helen Morgan
I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 15 ordered to stand part of the Bill.
Clause 16
Regulations about commissioning by integrated care boards
Dr Johnson
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times.
Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was
“no formal national policy supporting minimum waits”,
local areas may
“choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”.
I do not understand why we would want to make people wait longer than necessary.
The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is
“counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.”
Age UK deemed it a “rationing approach” that is
“potentially harmful to the health and wellbeing of older people.”
NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea?
Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing.
Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically.
Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource.
Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks.
Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose.
Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted.
Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.
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.
Karin Smyth
We know that in some areas of Scotland and Wales that are near the border with England, the way that health services are planned and commissioned in England can have implications for the people who live in Scotland or Wales. That is why clause 17 inserts new section 14Z45E into the 2006 Act, to place a duty on integrated care boards, when exercising their commissioning functions, to
“have regard to the likely impact of those decisions on the provision of health services”
to persons in Scotland and Wales living near the English border.
I assure the Committee that the clause will operate solely in relation to the exercise of ICB commissioning functions in England. It will neither confer functions on ICBs in relation to the commissioning or provision of services outside England, nor affect the responsibilities of devolved Administrations for the organisation and delivery of health services in Wales and Scotland. I commend the clause to the Committee.
Helen Morgan
I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.
Edward Argar
The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable.
I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.
Health Bill (Sixth sitting)
Helen Morgan ExcerptsThursday 25th June 2026
(2 months, 3 weeks ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 25 June 2026 - (25 Jun 2026)
Helen Morgan (North Shropshire) (LD)
It is a pleasure to serve with you in the Chair, Ms Lewell. In general, the Liberal Democrats support clauses 12 and 13. We think that local decision making and community empowerment in the NHS, including on commissioning decisions, is the right thing to be doing.
However, I echo some of the concerns of the shadow Minister, the hon. Member for Sleaford and North Hykeham, particularly on specialist commissioning. I declare an interest as vice-chair of the spinal cord injury all-party parliamentary group. We are concerned that expertise in low-volume, very specialist concerns will be lost if the commissioning is pushed out to multiple ICBs. My understanding is that specialist commissioning sat with NHS England in the first place because of concern that multiple commissioning groups would struggle to deal with low-volume, complex issues.
The president of the Royal College of Psychiatrists warned earlier this month that the new commissioning structure lacks mental health experts, with only one senior mental health lead across the seven new regional commissioning hubs taking specialised services from NHS England. Equally, the chief executive of the Derby and Derbyshire, Lincolnshire, and Nottingham and Nottinghamshire ICB cluster has said that it does not look like there will be a requirement for senior mental health expertise in reorganising ICBs. Will the Minister reassure us that when the Department designs which specialist services will be pushed back down to ICBs and which will be retained centrally, it will be minded to listen to representations from experts in the sector?
There are excellent services located geographically by accident—for example, the orthopaedic hospital in my constituency and the veterans service that goes with it. Both are highly valued, but they need specialist commissioning at national level to be utilised properly and to provide the best outcomes for patients. I would be grateful for the Minister’s reassurance on those points.
Dr Johnson
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
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.
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.
Helen Morgan
With permission, I will explain to the shadow Minister our votes on amendment 57, which she pressed to a vote. I was reassured by the commitment the Minister made to consult widely on those commissioning changes, so the Liberal Democrats switched our vote from support to abstain.
I move on to new clause 2, our amendment in this group, which the shadow Minister was just discussing. It would require the Secretary of State to introduce a scheme to ensure patients have the right to see a GP or another appropriate clinician within their GP practice within seven days.
The NHS constitution currently confers rights on patients when they are considered really important. There are, for example, rights within the NHS constitution around receiving cancer diagnoses and treatment. We felt that there was a gap on access to GPs. Given the Government’s stated aim of transferring more care into the community, which we fully support, and given the observation in the Darzi report that more and more money is being spent on secondary rather than primary care, we think it is really important to confer the right on patients to be able to access primary care when they need to.
As the hon. Member for Sleaford and North Hykeham pointed out, this measure would require a large number of additional GPs and would therefore not be achievable overnight, but over the course of a Parliament. The Liberal Democrat plan includes recruiting and retaining an extra 8,000 GPs, relieving pressure on the rest of the health service and enabling that shift into the community. When patients—
Sojan Joseph (Ashford) (Lab)
New clause 2 clearly states that everybody should have a legal right to an appointment with their GP “within seven days”, while the current provision is that patients are entitled to see a GP or other professional within 24 hours or two days for urgent care. Would creating this legal burden on GP practices not reduce their ability to prioritise, meaning that the people who need urgent treatment will be delayed further?
Helen Morgan
We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.
Edward Argar (Melton and Syston) (Con)
I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.
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.
Helen Morgan
I am going to make some progress, actually, because I think I am going to be asked the same questions.
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.
Dr Danny Chambers (Winchester) (LD)
Just to reiterate what my hon. Friend is saying, in Winchester we are now putting an urgent treatment centre in front of the A&E, staffed by GPs to do the triage, because so many people who turn up are only there because they cannot get a GP appointment. So we now have hospital trusts paying for GPs to provide same-day GP appointments, and that is coming out of the secondary care budget instead of the primary care budget. That is obviously the most expensive place to treat patients for routine things.
Dr Johnson
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
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—
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.
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.
Helen Morgan
I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.
Edward Argar
I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation.
My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.
Helen Morgan
I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.
Edward Argar
I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion.
We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.
Nottingham Maternity and Neonatal Services
Helen Morgan Excerpts(2 months, 3 weeks ago)
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Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
May I start by acknowledging the hon. Member for Sherwood Forest (Michelle Welsh), Donna Ockenden and the Secretary of State for the statement and for their hard work? I thank the Secretary of State for the actions that he has proposed so far, which I think are the first tangible actions we have heard in this place. I must also acknowledge the incredible courage and resilience of the Nottingham families who have been instrumental in bringing about this review. No one can imagine the pain that they have gone through.
I am distressed and angry to be stood here once again speaking about babies who should not have lost their lives, mothers who should not have lost their lives and trauma that families should not have experienced. Review after review has led to 748 recommendations since 2015, but birth injury and mortality rates have continued to rise. These reviews all reveal similar issues: unsafe staffing levels, lessons not learned, issues not escalated, insufficient training, and women’s concerns ignored.
Four years ago, after the Shrewsbury review, we found that over 200 babies had died unnecessarily in Shropshire, yet things have got worse. Donna Ockenden’s Nottingham report reveals new and extremely distressing revelations about serious failures to protect the dignity of the deceased in after-death care, something that must be addressed through proper regulation.
Liberal Democrats have put forward a maternity rescue package that would guarantee one-to-one midwifery care and introduce a national maternity commissioner to oversee vital improvements. It would be nonsensical for the Government not to take a strategy forward. Will the Secretary of State pledge to implement every single one of the Nottingham report’s essential actions, and to work with us to deliver the essential investment we need to make Britain a safe place to have a baby, and end this shocking cycle of failure? Anger is not enough. Mothers, doctors and midwives are sick of seeing review after review and being met with stasis, with the same failures repeated over and over again. This must be the moment we say, “Enough.”
James Murray
I thank the hon. Lady for her words. When she spoke about ending this cycle, she sums up a feeling that I think many of us have: the cycle of inquiries and investigations revealing what has been happening in maternity services and leading to recommendations, which are accepted, but then things do not change enough, and action is not taken to address all the issues raised. That is the cycle we need to break. The national taskforce, which is established and which I chair, will take all the recommendations from Donna Ockenden’s report, as well as those from Baroness Amos’s national review, which will be published shortly, as well as some of the other hundreds of recommendations that the hon. Lady mentioned, and ensure that it produces a comprehensive action plan by the end of the year. The challenge for us is not simply to accept recommendations, but to produce and deliver that action plan.
Health Bill (Fifth sitting)
Helen Morgan ExcerptsTuesday 23rd June 2026
(2 months, 3 weeks ago)
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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—
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?
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.
Health Bill (Fourth sitting)
Helen Morgan ExcerptsTuesday 23rd June 2026
(2 months, 3 weeks ago)
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Karin Smyth
I am grateful to all hon. Members who tabled amendments in this group, some of which have not been spoken to. I will address the central points that Members have rightly highlighted. I am grateful to the Chair and members of the Health and Social Care Committee for their report and recommendations for the Bill.
Before I turn to the detail of the amendments, I will set out what clause 4 does. As my hon. Friend the Member for Wolverhampton North East highlighted, the wider determinants of health inequalities are important. On the point that the hon. Member for Isle of Wight East made about the Labour party, they absolutely run through our DNA. Clause 4 restates and reaffirms our commitment to tackling health inequalities. It reformulates section 1C of the National Health Service Act 2006, aligning it with the duty imposed on NHS England by section 13G of that Act. It makes plain the need to achieve greater equality between the benefits that people receive and the provision of health services—for their ability to access those services and for the outcomes achieved. Importantly, “outcomes” includes the safety and effectiveness of health services and the quality of the experience undergone by patients. The clause will ensure that the Secretary of State must have regard to reducing inequalities in respect of all those benefits.
The wording of the revised duty more directly encapsulates the benefits that must be taken into consideration and obtained from the health service to support action that reduces or prevents inequalities. Fundamentally, the clause underpins our commitment to improving the health of the population and tackling the stark inequalities that blight the health of communities up and down the land, which have got worse over the past 14 years. That is central to this Government’s ambition, which is why we highlighted it in the 10-year health plan.
We also recognise that this is not a matter for the Department of Health and Social Care alone, which is why we are already working across Government to address the root causes of health inequalities and the barriers to accessing health and care services. We are ensuring that our action on health is embedded in policies that shape people’s daily lives, from the homes they live in to the air they breathe.
Helen Morgan (North Shropshire) (LD)
Before the general election, I was the Liberal Democrat housing spokesperson, and one thing that came up regularly was how important housing is, and not just for obvious physical conditions—mouldy houses can cause breathing issues. Temporary accommodation is devastating for the long-term health outcomes of the people who are placed in it. Does the Minister agree that working with MHCLG to improve housing—particularly social housing—is critical to achieving the Government’s objective?
Karin Smyth
The hon. Lady pre-empts my next comments. I absolutely agree with her, and so do the Government. That is why we are improving living conditions through the new decent homes standards, which set standards across all rented sectors. Awaab’s law requires social landlords to act promptly to fix housing hazards. Since coming into government, we have launched the warm homes plan, the Keep Britain Working review and the homelessness strategy. In April, we published a renewed women’s health strategy, marking a decisive shift to ensure that women and girls receive the care, respect and outcomes that they deserve. Last November, we published England’s first ever men’s health strategy, to improve the health and wellbeing of all men and boys. Within the Department, we are reviewing the Carr-Hill formula and the Advisory Committee on Resource Allocation to ensure the funding matches need.
However, there is much more to do. The Minister for Public Health and Prevention, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), will continue to engage with key stakeholders, including representatives of Health Equals. I have a meeting with representatives of that body this week.
I sympathise entirely with the motivation underpinning amendment 13, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, and I commend hon. Members for working on this important agenda, but I am not convinced that the amendment is necessary. I note that it draws on the duty that was recently placed on combined authorities by the English Devolution and Community Empowerment Act 2026, with a view to creating a similar duty for central Government.
Fortunately, I can reassure hon. Members that the Secretary of State already has a duty to secure improvement in the health of people in England, and the power to take such steps to improve public health as they consider appropriate. We would not want to narrow the definition of the existing duty, because health inequalities come from many causes, as has been discussed. As I have said, we are already working across central Government and local government to address those wider inequalities, including in housing and air quality, and by getting more people into work.
The hon. Member for Sleaford and North Hykeham said that innovation might expand inequalities across our country, but we have seen a shocking expansion in the inequality gap across our country. That is what we are seeking to reverse, as we have made clear in our 10-year health plan, and the Bill will ensure that that happens. That is why we say that we will take the best to the rest; we are not about taking people down.
Finally, I turn to amendment 34 in the name of the hon. Member for Winchester. He has spoken before about his constituents’ experience, and I have spoken with him about the new hospital programme, his constituents’ reliance on transport to access hospital appointments, and the difficulties experienced in more rural areas, which the hon. Member for Isle of Wight East also mentioned. That is why, in our 10-year health plan, we are very clear about our strong commitment to rural and coastal communities—we are the first Government to do that.
We agree that reducing inequalities in hospital transport is important. The Bill already places a duty on the Secretary of State to
“have regard to the need to…reduce inequalities between the people of England with respect to their ability to access health services”.
Inequalities in access to transport to receive care fall under the scope of that duty. As such, the amendment is superfluous.
I also offer the reassurance that NHS England has been implementing a range of actions to reduce inequalities in patient transport, including the speeding up of reimbursement for patients eligible for the healthcare travel costs scheme. I also inform the Committee that the cancer plan included a commitment to provide up to £10 million a year to pay for the travel costs for cancer care for children and young people, and their families, as people have long campaigned for.
Some important issues have been raised in this debate, and I am sure that we will return to them. In the meantime, I ask my hon. Friend the Member for Bury St Edmunds and Stowmarket to withdraw the amendment. I commend clause 4 to the Committee.
Dr Johnson
The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those.
We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.
Helen Morgan
One of the challenges of recruiting staff in Shropshire relates to exactly that point: some areas of the health service are perhaps less exciting to work in than others. Ensuring that innovation is driven across every NHS site and every region will help us understand the recruitment and retention problems that have plagued some of the country’s more rural areas.
Dr Johnson
The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress—in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation.
I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that—not because they are not taking higher rates of tax, but because they are squeezing the economy.
There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is also a risk that prizes will be awarded on the basis of who shouts loudest. Certain charities will want the Government to focus on awarding innovations in cancer care, for example; some unions will want the Government to focus on awarding innovators who achieve greater equity in service delivery. There is little doubt that Ministers will have a tough time batting away lobbyists calling for more funding to incentivise this or that type of innovation.
Clause 6 also gives the Secretary of State the power to set up a committee to provide advice on awarding prizes. It is right that the Health Secretary should solicit expert advice when determining which trusts, teams or individuals deserve incentive payments, but does that require the power to set up what is effectively a whole new quango? The Government created more than 25 arm’s length bodies and advisory councils in their first six months. Does the Secretary of State require the power to pay members of the advisory committee when there are many experts in their field who can give their time charitably? I notice there is no requirement for any prize committee to include the chief scientific officer or representatives from ICBs. It is ultimately an unchecked spending power.