Health Bill (Twelfth sitting)

Joe Robertson Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

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

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

[Gregory Stafford]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr Benneyworth went further. She explained:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

--- Later in debate ---

I know that the Minister is a diligent and thoughtful Minister who knows her brief very well, so I hope that she will reflect on the points made in Committee and reconsider the clauses.

[Joe Robertson]

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

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

“The Health Services Safety Investigations Body is abolished.”

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

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

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

[Gregory Stafford]

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

[Joe Robertson]

My hon. Friend leads me to a point I was going to make later, but I will make it now. He is absolutely right: the CQC has not had a lot of good press and does not instil a high degree of confidence in professionals and the public. That is a very real issue. The Minister and, I think, Dr Dash have said that the transfer of powers from HSSIB to the CQC will not happen until it is in a better place, and that is all very well, but these changes are intended to last for a long time—indefinitely, presumably. To merely wait until an organisation is in a better place to transfer those powers, and to expect that organisation to remain in a better place in perpetuity, is wishful thinking.

The CQC has had leadership issues. We all hope and I am sure that the leadership will be in a better place in the near future, but if an organisation can be in such a bad place because of a failure of leadership, those circumstances can return in the future. Of course, it might be leadership failings within the regulator that HSSIB is asked to investigate. Again, if its functions are delivered by a regulatory organisation with leadership failings, there will be no confidence whatever that a truly independent and meaningful investigation can take place.

Let us not forget that the public are somewhat jaded by investigations, inquiries and reports—justifiably so. They clearly have a valuable function, but their function is far more valuable if there is confidence in them. If a powerful organisation such as the CQC—the regulator—can effectively mark its own homework, that does nothing to help the reputation of investigations and inquiries with the public. I suspect that the problem with them in the public’s mind is that it always looks a little bit like the establishment is looking at itself and coming up with an argument it can then justify. There is a perception that that does not lead to meaningful change. With this Bill, we will create an environment where that perception is even stronger.

[Edward Argar]

My hon. Friend is rightly highlighting the importance of independence, and trust in the independence, of the organisations investigating failures and making recommendations. Does he agree that that is only half of it? Those organisations are not at fault when recommendations are not implemented, so the other half of this is that the NHS and the system need to act on those recommendations when they are made.

[Joe Robertson]

It is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it—an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.

[Dr Johnson]

My hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or—