Health Bill (Seventeenth sitting)

Joe Robertson Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

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

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss

New clause 97—Publication of annual dementia care report—

“(1) The Secretary of State must publish annually and lay before Parliament a report on—

(a) the provision of NHS care in relation to dementia, and

(b) provision of social care in relation to dementia.

(2) In preparation of the report under subsection (1), the Secretary of State must have regard to targets, standards and outcome measures set out in national plans, guidance and frameworks relating to dementia services.

(3) In preparation of the report under subsection (1), the Secretary of State may have regard to any such measures or information that they consider appropriate, including—

(a) an assessment of any variation in dementia services and outcomes between integrated care board areas,

(b) information on workforce capacity, capability and training standards relevant to dementia care,

(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers,

(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,

(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,

(f) progress on dementia prevention and risk reduction, and

(g) dementia research activity in the NHS.

(4) The Secretary of State must publish the first such report under subsection (1) within 12 months of the passage of this Act.”

This new clause would require the Secretary of State to produce an annual report on the delivery of dementia care by the NHS and social care sectors against relevant national targets, standards and outcome measures.

[Joe Robertson]

It is a pleasure to serve with you in the Chair, Ms Lewell. These two new clauses, the latter of which is in my name, deal with the publication of an annual report detailing NHS and social care provision for dementia care and how the Government are performing against targets, standards and outcome measures set out in national guidance and frameworks relating to dementia services. I would like to thank three important charities working in this area: the Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK. All three back the two new clauses.

The data requested is imperative to ensuring that the Government can measure and monitor progress against relevant national targets, standards and guidance, including the new modern service framework on dementia, the forthcoming Care Quality Commission statutory guidance and outcome measures that may be set in future NHS operational planning guidance. That is crucial to improving transparency and accountability, allowing systems to see the full picture of dementia provision in England and highlighting challenge areas or inequalities. The Bill makes provision for the establishment of information systems to collect, analyse and publish health and care data that is in the interest of the health service in England. The clause fits into that and would require the collection of data on the provision of dementia services in health and social care.

I do not propose to speak too long, but I do want to make a couple of remarks on the current situation, which sets these new clauses in context. Dementia data is not currently comprehensively or consistently collected, analysed and published. That means that we cannot fully understand the provision of NHS care or social care for dementia, which is the biggest cause of death in the UK; how national targets, guidance or frameworks are being met; and where inequalities and challenges lie.

As well as being the leading cause of death, dementia is a disease that around 1 million people live with. That number is expected to rise to 1.4 million by 2040. That will, of course, impact many more friends, families and carers who support those living with dementia. More than a third of people living with dementia in England do not have a formal diagnosis. Those who do receive a diagnosis live with the condition for an average of three and a half years before that diagnosis. Post-diagnostic care and support is often fragmented, leaving people affected by dementia without a clear point of contact, co-ordinated care, or access to specialist support for those with complex needs. Recent findings show that only 14% of people with dementia have an advanced care plan in place. That is not good enough for a disease that affects so many people and is the leading cause of death in England.

Dementia puts immense pressure on our healthcare system: one in six hospital beds is occupied by someone living with the condition. Lord Darzi’s investigation into NHS performance highlighted how

“there is an important challenge to improve both the quality and quantity of care for people with dementia.”

The new clauses would go some way to addressing that, and I urge the Government to support them.

[Karin Smyth]

We largely agree with new clauses 96 and 97 and the comments of the hon. Member for Isle of Wight East. He cited some organisations: Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK; hon. Members across the House have worked with them, and many other organisations in this field, and value the work that they do. The hon. Member rightly notes the work that they do to support the friends, families and carers of people with this disease, which is increasing in prevalence. He also commented on the importance of getting diagnosis earlier, and we are moving forward but we need to do so as fast as we can; I think we would all recognise that. I completely understand the rationale behind the new clauses and the urgency with which people want to have sight of the sort of information outlined in them, but we do not think that the new clauses are necessary. I will highlight why.

Some of the data that would be requested by new clause 96, such as details of research in the NHS and reports of lived experience, is already available and often provided by our charity partners, as well as by others. The new clause would therefore lead to a duplication of work. Provision of the other pieces of requested information and the data collection required to produce the report required by the new clause would likely be very onerous, placing additional stress on an already overstretched sector, and would distract from the core task of improving dementia care. It would be especially difficult to get consistent and comparable information from across the adult social care sector, where data can sometimes be fragmented.

Instead, we think that the modern service framework for dementia and frailty is a more helpful vehicle for setting national standards of dementia diagnosis and care, and will serve to hold the sector to account. Additional reports, such as those requested by the new clause, would distract from that and result in duplication.

The framework is still in development and work is ongoing to review the relevant data, metrics and targets to inform it. The framework will also set new national standards, which will help to inform meaningful analysis in the future—something that we are all very keen to see. For those reasons, I ask the hon. Member to withdraw the clause.

[Joe Robertson]

I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 97

Publication of annual dementia care report

“(1) The Secretary of State must publish annually and lay before Parliament a report on—

(a) the provision of NHS care in relation to dementia, and

(b) provision of social care in relation to dementia.

(2) In preparation of the report under subsection (1), the Secretary of State must have regard to targets, standards and outcome measures set out in national plans, guidance and frameworks relating to dementia services.

(3) In preparation of the report under subsection (1), the Secretary of State may have regard to any such measures or information that they consider appropriate, including—

(a) an assessment of any variation in dementia services and outcomes between integrated care board areas,

(b) information on workforce capacity, capability and training standards relevant to dementia care,

(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers,

(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,

(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,

(f) progress on dementia prevention and risk reduction, and

(g) dementia research activity in the NHS.

(4) The Secretary of State must publish the first such report under subsection (1) within 12 months of the passage of this Act.”—(Joe Robertson.)

This new clause would require the Secretary of State to produce an annual report on the delivery of dementia care by the NHS and social care sectors against relevant national targets, standards and outcome measures.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Health Bill (Fourteenth sitting)

Joe Robertson Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

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

It is a pleasure to serve under your chairmanship again, Dr Huq.

New clause 6 raises an important question on how we govern health data, which one of the greatest assets of the NHS. The development of the single patient record platform and database, and the wider use of the linked NHS data, present enormous opportunities.

When used responsibly, healthcare data can support much more personalised care, improve NHS planning, accelerate medical research, enable earlier diagnoses and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, those benefits can be realised only if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy.

NHS health data is currently overseen by NHS England, following the merger of NHS Digital into that organisation. With the Government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it is right that we consider future governance arrangements. In principle, I agree that an independent body may be needed to ensure and maintain the security, integrity and responsible stewardship of NHS data. There is definitely scope for an independent body to oversee the management and regulation of the public’s health data. That proposal places patient privacy at its heart, and would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymisation and trusted research environments, allowing valuable research to take place while reducing the risk of inappropriate disclosure. We have discussed inappropriate disclosure by a malign actor, or even inadvertent disclosure, during debate on other clauses.

The Liberal Democrat new clause also seeks to address a concern that has attracted significant public attention: where commercial organisations derive substantial value from NHS data, the NHS itself should share in that benefit. Although we did not support a number of Liberal Democrat proposals because of the inadvertent implications of their drafting, I still have sympathy with the overall thrust of what they were trying to achieve. There is a strong argument that the value generated from the data contributed by NHS patients should help to support future patient care and research.

Transparency is another important feature. Publishing data-sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help to strengthen public confidence. The proposed trust would bring those principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data.

Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research. To reassure the Committee that the framework would not create a block or dampener, or insert inertia into the system, will the hon. Member for North Shropshire tell us what evidence she found when drafting the new clause? If we are going to do something like this, the oversight should be proportionate, and it should complement, rather than duplicate or frustrate, any existing regulatory responsibilities.

Ultimately, the new clause has potential benefits. It would establish a clear social contract for NHS health data, which would hopefully protect privacy, support research and innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of a very valuable national asset. In terms of what it could be used for, that data is probably second to none in the world, but I am concerned about adding extra bureaucracy and inertia to the system, when we want a vibrant life-sciences industry that is able to use the data for the benefit of British citizens and patients. What does the hon. Member for North Shropshire think would happen in that case?

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

It is a pleasure to serve with you in the Chair, Dr Huq.

My hon. Friend the Member for Farnham and Bordon has set out the arguments clearly; I will just add some of my own views. As he stated, the single patient record provides a unique and special opportunity to improve efficiency across the whole health and social care space and to empower patients, but it faces significant challenges. As I said in an earlier sitting, perhaps one of the biggest challenges is ensuring that it means something in practice. In a previous debate, the Minister helpfully clarified that the data currently held on a great variety of databases and electronic record-keeping systems in the NHS will remain on those wide and disparate recording systems. It seems that the advantages will be realised only if those systems are able to speak together and are fully interoperable.

I know from a previous time in my career that, in reality, many such systems are not interoperable or are only part-interoperable, and that, even where they do speak to one another, the data is collected and recorded in different ways. Simple things—someone’s name, their age or the principal field of the issue for which they are presenting to a clinician—are recorded, but because the systems are not standardised, that data cannot be transferred between them easily.

The advantages of the single patient record will be realised only when all those systems are unified in some form, but the Bill does not address that directly. I am not necessarily suggesting that it should, but I do not see the Government acknowledging anywhere that systems are contracted and provided by private providers through procurement processes at a local level, and asking, “How do we knit that all together?” It seems that somebody somewhere will have to produce some gateway software or system to allow the single patient record to be accessed. If every other existing system needs to be able to feed into that, the public sector will have a huge role, and the private sector will sit behind it to try to deliver that. It seems a huge project that could be fraught with difficulty, it could take many years before the single patient record is established, regardless of when the Bill is passed—although I am sure it will be passed fairly soon.

New clause 6 seeks to address another significant issue with the single patient record: security and the control of data. The single patient record, if fully realised, will make it easier for data to be accessed and shared. Its very purpose is to ensure that systems and services are more integrated and data flows more freely, to avoid the ridiculous situations in which a GP fills out a patient note but cannot share it with a secondary care provider, so must print it out for the patient, or attach a PDF to an email, so that somebody at the other end can input it to their database.

One issue with making it easier to share data—including personal data of the most intimate kind—is that once it has been accessed by bad-faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also much easier for wider access to be shared accidentally, because the whole system is lubricated by the single patient record. I therefore understand the reason for the health data charter as a cure for potential ills.

New clause 6(3)(b) states that the charter must

“include the primary goal of protecting people’s privacy and their data from exploitation”.

That is a fantastic goal that we all support, but I do not necessarily agree that the measure will achieve that. It is an added layer of bureaucracy. My hon. Friend the Member for Farnham and Bordon asked a rhetorical question about the bureaucracy and effectiveness. I endorse that question and hope that the hon. Member for North Shropshire will answer it.

I am minded not to support the proposal, though I agree with what it tries to achieve. If the Minister does not support the new clause, will she explain how its aim of protecting people’s privacy will be delivered by the Bill? There seems to be great scope for the undermining and abuse of privacy, not just deliberately by bad faith actors, but inadvertently.

A second issue aim of the charter is the balance between the security of personal data and the recognition of the value of anonymised data gathered by the NHS for research and development. Fully anonymised data that cannot be unpicked through reverse engineering is of huge value, both commercially and for the public good. Commercial value and the public good are not necessarily opposed to each other; in fact, they often come together. The NHS should be able to exploit the value of that anonymised data—“exploit” is probably seen as a negative word—for the public good. How do we balance that with people’s right to privacy?

Again, there is the possibility of inadvertently using for a wider public good data that was intended to be anonymised but in which people can be identified. The charter tries to get to the heart of that issue as well, which I welcome. Indeed, new clause 6(4)(a) states that the sovereign health data trust will

“hold continuous oversight of all health data and oversee the trusted research environment”.

The Minister may not agree with the new clause, but how will the Government’s proposals balance the security of an individual’s personal data while exploiting, for the public good, the value of the huge depth of anonymised data that the NHS holds and will hold? It could be used to drive so much innovative research and development, for the benefit of health delivery not only in this country, but across the world. Such a valuable commodity has commercial value that could deliver financial benefit to the NHS. I think we all agree that we have not yet exploited that area to the fullest. There is an opportunity to do so with the single patient record—if it is done properly, with all the necessary safeguards.

--- Later in debate ---

[Dr Johnson]

My hon. Friend is, as ever, correct. I would be interested in whether the hon. Member for North Shropshire has made any estimates of personnel time or cost that the proposal would entail.

In summary, the new clause would create an unelected committee removing democratic control. Essentially, it is asking a committee of unelected individuals to write and implement policy, which is the job of the Minister. That should be under ministerial control.

[Joe Robertson]

Does my hon. Friend agree that there is an overarching issue here of public confidence in the safety of their data? That is not about one company or another; it is about ensuring that robust safeguards are in place for everyone and for every provider of a data and record-keeping system. If the public do not have confidence, they will understandably withdraw consent for their data being held. That will undermine the single patient record and the whole way in which health can be delivered efficiently in the best interests of patients.

[Dr Johnson]

I agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.

--- Later in debate ---

[Gregory Stafford]

I am grateful to the hon. Member; she makes an interesting point. She talks about irony, and I respond in the same manner as that which she intervened on me with a gentle response, which is to ask why, if everything was going so swimmingly well, she and the rest of her colleagues got rid of the Prime Minister?

[Joe Robertson]

I am grateful to my hon. Friend for giving me an opportunity not to chunter from a sedentary position and to remark that this tedious rhetoric about the last 14 years—when all the public want to do is hear about plans for the future and how they will work—is the reason why we are in the state that we are. Will my hon. Friend continue and address the points that the public want, which he had already begun to do?

[Gregory Stafford]

My hon. Friend is absolutely right. The public do not want to hear about the last 14 years or the rhetoric around them.

Health Bill (Fifteenth sitting)

Joe Robertson Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Dave Robertson]

I very much appreciate that intervention, and I congratulate the hon. Gentleman on getting published in a very important journal. I am not in any way saying that the Secretary of State should not have any regard—[Interruption.] Now that he has made a joke, I want to say that I think he looks like a trombonist, rather than a trumpeter.

There is a very important point to draw out here. Although Departments can think about the public health impacts of the work that they undertake—I am sure many Ministers will do so—I am not sure there needs to be such a requirement to focus on public health for the Ministry of Defence, which obviously has a very significant, serious role.

New clause 80 would require all Ministers to have regard to public health. I really appreciate and value that—I think this is a good debate for us to have—but if the Minister for investment has managed to secure an investor to save a large business that is essential to the economy of an area, do I want them to be held up by having to demonstrate that the investment will ensure public health? I am not sure I do. A lot of decisions have to be made very quickly. I am not going to go through a long list of Ministers; we would all be here until next week. I just think the wording of the new clause is too broad, and I am not sure I can support it in its current form because it would place too much of a requirement on too many Departments to focus too much on areas that are not their core responsibilities.

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

It is a pleasure to serve with you in the Chair, Ms Lewell. I find myself unequal to the level of analysis and detail that the hon. Member for Lichfield brought to public health in the Ministry of Defence.

I will add just a few brief thoughts. The good intention of extending the life expectancy of the people in this country—although my hon. Friend the Member for Sleaford and North Hykeham made the good point that it is about living well, not just for a long time—is not always best served by creating committees, and additional duties, reports and responsibilities in legislation.

The hon. Member for Winchester argued—I paraphrase, but it is a matter of record—that he would like all Departments to have an eye on the health of the nation. That sounds sensible. There are other things that I would hope all Ministers have an eye on in everything they do, such as the wealth of the nation and inequality, but I would not advocate for embedding those things—I hope they would come with good governance, public duty and responsibility—in legislation as a duty, a committee, a set of meetings and a report. Indeed, it is things done with good intentions that lead to growing bureaucracy, which slows down decision making and requires more people to be employed to discharge those duties at a growing cost to the public purse. It is something that western democracies do all too well, and not always for the good. I would not want this well-intended set of new clauses to lead to growing bureaucracy with very little benefit. The benefit that the hon. Gentleman wants to see, which I agree with, can be best delivered in other ways.

--- Later in debate ---

[Gregory Stafford]

Yes, I agree entirely with the hon. Gentleman. It would be a very slippery slope to write that into legislation. I understand the motivation—as I often do—behind Liberal Democrat new clause 76, but I do not think its drafting is appropriate in this context, and I cannot support it.

[Joe Robertson]

As my hon. Friend the Member for Farnham and Bordon said, we on the Health and Social Care Committee heard from the Secretary of State yesterday. These new clauses were obviously drafted in advance, but the timing of their consideration is rather good.

We had the opportunity to ask the Secretary of State, who sits right at the top of the Department, some fairly basic questions about the deal that will apparently see the NHS pay 25% more for US drugs than it does currently. We asked, for example, how much it will cost. The Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, skewered the Secretary of State within minutes. A short while later, once the Secretary of State had had the chance to reflect on her queries, I had the opportunity to ask some even more basic questions. I asked not what the figure was, but whether one even existed or whether any analysis had been done. We ended up going backwards.

We parliamentarians and the public still do not know the answers to some basic questions, even though a deal has been done. Do we know how much it will cost? Does a figure exist? Has an analysis been done? Are we talking about a figure or a bracket? On what basis was the deal agreed? We received absolutely no answers at all to those questions. To conclude, I posed a fairly obvious question: how on earth can we strike a deal to pay 25% more for drugs that we already get without knowing how much it will cost? No answer was given to that question either.

It is no wonder that these fundamental questions have effectively come in the middle of the Bill’s passage. This is not the place for them, but in the absence of basic answers, I can see why the hon. Member for Winchester and others have raised these issues. I will ask the same questions of the Minister. If her boss cannot answer them, perhaps she can, as the Department has had 24 hours to reflect. How much will the deal with the US cost? Are there—even if the Government do not want to disclose them—a figure and an impact assessment?

If the Government can confirm that a figure or bracket exists, why are they not willing to discuss them? If the Government can confirm that some sort of impact assessment has been done, when did it happen and why are they not disclosing it? Until we get those answers, so that people can see the fundamental considerations on which the Government base their decisions, this is a fairly unappealing way of going about securing investment for life sciences.

The Secretary of State talked about the benefits of this deal, and I am sure that there are benefits. I do not disagree with the principle of paying more for drugs if it has benefits for research and development—I understand and support that principle—but I want to be able to see what those intended benefits are, in some form of document or analysis. I do not want bare statements that say, “Research and development is good.” We all know that; I want to see the cost.

New clause 15 would also set a cost threshold of £100 million. The Government are not in a position to confirm whether the US deal would qualify under clause 15. It would at least force the Government’s hand. I suspect that the sum is far higher—into the billions—but we do not know. We are left to sit and speculate, despite the Secretary of State’s appearance before the Health and Social Care Committee. He must have expected that question to be asked. He was flanked by the permanent secretary of the Department and the chief executive of NHS England. By the way, he was a Treasury Minister prior to becoming the Secretary of State just two months ago. We had all the key people in the room to give some sort of indication about cost and benefit, yet none was forthcoming.

Although I cannot back the new clause, because I do not think statute is the right place to ask these questions, I completely understand why it was tabled. She will not accept the new clause, but could the Minister at least answer some of the questions that parliamentarians and the public are asking?

--- Later in debate ---

[Karin Smyth]

I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that.

New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.

[Joe Robertson]

To strip this back further, can the Minister confirm whether a deal has been done?

[Karin Smyth]

I am not party to the negotiations. That is above my pay grade, like the conversation yesterday that the hon. Gentleman alluded to. I will get back to him on any outstanding questions, as the Department will to the Select Committee with other details.

--- Later in debate ---

[Dr Chambers]

I thank the Minister for her comments. It is good to hear cross-party recognition of how important the life sciences sector is in the UK, to universities and businesses as knowledge transfer partnerships. This is a huge opportunity not only to improve the health of the nation and the treatments available, but to boost the economy.

We will withdraw new clause 15, but I thought the hon. Member for Isle of Wight East spoke extremely well about his concerns relating to the trade deal.

[Joe Robertson]

I think that the hon. Member has spoken very well, too, and I am grateful to him for airing this important subject through his new clause.

[Dr Chambers]

I appreciate that. Just to reiterate, I am talking specifically about the trade deal with the United States, not about every single trade deal. We completely accept that primary legislation is not necessarily the best way to scrutinise a trade deal, but given the lack of options at the moment, we must use every political mechanism available to create transparency.

--- Later in debate ---

[Sojan Joseph]

As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers. I have seen so many vulnerable patients benefit from the enormous amount of work that carers do. In some services, such as the mental health service, there is already provision for identifying carers, carers’ assessments and support for carers. Carers provide extraordinary support, often at great personal sacrifice.

Although the intention here is to make the wellbeing of carers a statutory duty, we need to be careful that we do not put any statutory responsibility for that on the NHS and create more administrative burden for it. I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.

New clauses 16 and 17 would impose new obligations on integrated care boards to promote carers’ wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services. I want to make it clear that we should not create any more administrative burdens for NHS frontline services. Although identifying and supporting carers is important, the requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care.

We should be cautious about creating new statutory duties that divert resources and staff time away from patients. The proposal for a national respite care scheme is similarly well intentioned, but it risks imposing a centralised, one-size-fits-all model across a system that already makes local authorities and health boards responsible for assessing local needs and delivering support. Again, although we need more support for carers, we should be careful that we are not duplicating any of the services that are already available. Some charities also do a brilliant job of supporting carers. The provisions in these new clauses should be looked into, but we need to be cautious that we do not create more burdens for our existing systems.

[Joe Robertson]

I am grateful to the hon. Member for Winchester for introducing these new clauses and for the debate that that is allowing us to have. Unpaid carers are too often a silent and fundamentally unappreciated part of society, which the system could not cope without. They are family members who are thrown into the role of looking after their loved ones, which they did not expect to have to do. Most of them have no formal qualifications, but through love and family ties, they provide unpaid support, which in many cases has a negative effect on the financial wellbeing of the household and involves a huge amount of emotional toil.

The crisis in social care has lasted for decades under different Governments, who have struggled to tackle it, and it is putting increasing pressure on family carers. Many do not see themselves as a carer—they see themselves as a husband, wife, daughter, son or friend—but they provide millions of hours of care and support, year in and year out. My former role was at a national nursing charity that seeks to support the families of those living with dementia. I saw for myself how much wraparound care can achieve in relieving pressure and unnecessary suffering, not just for the person living with dementia—it does not have to be dementia, but that is what I have experience of—long-term frailty or conditions that require support, but for their family and carer. Very often, the biggest care need for the person living with dementia is the biggest need their family carer has; if we can sort the family carer’s biggest need, they can go on and do so much more for the person they love.

I thank the hon. Member for Winchester for allowing us to have this debate. I urge the Government, if they do not adopt these new clauses, to do all they can to relieve the pressure on unpaid carers up and down the country and to provide support for them.

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.

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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—

Health Bill (Thirteenth sitting)

Joe Robertson Excerpts

Tuesday 7th July 2026 Public Bill Committees

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

My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.

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

The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.

There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.

The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.

A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.

As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:

“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]

That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.

If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.

I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.

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

It is a pleasure to serve under your chairship, Ms Lewell.

The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully.

For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us.

Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working.

As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it.

To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report.

The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at.

Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape.

Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

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[Karin Smyth]

No.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

[Joe Robertson]

Will the Minister give way?

[Karin Smyth]

I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

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[Dr Danny Chambers (Winchester) (LD)]

For over 50 years, there has been a statutory independent patient voice in the health and care system. The creation of Healthwatch was, in part, a direct response to the issues raised by the Francis inquiry into Mid Staffs. In a 2024 Healthwatch poll, almost a quarter of NHS patients said that they had experienced poor care in the past year, but 56% of them—more than half—took no action. Of that 56%, 20% said that that was because they were scared that giving negative feedback directly to NHS services would affect their ongoing treatment. Women, people living in areas of greater deprivation, disabled people and unpaid carers were significantly more likely to give the fear of retribution as a reason for not speaking up.

The Government are stripping patients of their voice in our NHS. Rather than being able to go to an independent body and express how the NHS can work better for them, patients will now be able only to give feedback to the same organisation that might have failed them. I have had experience of that in the past few weeks. My partner Emma has endometriosis, which has been an ongoing condition. She was worried that speaking to the local hospital trust specifically about the treatment she received might affect her treatment going forward.

The Government have argued that the changes will bring patient insight closer to decision making, making it much more effective at securing change. The former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), stated that patients do not need “ventriloquists”. That blatantly disregards the vital role played by Healthwatch in advocating not only for vulnerable patients who, understandably, do not feel confident navigating health services with often complex or combative systems, but for whole communities with a pre-existing distrust of the system.

We believe that removing Healthwatch leaves the health service to mark its own homework, which creates a conflict of interest. It will significantly undermine public trust, as independence is removed. Will vulnerable people who have suffered harm or poor experiences in the health and care system really have faith in a system headed by a director in the Department of Health and Social Care, which is the very organisation running the system that caused them harm in the first place? On a local level, will they have faith going to the same ICB that oversees the providers that have failed them? One need only look at the long list of maternity failings in Mid Staffs to see that internal functions can fail catastrophically. We know all too well that the NHS default is sometimes to cover up. The public knows that, too, so independence is everything.

Healthwatch has been keen in spotting and exposing challenges in the health service, such as widespread failures in the NHS referral process, yet there will be no incentive for the new system to investigate such issues, which are invisible in the main NHS performance metrics. The system does not always know what questions it needs to ask, so an independent route for unsolicited feedback is important. We also think that the provisions disadvantage hard-to-reach communities and those who may have a distrust towards the NHS and public authorities, making it harder to gain the feedback and concerns of those communities. That risks inadvertently further baking in inequalities.

More widely, clarity has not yet been provided on how those functions will be funded. The reform is coming alongside major reductions in ICB running costs. Healthwatch currently receives almost £26 million a year; that is already 60% less in real terms than the original DHSC estimate to fund the network. There is a risk that the money will be absorbed into wider budgets and never spent on the patient experience infrastructure. If people want to see the value of Healthwatch, they need look no further than the Cabinet Office briefing notes on the King’s Speech, which reference a May 2025 Healthwatch report on missing medical records to make the case for the single patient record.

Fundamentally, the Government are conflating patient voice with patient involvement in decision making. While greater patient voice in commissioning and decision making is needed, it is not a replacement for the advocacy and other functions of Healthwatch, which helps vulnerable people to navigate a complex health and care system and performs signposting functions. Splitting local healthwatch functions across ICBs and local authorities once again separates health and care and reinforces existing gaps between them. As we know, many issues span both areas and need a joined-up investigative approach. How will the new model ensure a joined-up view of people’s experiences across the NHS and social care? We urge the Minister to reconsider this decision. We have seen overwhelming support for Healthwatch across the sector, and it is becoming increasingly clear that many people in the NHS and the medical profession think that this is a huge mistake.

Healthwatch England has played a central role in escalating the findings of local healthwatch organisations and in advocating nationally. We have three examples. The first is the call to publish research highlighting inequalities in waiting times for disadvantaged groups, and for a demographic breakdown of waiting lists, which the NHS obliged with last summer. The second example arose after Healthwatch Sunderland supported a patient with a learning disability who had received accessible screening information but risked missing care because of inaccessible follow-up letters. Healthwatch England raised that gap with national bodies and highlighted inconsistencies in communication, and, as a result, the national easy-read templates were introduced across the cancer pathway, which improved accessibility and reduced risk. The third example is that Healthwatch feeds back patients’ horrific stories of corridor care—including that of a pensioner who was left in a corridor—to NHS leaders, and lobbies for increased transparency and oversight when it comes to corridor care.

I have several questions in three forms. Is the Minister genuinely sure that a director of patient experience in DHSC will be eager to advocate for patients and flag issues at a national level given that they will essentially be flagging to their bosses where work is not up to scratch? Is she sure that the level of persistence that has so often been needed to advocate for change at a national level would be forthcoming from a director employed by DHSC? What will be the mechanism for escalating local concerns that indicate national or systemic issues?

Will the Minister explain where the Government envision the new director sitting in the DHSC structure, and what the reporting lines will be? How will the Government ensure that they have the resources and sense of operational independence to investigate and raise concerns nationally? Healthwatch England has often flagged issues to MPs and to the Health and Social Care Committee as a way of applying pressure on NHS leaders and Ministers to enact change.

[Joe Robertson]

I am a member of the Health and Social Care Committee, and the hon. Member is absolutely right to say that Healthwatch England raises issues with us. When the Department assumes those roles and functions, I very much doubt that it will be as keen to disclose such issues to the Committee.

[Dr Chambers]

The hon. Gentleman must have read the next line of my speech. We are concerned that a DHSC employee appearing before that Committee will not clearly and openly state whether DHSC is failing.

New clause 78

“would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care”

in 2013-14. We do not just want to protect Healthwatch; we want to strengthen it. As I mentioned, it receives almost £26 million a year, which is spread over 153 organisations. In real terms, that is about 60% less than the £43.5 million that DHSC originally estimated would be needed to fund the network. The Healthwatch network does such amazing work—I will not go through it all again—despite being underfunded compared with those original estimates. Imagine the work it could do if it was adequately funded.

Even more worryingly, there is still no clarity on how Healthwatch’s functions will be funded once they have been transferred to the new system. Given the ongoing constraints and cuts to ICB running costs, there is a real risk that the funding for Healthwatch will simply end up being incorporated into wider ICB budgets, and money for the patient experience infrastructure could end up being cut entirely. The new clause aims to ensure that the Healthwatch network is properly funded, but it also raises the point that, if this change is to go through, funding for patient experience infrastructure must be protected. Otherwise, the Bill risks not just weakening patient experience, but removing it altogether as the funding gets swallowed by wider NHS operational demands.

--- Later in debate ---

There are some problems. The new clause mentions complaints but, although I fell into this trap when talking a moment ago, Healthwatch does not really deal with complaints; it raises issues and systemic failures that can be brought up through the system. Likewise, I am concerned that nothing in the new clause covers what happens once the Government have done their impact assessment. Even if the impact assessment comes back and says, “Actually, this has been a terrible idea,” the Government cannot do anything and, to be honest, once they have abolished these things it will be extraordinarily hard to pull them back. I have a lot of sympathy for the new clause, but unfortunately it will probably not achieve what the hon. Member for Rugby and I want.

[Joe Robertson]

It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone.

The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that.

That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice. We have heard how the Select Committee and MPs, in their free-ranging Back-Bench function, benefit from hearing that voice through an independent organisation such as Healthwatch England, because it allows them to fulfil their scrutiny function. This is not just about decision making; it is also about scrutiny of decisions once they have been made. What will the Select Committee, MPs and journalists do when they no longer have the light shed by that independent voice?

As my hon. Friend the Member for Farnham and Bordon has pointed out, representatives who are employees in the Department of Health and Social Care rightly have other overriding primary duties to the employer—the Department itself. Let us ensure that patient voice is articulated by those who do not have a primary obligation to their employer, but have an obligation to an independent organisation with functions that serve solely to amplify and project the voice of patients.

There are a number of issues with the abolition of local healthwatches, but I will save that for the next discussion. I want to make the wider point that there is a centralisation issue here too. Whether the Government like it or not, this measure will centralise powers into the Department; it will take outside powers from Healthwatch England and bring them in-house. That is nothing short of a centralising measure. The Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. So far, they are light indeed, or she has failed to articulate them. I think that there is a reason she has failed to articulate the positives: they simply do not exist.

I look forward to the Minister’s response. I urge her to take some more interventions, because the arguments she has given to the Committee in her speeches at the end of each discussion have tended to raise more questions than they have answered. We can only deal with that by intervening on what she says.

[Karin Smyth]

I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell.

I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously.

I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different.

The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them.

The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention.

On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.

--- Later in debate ---

The Government have relied heavily on one review. The Committee has heard from those who work with patients, represent patients and speak for patients, and their message has been clear: “Preserve independence.” If Ministers believe that Healthwatch can be improved, please improve it. If they believe consistency can be strengthened, strengthen it. But let us not abolish the only statutory body whose sole purpose is to represent patients independently of those who commission and provide NHS services, because once that independence is lost, it cannot be recreated. For those reasons, I hope that the Minister will reconsider.

[Joe Robertson]

The Government’s proposal to abolish the independent voice of patients is a mistake. It is a backward step, and I have seen no compelling reason why it should happen. Apparently, the voice of patients is going to be realised through integrated care boards and local authorities themselves, but that is not an independent patient voice. The very point of independence is that that voice is represented through an organisation that has no other function—no other skin in the game other than to represent that voice. It is remarkable that the Government are taking this step.

I suspect the Minister will say—she has already given a number of reasons—that this is happening in order to bring the voice of patients closer to those who make decisions, but that is not the function of Healthwatch. If she wants to achieve those things, she can achieve them while maintaining Healthwatch as an independent patient voice.

That independent voice ensures not only better decision making, but more effective scrutiny of decisions that have been made, and it does it by ensuring there is no blending or conflict of interest within a certain organisation—the decision maker. It does it by ensuring that light is cast on the critique, the scrutiny and the voice of patients, and that that process takes place outside the closed doors of, in this case, the integrated care board, not behind them.

I suspect that the Minister will say that the system is not working, because there are too many good reports by Healthwatch that sit on a shelf and have not been implemented. I would far prefer for us all to be able to see reports that have not been implemented sitting on a shelf and try to do something about them than for the patient voice to be heard behind closed doors and not acted upon. That is the inevitable conclusion from this merger—this abolition of the independent patient voice.

I want to talk about my experience on the Isle of Wight of the important work that our local healthwatch does. It assists me in my role as a parliamentarian and representative of the people, which is to scrutinise the decision-making of my local integrated care board and others, by providing the objective and unfiltered voice of patients through data, statistics and records, all of which will be lost within the ICB when this abolition takes place.

Guess who is often on the sharp end, or who is often critiqued by the evidence provided by Healthwatch? It is the ICB itself. Therefore, it is no wonder that Professor Croisdale-Appleby, the chair of Healthwatch England, agreed with the characterisation that this looks like the ICBs or other bodies marking their own homework. They will get to decide which part of the patient voice is acted upon, and which part is ignored, without the public gaze or scrutiny that is provided by an independent report that decision makers, parliamentarians, local councillors and the independent media can also use.

I will give a particular example from the Isle of Wight. Not so long ago, the integrated care board for Hampshire and the Isle of Wight proposed to reduce funding for Mountbatten hospice on the island and to redistribute that money to the mainland—it was, in my view, outrageous. The integrated care board had all the information available at its fingertips to realise that that was a bad proposal, and it had all the patient voices and views that it could possibly come across to realise that it was a mistake. It did not first consult representatives, such as me, my neighbour the hon. Member for Isle of Wight West (Richard Quigley) or local councillors, before making its proposal.

It was then Healthwatch’s data on the views and voices of patients, which had already been gathered, that helped the hon. Member, local councillors and me to make an argument against the proposal, directly to the ICB, in the media and to councillors at county hall. Without the tools that Healthwatch provided, it would have been so much harder to make that case. The ICB backed down on that proposal, but, if all that infrastructure, and all the information that Healthwatch independently provided, had sat behind closed doors within the ICB, we would not have had the opportunity to make our case and reverse the decision. That is one of the many thousands of real-life examples across the country where the affected patient voice was aired and properly used to reverse a bad decision, and it is an ability that will be lost.

Another issue is the fact that the centralisation of powers will inevitably water down the patient voice. There are over 150 local healthwatch branches, but there are not 150 integrated care boards. In the case of the Isle of Wight—I use that as an example because it is my own patch, but it will be the same situation up and down the country—we have our own Healthwatch Isle of Wight, which represents the unique insight and views of patients on the island. If those powers go to the integrated care board, that will cover Hampshire and the Isle of Wight, a population nearly 10 times as big. Our unique patient voice will be watered down into the patient voice of Hampshire; while the Hampshire patient voice is equally valid, that will nevertheless reduce the unique insights of smaller populations all over the country by including them in something bigger.

Particularly unique to my constituency and Isle of Wight West is health travel—that is, the reality of having to cross the Solent on a ferry to access so many health services. That is something that Healthwatch Isle of Wight uniquely understands through its direct consultation and work with island patients. Indeed, the people who work for our local healthwatch and its trustees are islanders. They do not just get it because they hear it; they get it because they live it. If that entire function is taken up to the Hampshire and Isle of Wight level, that unique insight will be lost. The ICB may give some regard to the cost of ferry travel and the implications of the disruption caused by having to travel on a ferry in order to access a hospital service that is not available on the Island, but its decision making will be much devalued in weight if it does not have the unique, independent patient voice coming from the Isle of Wight via our Healthwatch.

Health Bill (Tenth sitting)

Joe Robertson Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Gregory Stafford]

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

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

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

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

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

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

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

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

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

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

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

[Gregory Stafford]

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

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

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

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

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

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

Health Bill (Eleventh sitting)

Joe Robertson Excerpts

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[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.

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

It is a pleasure to serve with you in the Chair, Ms Lewell. I wish to speak on this aspect of the single patient record. Although I support the general intention and aim of the single patient record, I have some wider concerns about how it will be implemented. I will restrict my remarks to the issues related to this group of amendments, and particularly amendment 49 in the name of the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham.

Plainly, most people—I would probably include myself in this—are not immediately familiar with all the ins and outs of how their medical records are kept and used, and why should they be? However, they have some pretty clear views on what they expect, whether that is confidentiality or their records being used and stored in such a way that does not inadvertently act as a barrier to accessing healthcare in an efficient and timely way. That is why the Government have introduced these proposals, which I mainly support.

--- Later in debate ---

[Gregory Stafford]

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

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

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

[Joe Robertson]

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

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

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

--- Later in debate ---

[Dave Robertson]

I am not entirely certain that I want to agree with “one of” the most valuable datasets in the world; I think it could potentially be the most valuable dataset in the world.

We know that the NHS is the largest healthcare provider in the world. We know that the data is potentially very valuable. Creating this will allow our NHS to be at the forefront of managing how it works, in a way that no other health system will be able to, and certainly to a scale that no other health system anywhere in the world will be able to. That obviously comes with risks.

I have been listening carefully, and it is important that we tease out those risks and make sure that we stay as red hot as we can on all the issues that hon. Members have raised. I go back to the salient point of whether this clause should stand part. I fully support that this measure should be part of the Bill and that we should be moving in this direction.

I have spoken about the more global ideas and the reasons why, intellectually, I think this is a good idea, but let me take an example from my home county of Staffordshire up in the west midlands. There are reports that one hospital in Staffordshire uses 450 different electronic systems, which is absolutely bananas.

For so long, we have not had a single patient record. We have not had one unifying system. Over a cup of tea with the Minister a couple of days ago, I got very excited and started talking about primary keys because, although I am not a data scientist, I like the use of data. I do not think we need to get into a situation where there is a single primary key that is instantly recognisable to everybody and where we are necessarily using some machine learning to assess that. That could potentially come later down the line. That is not what the clause is doing, and it would need a much wider discussion than we are currently having.

If we take the example of Staffordshire and its 450 different data systems in one hospital—I do not know that number for certain, although it has been reported to me by two or three colleagues—I cannot imagine the difficulties that the IT team has in trying to get that number of systems to talk to each other. It will be nigh on impossible. All it leads to is delays. All it leads to is people having to reproduce data from one system to another manually. By creating an overarching single patient record, we will force it to happen.

[Joe Robertson]

The hon. Member has hit the nail on the head. A single patient record is not the same thing as mandating that 450 record-keeping systems become one. In fact, the single patient record will work as a theory on paper only if there is interoperability between different databases. That is a massive challenge that is not dealt with here. It cannot be dealt with here, in the real world, and the single patient record will not be realised until it is dealt with, which could take years. Does the hon. Member have a reflection on that point?

[Dave Robertson]

I appreciate the intervention, and it is nice for the hon. Member to get me back after I got him the other week. He is absolutely right. I do not think anybody in this room expects that after we have this discussion and the clause forms part of the Bill, and after the Bill goes through the parliamentary process and hopefully becomes an Act very soon, the next day there will instantly be this magical, ethereal thing called a single patient record and everything will drop into place immediately. I have a bridge to sell to anybody who thinks that.

What the clause does is put the NHS on a path to being able to deal with data appropriately, in a 21st-century way, by adding the ability and requirement for the NHS to use data appropriately. In terms of how that is done technically, I am very far from a computer programmer—I have done a tiny bit in parts of my life, and it always drives me absolutely wild—but there would be a number of architectures that could be used to make this work. I am not an expert and would not profess to be or to give anybody advice on that.

An advantage of the way the Bill is written is that things can be picked up by secondary legislation, which can go into a lot more technical detail. That is a real strength of how this is drafted. If we tried to mandate in primary legislation, in an Act of Parliament, far too granular a level of data science and information technology architecture, we would run a real risk of falling behind. Everybody is very aware of AI, and it is rare that I go a day without hearing people talk about it. Quantum is just behind it, and it is potentially much more disruptive and much more beneficial to huge parts of the economy, especially healthcare.

Trying to do everything through primary legislation is absolute folly. However, making sure we have primary legislation that allows us to drive the NHS into this space and to require and enable the NHS to stay on top of the proper use of data and to modernise its structures and practices can only be a good thing.

I close by saying that I absolutely support clause 47 standing part of the Bill. It has the potential to drive huge improvements in the NHS, both on a local scale and on a more global scale.

[Joe Robertson]

I will pick up where the hon. Member for Lichfield left off.

I make it clear that a single patient record is not a single electronic record-keeping system. Also, the single patient record is a theory, and it will remain a theory long after this legislation has been passed, as I am sure it will be, unless and until the electronic record-keeping databases and software in this country are able to speak to each other.

I have experience of working for a national nursing charity, and my role specifically dealt with the legal and governance issues of trying to embed community nurses in different settings. However, that work was beset by the problem of different databases—different electronic record-keeping systems—that did not speak to each other. Even those systems that were supposed to speak to each other did not do so. As the hon. Member for Lichfield said, sometimes there can be dozens, even hundreds, within even one NHS trust.

That should not be a problem today, but it is, and the Bill will get us no further on the technicalities and the technology problems we have. These systems are already meant to speak to each other, and we do not need legislation to realise that should be happening. Indeed, there are still paper record-keeping systems in many places up and down the country. The theory of a single patient record is a good one, but it will mean nothing in practice until those paper record-keeping systems have become electronic and then all the electronic systems speak to each other.

That makes me wonder whether a single patient record will ever be realised, regardless of legislation on the model that is supposed to exist. Indeed, the Bill does not mandate a single preferred electronic record-keeping system, and nor should it; there is a competitive market out there in which NHS trusts are free to engage and contract with different providers of electronic record-keeping.

I wrote to the local health bosses in my area after being made aware that the provider of one of their main electronic record-keeping systems had offered to extend the system further throughout the trust in order to save money. However, the trust has not yet responded. I am not in a position to say whether that offer is a better one, but on the face of it, it certainly looked like it would save money because it was a record-keeping system that the trust was already using; it just was not being used across all parts of the trust. That letter has gone unanswered for a year. It is not just a technological issue; there is also a cultural issue of the lack of nimble, joined-up decision making.

Some health bosses, not necessarily those in my area, are unable to take advantage of the financial benefits of changing or adapting to using new systems. Until that is resolved, a single patient record will remain ever wanted but never actually delivered.

To use an analogy, different companies provide the services on people’s mobile phones—the internet access, social media; software and even hardware. Most of us end up with a smartphone that does pretty similar things to every other smartphone and, broadly speaking, all the different apps co-operate with each other. Of course, the major global technology companies have faced legal action in the US, Europe, this country and elsewhere to ensure that their systems talk to each other, and primary legislation has been required to make them do that.

[Dave Robertson]

The phone analogy is really valuable. I am not an expert on the various architectures that make up phone operating systems, but I know a little about drivers and a little about computer programming languages. The hon. Gentleman is right that all the different bits of hardware in every single phone speak to themselves in a different language. Lots of them use different computer programming languages, and they all require drivers to translate that into whatever the operating system uses.

There are two or three major providers when it comes to mobile phones in the UK: Google and Android, and iOS. There is effectively a requirement on the phone companies that says, “If you want your app to be on our phones, it’s going to have to be able to use this language.” Depending on the operating system, the language will be slightly different, but the commercial requirement that apps must be able to use a certain language obliges the individual app producers and the individual pieces of hardware to have the driver to translate whatever language they use to talk to themselves into the one that works with the operating system.

Does the hon. Gentleman think there is a parallel in the Bill? Having a piece of legislation that requires a single patient record, whatever that looks like and whatever language it uses, potentially shortcuts some of the problems he is talking about with using a plethora of systems. Rather than having 450 systems, which could potentially use 450 languages, and trying to teach all of them all 450 languages, we create the requirement to use a specific language. We then teach all 450 one additional language and they will all be able to feed in—

[Dave Robertson]

Apologies.

[Joe Robertson]

That was a long intervention, but it was helpful. I disagree with the hon. Gentleman, because the legislation is not seeking to require technology companies or the providers of electronic record-keeping systems to be able to talk to each other. It is trying to create the concept of a single patient record, which is good, but it does not mandate a way to achieve that. I do not particularly want to name companies, but a big provider that is already in the health space and that provides electronic record-keeping systems might say, “We can already provide a single patient record. It is for other providers to adapt and feed into our record-keeping system,” and there is nothing in the Bill that says one technology company must adapt to another.

The technological issue is completely unaddressed. I am not even saying that it should be addressed in the Bill, because there are all sorts of issues around competition law and state support for particular companies. It is not a criticism per se of the way in which the Bill drafted, but this is an opportune moment to make the point that absolutely none of the clause will be delivered until a major issue that the Government have not yet addressed is dealt with. That issue is the interoperability of different electronic record-keeping systems provided by the private sector. They are all in competition with each other to get a bigger share of the market; unless and until that is addressed, the Government are not going to realise any of this. I do not want that to be the case. I want the single patient record to be realised, broadly speaking.

[Sojan Joseph]

I wish to speak in support of clause 47. I spoke on Second Reading about my strong support for the introduction of a single patient record. I am not a tech expert like my hon. Friend the Member for Lichfield—

--- Later in debate ---

Those are just some examples. In my constituency, a patient’s records are kept in five, six or seven different locations.

[Joe Robertson]

The hon. Gentleman is making the point that I have been trying to. He referred to a number of companies that each provide an electronic record-keeping system. The Bill does not mandate those companies to speak to each other and create a single patient record; there is no requirement on those private companies to do anything. As they are in competition with each other, their answer could be, “We can provide the single patient record—we are already doing it—if you just use more of our system and pay us more money.”

I am not suggesting that this is the hon. Gentleman’s responsibility, but does he have anything to say about the practicalities of a single patient record as a theory and the interoperability of electronic record keeping—a practical thing not dealt with in the Bill?

[Sojan Joseph]

My patient record is currently kept by different organisations or providers, which cannot see each other. If I speak to the GP about my blood sugar and then end up in A&E, they cannot see that record. If I go to the mental health service, they cannot see what medication I was taking. When I get discharged back to the GP, he will not get the information on my medication. That is the clinical aspect I am talking about, although I fully understand the hon. Gentleman’s concern. I hope the Minister will address some of those issues.

The responses I collected demonstrate how disparate and fragmented digital record systems are within just one local area. I do not think any of our constituents are aware that their data is kept in different places and that the services do not talk to each other. That is what the Bill is trying to address. All that information will be available for doctors, nurses and any other healthcare providers so that they can see patients’ history and medication and those patients will be more safe. Things will be more transparent. It will be easier for admission to discharge processes.

--- Later in debate ---

[Karin Smyth]

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

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

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

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

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

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

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

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

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

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

[Joe Robertson]

I thank the Minister for clarifying that the data will continue to be stored and held in the databases in the electronic record-keeping system where it is currently kept. I am not looking for her to give me a detailed solution on the spot, but does she accept that unless there is seamless interoperability across all those systems the single patient record will not be realised, and that we are still an awfully long way from seamless interoperability across England, let alone the UK?

[Karin Smyth]

The hon. Gentleman tempts me to spend the next hour talking about the shocking state of the capital and infrastructure systems that we inherited from the previous Government, but I will not. Of course they do not work: that is one of the biggest issues around staff morale. We saw through the 10-year health plan, particularly with clinicians having to log on to nearly 10 different systems, how that impedes progress and efficiency at a local level. Where it is rolled out, the federated data platform helps to make systems more efficient, particularly in local hospitals. We heard in our evidence sessions about maternity and frailty, which are the areas in which we will be testing and rolling out this approach to make the best use of it on the ground. Alongside that, the work to make systems more interoperable and efficient at a local level continues. I commend clause 47 to the Committee.

Question put and agreed to.

Clause 47 accordingly ordered to stand part of the Bill.

Clause 48

Information about health service products

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

Department of Health and Social Care

Joe Robertson Excerpts

Tuesday 30th June 2026 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I will dispense with the formalities to jump straight in. The hon. Member for Oxford West and Abingdon (Layla Moran) asked whether the Government have a clear, funded and transparent plan. Simply put, the Government appear to have made commitments they cannot properly explain, cannot fully cost, and cannot tell Parliament how they intend to pay for.

We are of course talking about the UK-US pharmaceutical arrangement, which will see 0.3% of GDP in 2026, rising to at least 0.6% by 2036—or an overall medicine spend of 10% to 12% of the UK NHS budget by 2036. That may bring benefits and investment, it may avoid tariffs, and it may help some patients get treatment faster, but those benefits do not remove the three key basic questions: what will this cost, how will it be funded, and what will the NHS have to forgo as a consequence? Those questions remain unanswered, which is a running theme from this Government.

Since Labour took office in July 2024, the pharmaceutical sector has issued a serious set of stark warnings. In January 2025, AstraZeneca cancelled its £450 million expansion near Liverpool, citing as a factor in the decision

“the timing and reduction of the final offer compared to the previous Government's proposal”.

However, that was not isolated. In March 2025, the leaders of some of the UK’s biggest pharmaceutical companies warned that the country risked becoming “uninvestable”. That warning turned into decisions, with MSD cancelling its plans for a £1 billion research centre in London, Eli Lilly pausing its work on the Gateway Labs hub, and Sanofi saying that it would not make substantial UK R&D investment until it saw appropriate recognition of the value of innovation.

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

Given that there are so many unanswered questions and such little information, rather than estimates day, wouldn’t the better name for this debate be “a complete stab in the dark” day?

[Dr Evans]

Or guesstimates day, for want of a better pun. That is part of the problem. If the Government are so confident, why do they not produce the impact report so that they can justify this? At the end of the day, we have seen that those decisions are not isolated; they are different companies, making different decisions, but all with the same concern. It is a pattern: tax rises, more regulation, more red tape—a more toxic concoction.

The Government will say that the deal is part of the answer, but Ministers cannot point to potential benefits while avoiding certain costs. The House of Commons Library is clear that the Department’s main estimate for 2026-27 does not include budget cover to meet the expected increase in pharmaceutical spending associated with the UK-US arrangement. That is the central problem. The Government say that the total cost in the current spending review period is expected to be around £1 billion, but the former Minister, the hon. Member for Glasgow South West (Dr Ahmed), also said,

“Total costs over the Spending Review period are expected to be approximately £1 billion. The final costs will depend on which medicines NICE recommends and the actual uptake of these.”

That is an important admission, because the final cost depends on future NICE decisions and uptake, and other estimates are higher.

The Library briefing cites analysis suggesting that spending could be around £1.7 billion by the end of 2028, and around £14 billion by 2036, depending on the assumptions. Is the £1 billion the central estimate, and if so, what are the lower and higher ends of the estimate range? Why will the Government not publish the modelling so that we can see? My next question is even sharper: where is the money coming from? We know from leaked WhatsApp messages that Labour MPs have been asking who they can tax to pay for benefits, so where is the money coming from? Both the House and the public are right to ask.

The Government have said that additional costs will be funded from existing NHS budgets, with future funding settled at the next spending review. However, if the money is coming from existing NHS budgets, it is coming from somewhere within the NHS. It might be the workforce, services, capital or future growth, but it will not be cost free. As Jonathan Benger, the chief executive of NICE, put it,

“If they choose to spend money on defence, they’ve got to pay for that somehow, either by raising taxes or removing money from somewhere else. If they choose to spend money more on medicines, similarly, that has to be paid for.”

That is the reality.

The former Secretary of State told the House that the Government would not cut NHS budgets to fund the pharma deal, but the former Health Minister, the hon. Member for Glasgow South West, later turned around and said:

“The deal will be funded by allocations made at the Spending Review, where record funding for the NHS was secured. Future funding will be settled at the next Spending Review.”

Those statements need reconciling. If it is funded from NHS allocations, that is NHS money. Can the Minister rule out any cuts from the frontline?

Finally, I will turn to transparency. I want to point out that the UK-US pharmaceutical arrangement is not a treaty-based free trade agreement. It has not been through the Constitutional Reform and Governance Act process. We have not seen what is going on. The Government need to publish their impact assessment, and yet they cite commercial sensitivity. Of course, there is a way round that: the Minister could redact it and give that to the Committee so that we and this House can see what is going on.

I will cut my speech short there. I will simply pose—

Health Bill (Eighth sitting)

Joe Robertson Excerpts

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[Dr Johnson]

In essence, the clause abolishes integrated care partnerships and strategies, which are where ICBs come together with local authorities to discuss how they can make their services more integrated. We know that many of the challenges facing the NHS are caused by difficulties in social care provision and some of the difficulties in social care provision are caused by issues with health provision, and that if those commissioning services in those two areas work together, we can see an improvement in both.

The Local Government and Public Involvement in Health Act 2007 made changes to local government structures and enhanced public involvement in health services. Section 116 requires local authorities to produce joint strategic needs assessments for the local authority and its partner ICB. When preparing the assessment, the local authority and its partner ICB must

“co-operate with one another…have regard to any guidance issued by the Secretary of State…involve the Local Healthwatch organisation”,

and involve local people and the relevant district councils. I note that later in the Bill we will also come to the abolition of Healthwatch.

Section 116 of the 2007 Act has been modified by the Health and Social Care Act 2012 and the Health and Care Act 2022 to ensure that references match the current NHS structure. For instance, in 2008 there were primary care trusts, rather than ICBs. Section 116ZA of the 2007 Act requires ICBs and local authorities whose areas coincide or overlap to create integrated care partnerships, which consist of a member appointed by the ICB, one from each responsible local authority and any other members that they choose to add; to some extent, they can determine their own procedures.

Section 116ZB of the 2007 Act requires ICBs to prepare an integrated care strategy

“setting out how the assessed needs in relation to its area are to be met by the exercise of functions of…the integrated care board…NHS England, or…the responsible local authorities”.

When developing that integrated care strategy, the integrated care partnerships must have regard to NHS England’s mandate and any guidance issued by the Secretary of State. Clearly, that would now apply only to guidance issued by the Secretary of the State, because NHS England is also being abolished. An integrated care partnership must publish its integrated care strategy and give it to each local authority and partner ICB. Integrated care partnerships must reconsider and, where necessary, revise the strategy each time they receive a new needs assessment.

Clause 23 deletes section 116(5A) of the Local Government and Public Involvement in Health Act 2007. That subsection required the local authorities to give a copy of the needs assessments to the ICBs, which is of course no longer necessary because they are being abolished. Clause 23 also deletes sections 116ZA and 116ZB of the same Act, which established ICBs and defined integrated care strategies respectively.

As Conservatives, we believe that streamlining bureaucracy is sensible, and I am sure that this is a well-intentioned reform. However, a survey conducted by the NHS Alliance in November indicated that a quarter of integrated care system leaders are likely to keep the integrated care partnerships anyway on a non-statutory basis, and 40% plan to fold them into health and wellbeing boards and working partnerships with the authorities. It is not really a ringing endorsement of the policy if a sizeable number of people intend to keep it anyway.

Like many other elements of the Bill, these changes are uncosted—if we read the impact assessment, it says “N/A” for the cost. Clearly, there will be a cost incurred by the abolition of the process, but there will also be an opportunity cost to services if ICBs and commissioners are not working together in the provision of social care as effectively as they were before. That will cost people in social care, and it will cost people in healthcare.

As recognised by the impact assessment that the Government have produced themselves, there is a risk of reduced focus on the wider determinants of health at system level. Committee members on both sides of the House have already stressed the impact that other health determinants can have on the health service and social care, and we have previously considered amendments to that effect.

Overall, it is regrettable that local government does not have the direct feed into ICBs that the design of those integrated care partnerships provided. Whether or not I agree, I can follow the theory or principle behind making the area covered more local, in line with the strategic authority. However, if the Government wanted to do that, I do not understand why they did not decide the mayoral areas first. At the moment, we do not know where the mayors will be, and where they are now is not where the ICBs are. The Government have decided to cut ICB budgets and force mergers before they have decided where the mayoral authorities will be in some cases. Even where there are mayoral authorities already, the Government have not mandated that the ICBs be coherent with them, and, therefore, in many cases, they are not. We have a very confusing pattern emerging, which may require further reorganisation of ICBs to line them up, with a further cost down the line.

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

Will my hon. Friend reflect on the fact that, even if the Government get through the combined mayoral authorities they are trying to in this Parliament, there are still great swathes of England where there are no active plans for a mayoral authority at all. Even if the Government get their own way, some areas will not have a mayor for many years—if they get one at all.

[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.

--- Later in debate ---

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

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

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

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

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

[Joe Robertson]

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

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

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

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

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

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

[Karin Smyth]

There has been a wide-ranging discussion on this clause. I remind Members that the abolition of ICPs is about reducing that complex legal framework, allowing for local decisions and putting partnership work in place in the most effective way. That is what the measure seeks to do. I do not think anyone has disagreed with the notion that the landscape is complex, and that people are producing a lot of reports. In future, health and wellbeing boards will be the focal point for the collaboration between ICBs and local authorities. They are statutory committees that bring together the NHS, local government and relevant community partners; set the strategic direction for health and care services; and oversee joint working in their area, which we are of course committed to making work in local areas. I do not think many people will disagree with that; I hope that is clear.

There is also an enhanced role, not only for the health and wellbeing boards—as I said last week, I think they have been underutilised in most areas; again, I do not think people generally disagree with that point—but for health scrutiny. Again, across the country, that has not been pursued to the greatest extent to create links with elected councillors in local areas.

We are clear that the role of local authorities is crucial at a local level—as the name describes—and particularly in working on our commitment for neighbourhood partnerships and developing the neighbourhood plan; most of that was covered in our sittings last week. I accept that there are a number of concerns about how that will work in different geographies. I think the Opposition said last week that a survey suggested a quarter of areas will keep those partnerships, which is absolutely fine. That is up to them.

On the one hand, the Opposition say that there is centralisation and a power grab in this Bill; on the other, they complain—I should not say complain, because it is their right and their job to do so—about the move to devolution and the freedom to allow, or indeed encourage, local leaders to work together across authorities on behalf of the populations they serve, even where some of them are politically divided, because the populations they serve voted for different people. It is incumbent on all of us as individual elected politicians to work with people—whoever the population around us voted for. These provisions provide for that.

Puberty Blockers

Joe Robertson Excerpts

Tuesday 23rd June 2026 Commons Chamber

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

I support an individual’s freedom to choose to live their life in whichever manner they want, subject only to the law. That includes someone’s right to want to live a life in a different gender identity to that which they were born with. But this debate is not about that; it is about administering powerful drugs to children. Although I have no direct experience of what it is like to want to live a life as somebody with a different gender identity, I have represented parents in the family court disputing their child’s gender identity—in one case, a child under that age of 10—in legal proceedings.

There is an absolutist argument that I want reject: the argument that this is only a clinical question, and that politicians, decision makers and the Government must follow clinical advice. The clinical advice itself is disputed, but I accept the weight that the Government have placed on the Cass review, which was commissioned under the previous Government. It is right that the current Government place weight on that. This is much more than a clinical question, though—it is an ethical question, a moral question and a legal question—and the issues that need to be grappled with fall on the shoulders of the elected Members in this place.

I want to explore one of the issues that I think is fundamental: the issue of consent. What can consent mean when we are talking about young children? What can it mean when we are talking about a parent giving consent for something to happen to their child? The issue of consent is not new. We have the legal age of consent for engaging in sexual activity. Society, through this place and the courts, has decided that children should not be engaging in sexual activity under the age of 16. That is not a fundamentally clinical issue; it is an issue around the emotional, psychological, moral and ethical impact on a child who does not fully understand what they are getting themselves into.

When it comes to a child under 13, we have a law that says consent is impossible. Under 13, there is no such thing as consent to sexual activity; it amounts to what we might term statutory rape. However, in the trial we are talking about today, children under the age of 13—at the age of 12—are going to be asked if they have engaged in oral sex in the last year. That is something that is illegal—something that they cannot consent to by law. Why are they being asked a question like that in these clinical trials? I ask the Minister to address that point directly. Plainly, consent is meaningful only if a child understands all the ramifications. I challenge anyone to stand up and back the idea that a child under the age of 13, for example, understands what it is like to give up the possibility of fertility, to live a life in a different gender and to really understand, at that age, what gender means in its adult entirety.

I turn now to the role of the parent. What parent can possibly say whether their child has been able to grapple with those issues in any meaningful way? They may be better placed than anyone else, but that does not mean that they can really form a judgment or view. After all, it would be preposterous to suggest that an adult could consent to their own child engaging in sexual activity, so how can they possibly consent to a child grappling with those ideas such that they administer a powerful drug to suppress their development and puberty?

We have a Government who have taken the view, which I welcome, that an adult cannot possibly consent to their own child having a social media account because they are not in a position to assess all the harms. How, by extension, can they say that an adult is in a position to consent to their child taking powerful drugs that will suppress their puberty and sexual development? It lacks any sort of coherence. I urge the Government to think again.