Underperforming NHS Trusts: Government Oversight

Karin Smyth Excerpts

Wednesday 14th October 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

That is very kind of you to encourage me, Mr Stuart. What are the timings now?

[Graham Stuart (in the Chair)]

We will finish at 4.15 pm, so ideally we will allow the wind-up at 4.13 pm.

[Karin Smyth]

Thank you. It is a pleasure to serve under your chairmanship, Mr Stuart.

I want to try to get back to most colleagues. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this debate, and all Members who have spoken about the experiences of patients, because this is absolutely about the experiences of patients, families and the NHS staff in all our constituencies.

When an NHS trust underperforms, however we define it, the effects are very real. Patients wait longer, staff work without the stability and support they need, and public money is not used as effectively as it should be. Since becoming a Minister, I have made it clear that I think Members of Parliament should be part of conversations with local trusts. I commend my hon. Friend the Member for Ipswich (Jack Abbott) for hosting his trust in the way he has and seeing an improvement in his constituency, as he outlined, with mental health being considered as well as acute services. The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), spoke about her work in supporting her local trust and seeing those improvements. It can and does happen.

Many of the trusts that have been discussed today have faced problems built up over many years. In fact, I remember some of them from being a manager in the health service over the past 20 years or so. There is rarely one cause or a quick fix. There are varying problems, whether they be workforce shortages, poor estates, weak leadership, organisational change or rising demand, and some of those can reinforce one another. Let us be clear for patients and members of the public who are paying attention and for all our constituents: this Government will not accept poor performance, and we are determined to accelerate the recovery, particularly in the most challenged trusts.

I will just clarify some of the rules. Everyone knows that NHS England is an arm’s length body. That was a decision taken a number of years ago by my good friends the Liberal Democrats and the Conservatives when we were in opposition. The Health Bill, which is progressing through the House of Lords, changes that arrangement to put the NHS together with the Department of Health and Social Care. The Bill was not opposed in principle by any political party, because we all know that the arrangement has not worked.

As we bring the two bodies together, it is important to maintain the distinction between running large trusts and running the system as a whole, with operational performance oversight. It is a skilled job. It is hard to run a big trust. It requires good clinical and operational managers, and good leadership and knowledge. The complete separation of the Department and Ministers from NHS England meant that the oversight and what we could see in our constituencies as Members of Parliament was not linked up under the previous Government. That is one thing that will improve. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) just said, of course Ministers will not be micromanaging. It is a skilled job. The complete separation that removed oversight from local trusts has been a dysfunction of the system over the last decade.

To be clear, I regularly meet teams and Members of Parliament in my role. I want to share how some of that operational oversight works. I will highlight two major areas. One is the oversight framework, which provides a clear and consistent assessment of every NHS organisation. In her expertise, the hon. Member for Sleaford and North Hykeham recognised that there are many ways to judge performance, but the new framework looks at what matters most to patients and taxpayers: waiting times, quality of care, use of staff and money, and leadership capability in order to have good-quality patient care. They cannot be separated in my view. I have made sure that it is transparent for the public and Members of Parliament. That is quite controversial; some people do not like what they call league tables, but I think it is important that people can see that.

[Dr Caroline Johnson]

Will the Minister give way?

[Karin Smyth]

I will move through some of these points for the moment. For providers with the most entrenched financial, operational, leadership and structural challenges that impact patient care—that is what these trusts are about—we are taking a more holistic approach to that enhanced support because, as the shadow Minister asked, how do we choose? They are the most challenged long-term systems.

At a national level, the intensive recovery programme is providing short-term, intensive support for organisations to help strengthen their immediate operational and financial stability while developing an organisation-owned plan for long-term sustainability. We cannot keep going round in this circle; at the end of the day, these organisations need to be well run and well led, and local systems need to own that problem. That is also part of our wider devolution agenda. I think I outlined that in my letter to the hon. Member for Chelmsford in September, but I am very happy to meet again and go through that in more detail if that is helpful.

The first IRP cohort includes Hull, Northern Lincolnshire and Goole, East Kent, North Cumbria and Mid and South Essex. Each faces very different circumstances, so there is not a one-size-fits-all response. I will touch on some of them, for hon. Members have raised their own issues with them.

There is interest in Hull and Northern Lincolnshire and Goole. Following an independent review, the decision has been taken to dissolve the Humber health partnership arrangements. In Hull, the focus is on strengthening core hospital services, making the best use of specialist services, improving productivity and reinforcing clinical leadership and accountability. For Northern Lincolnshire and Goole, the priority is to move more care into neighbourhood and community settings, reflecting the demands in those areas. There are good signs of progress.

The hon. Member for Chelmsford and others who intervened highlighted Mid and South Essex. The 2020 merger of those three trusts has not delivered the planned benefits for 1.2 million people. Staff culture and morale remain a serious concern, with little improvement, as was highlighted in those terrible survey results over the past five years. We have heard those. The trust has long-standing performance problems linked to how demand is managed across the wider health system in that part of Essex. Work is under way to improve the long waits, improve patient flow, strengthen governance and make better use of the estate. I shared the analysis in productivity packs with everybody earlier in the year, and I am sure that everybody looked at them in detail, but I am very happy to go through them again. It identified more than £122 million of productivity opportunities. It is not simply about saving money.

Better organisation across sites and stronger clinical integration should improve patient experience, reduce delays and raise quality for patients. The clinical strategy will make greater use of neighbourhood and community care in line with our 10-year plan and focus on maternity and planned care treatment. This is backed by £80 million for Southend hospital’s long-standing structural estate problems and support for a neighbourhood health centre in Maldon.

I will touch on North Cumbria because, for the hon. Members for Westmorland and Lonsdale (Tim Farron), for Honiton and Sidmouth (Richard Foord) and for Yeovil (Adam Dance), the work going on there really highlights what can and needs to be done in rural healthcare. I remind hon. Members that hospitals in some of those areas are additionally funded to cope with some of those rurality issues. We highlighted that in our 10-year health plan. We absolutely understand that across the country, there are different issues with regard to rurality. I will not talk about Kent, because it has not been raised, but again, it has very different issues. That is why those areas have been chosen. They have long-standing and deeply entrenched problems.

My hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) raised ambulance handover delays. I did not know she was going to raise that today, but to assure her, the continued problem with the ambulances was raised with me in my oversight meeting with the team yesterday. Those issues are flagged by NHS England and its operational management across the country. They are long-standing issues, as she knows, but I gently disagree with her. She is absolutely right in her assessments of history, but this issue is not a failure of oversight and accountability. Good co-operation, collaboration and management are the responsibility of the services locally. The oversight has worked. We know that this is a problem. We and her constituents can see that. We very much want the services to work together to resolve that flow so that the ambulance handover works much better.

My hon. Friend the Member for Salford (Rebecca Long Bailey) highlights, sadly, her constituency’s downward improvement trajectory. She asked to meet me, and I am very happy to do that. My hon. Friend the Member for Darlington (Lola McEvoy) did the incredibly difficult job of raising the terrible distress for women in her constituency. She highlighted a terrible case, and I will make sure that she has a meeting with the Minister to go through how that can be supported on behalf of her constituents. I know that she will work closely to make sure that they are served better.

We are seeing early improvements through the IRP, but we need to demonstrate progress through safer care, better operation and financial performance. We have clear milestones and credible plans for stronger organisations. Support nationally is time-limited but proportionate, because trusts ultimately have to stand on their feet. Intensive oversight is not about naming and shaming. Staff in challenged trusts are working in exceptionally difficult circumstances. As we need to encourage people to work there, we must show them that it can be better. The purpose is to remove barriers to improvement, provide the right expertise and hold boards and NHS leaders to account for results.

The Government will continue to work with NHS England. I am committed to keeping Parliament informed of significant developments. We will judge our approach by its effect on patients and staff, not by the creation of more processes. The oversight framework and the intensive recovery programme provide a clear route from identifying the risk to taking targeted action. There is much more to do. It can only be done in local circumstances with co-operation and transparency, including working with Members of Parliament. Where we hear examples of trust chief executives not doing that, I am prepared to call it out. It is not acceptable.

There is more to do, but we want practical, safer and more timely care, and stronger organisations. I am pleased to have had the opportunity to debate this issue today. It is important for MPs to be part of the discussion. We want to improve all trusts, but we are focusing on those with long-term issues, sometimes having been affected for decades. The people in those areas deserve better, and we are determined to make sure they get it.