Health Bill (Thirteenth sitting) Debate
Full Debate: Read Full DebateDepartment: Department of Health and Social Care
Karin Smyth
Main Page: Karin Smyth (Labour - Bristol South)Department Debates - View all Karin Smyth's debates with the Department of Health and Social Care
Health Bill (Thirteenth sitting)
Karin Smyth ExcerptsTuesday 7th July 2026
(1 month ago)
Public Bill CommitteesRead Full debate Health Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 7 July 2026 - (7 Jul 2026)
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.
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.
Dr Prinsley
I listened carefully to what the Minister said about a change of culture. A change of culture can certainly happen. In the surgical world, we used to bring patients into the operating theatre, check that the patient was on the operating table and do the operation. Sometimes, we operated on the wrong patient and on the wrong part of the body. We then introduced the World Health Organisation checklist, which checked absolutely everything before we started. It was a complete change of culture in the operating department. We made sure that we had the right prosthesis, the right patient and that we were operating on the right part of the patient. Now, the WHO checklist is a universally adopted process. I am absolutely sure that the culture in the health service can change.
Karin Smyth
I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.
Karin Smyth
I want to make some points first. I will pick up any outstanding points I do not cover.
The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.
Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:
“by bringing HSSIB into the CQC, you can align the work of the two.
For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]
to enable best action. These organisations can learn better from each other.
Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.
Edward Argar (Melton and Syston) (Con)
On that point, will the Minister briefly give way?
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.
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.
Dr Johnson
My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?
Karin Smyth
I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.
The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.
New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.
Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.
As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.
I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC.
The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.
The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.
The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.
Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.
Dr Johnson
The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?
Karin Smyth
We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp.
Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.
I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee.
Question put, That the clause stand part of the Bill.
Karin Smyth
Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.
On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.
NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.
This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.
This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.
Dr Johnson
I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?
Karin Smyth
My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong.
Question put and agreed to.
Clause 62 accordingly ordered to stand part of the Bill.
Clause 63
Time limit for bringing proceedings
Question proposed, That the clause stand part of the Bill.
Karin Smyth
The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.
Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.
The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.
A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.
Dr Johnson
As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.
Karin Smyth
Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?
Dr Johnson
The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.
The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.
The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?
Karin Smyth
Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention.
Question put and agreed to.
Clause 63 accordingly ordered to stand part of the Bill.
Clause 64
Abolition of Healthwatch England
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Schedule 9.
New Clause 74—Report on the abolition of Healthwatch England—
“(1) Within 12 months of the passage of this Act, the Secretary of State must lay a report before both Houses of Parliament on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.
(2) The report must consider—
(a) the effectiveness of escalation routes for complaints,
(b) the ability to receive responses to complaints from the relevant ICB officer,
(c) accountability of ICB CEOs for delivering new functions arising from the abolition of Healthwatch;
(d) independence in the delivery of patient surveys, and
(e) ability to investigate organisations from which the ICB commissions services.
(3) The report must make recommendations about how any issues identified under subsection (2) may be mitigated.”
This new clause would require the Secretary of State to publish a report within 12 months of the passage of this Act on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.
New clause 78—Healthwatch funding—
“(1) The Secretary of State, must within 12 months of the passing of this act, enact a scheme to fund Healthwatch England and local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14.
(2) The Secretary of State must consider uprating this funding with inflation for 2026/2027.”
This new clause 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.
Karin Smyth
This is a popular clause, Ms Lewell—and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.
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.
Liz Twist (Blaydon and Consett) (Lab)
I was flattered to hear my comments on Second Reading quoted by the hon. Member for Sleaford and North Hykeham, but I think she has misunderstood me. My question to the Minister was and still is about how we maintain within the new arrangements the ability to speak up on behalf of others. Could the Minister comment on that?
Karin Smyth
I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important.
At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable.
I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.
Helen Morgan
For the record, I tabled amendments to delete those clauses, so there was consistency of intention.
Helen Morgan
I tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.
Karin Smyth
I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.
Karin Smyth
Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.
At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers.
This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.
As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.
Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.
Dr Johnson
As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.
There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?
The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?
The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.
The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?
The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?
Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.
Karin Smyth
Again, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape—well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do.
I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure.
I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”—that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience? Who are they?” It constantly surprises me, as it did when I worked inside the system. These are not remote people. We know who they are and what is wrong with them. We know how remote they are from the system. That goes to the heart of why the taxpayer is so alienated in this country from public services and their poor functioning. That is what the Government want to change.
It is not a matter of ICBs adding a new function; the Opposition have fundamentally misunderstood that. It is about rewiring these organisations to do something very different. Their function as strategic commissioners is to understand and to use all the data and evidence, including direct voice. We can argue about how that direct voice is taken in, but that is fundamentally what a commissioner is—I say that, having been a commissioner. It is not being done well, and that is why we are changing the legislation. Under previous legislation, ICBs had multiple functions. We are changing that to force them to be commissioners, but it is not an add-on; it is fundamental to the commissioning process. It is a complete rewiring of the organisation to listen to patient voice, patient experience and the reality of health inequalities.
In my constituency, I am afraid have not seen examples of the independent voice really speaking on behalf of the people I serve—some of whom have the worst health inequalities in the country, largely as a result of the tobacco industry and its legacy—whereas their experiences and their health outcomes are very well known and should drive the necessary changes. That is why we are driving all the changes in the 10-year health plan: to meet the needs of communities. We will continue to have this debate, but I wanted to make that absolutely clear.
We assume that the independent voice is always clear, but it is not. We have heard that it is variable and fragmented. That is not the fault of anyone trying to provide it, but that is where it is. The system is supposed to listen and improve services, and it does not. Things need to be changed in order to achieve that, and that is what we intend to do. The changes will be supported by scrutiny, transparency and oversight arrangements. The alternative, which is maintaining a separate structure with limited levers to drive change, has not delivered, and it cannot continue to try.
We are not removing patient and user voice; we are embedding it at the heart of the new system. ICBs will be expected to carry out proactive, inclusive engagement, particularly with so-called seldom-heard groups, including carers, those who do not have access to digital platforms, those less proficient with technology and people for whom English is a second language. Crucially, ICBs will be accountable for demonstrating reach and impact, not simply how many reports or engagement exercises they have done. Impact is what we will be looking at.
As I have said, this is about moving from a model where voices can be collected but overlooked to one where they must be heard and acted upon. The new patient experience director in the Department will work closely with local systems to identify national themes and significant concerns, ensuring that patient experience informs policy and improvement at the national level. To answer a previous question, the Secretary of State will have the power to issue directions to ICBs and local authorities if they are failing to exercise that function.
As I have said in debates on previous groups, I understand that it is difficult when we are debating the abolition of something outwith the wider framework of the 10-year health plan, the Dash review, the patient experience directorate in the Department and changes to the national quality board. It is incumbent on the Government to make that architecture clear and to build confidence and trust. That is what we intend to do, and that is how this body will be taken forward.
All comments have been noted. There is a fundamental difference of approach. We are making those bodies fundamentally different and rewiring them to do something different. I understand the bumpy road—I have been part of that, with community health councils and links to Healthwatch, and it has been a long one. I think we will keep returning to this theme. Those organisations have not been changed to do what they are supposed to do, and that is the ambition of this Government.
Question put, That the clause stand part of the Bill.
Karin Smyth
As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response.
Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee.
Question put and agreed to.
Clause 66 accordingly ordered to stand part of the Bill.
Clause 67
Minor and consequential amendments
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following:
Government amendments 20 to 24 and 83.
Schedule 11.
Karin Smyth
These are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act.
Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others—primarily the Secretary of State and integrated care boards—and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67 to the Committee.
Question put and agreed to.
Clause 67 accordingly ordered to stand part of the Bill.
Schedule 11
Minor and consequential amendments
Amendments made: 20, in schedule 11, page 140, line 16, at end insert—
“91A The Armed Forces Act 2006 is amended as follows.”
This amendment and amendments 21 and 22 remove a reference to NHS England from section 343AZB of the Armed Forces Act 2006 (to be inserted by the Armed Forces Bill).
Amendment 21, in schedule 11, page 140, line 17, leave out
“of the Armed Forces Act 2006”.
See explanatory statement for amendment 20.
Amendment 22, in schedule 11, page 140, line 18, at end insert—
“92A In section 343AZB (inserted by the Armed Forces Act 2026), in subsection (5)(a) omit sub-paragraph (i).”
See explanatory statement for amendment 20.
Amendment 23, in schedule 11, page 144, line 5, leave out paragraph 118.
This removes an unnecessary consequential amendment to section 12E of the NHS Act 2006 (that section is replaced in its entirety by clause 10 of the Bill).
Amendment 24, in schedule 11, page 148, line 9, leave out paragraph 139.
This removes an unnecessary consequential amendment to a heading that is replaced by clause 11.
Amendment 83, in schedule 11, page 191, line 35, at end insert—
“Children’s Wellbeing and Schools Act 2026
400 In Schedule 1 to the Children’s Wellbeing and Schools Act 2026 (relevant authorities)—
(a) omit paragraph 9;
(b) in paragraph 12, omit ‘section 25 of’.”—(Karin Smyth.)
This is a consequential amendment to Schedule 1 to the Children’s Wellbeing and Schools Act 2026, which would remove a reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill.
Schedule 11, as amended, agreed to.
New Clause 20
Arrangements between NHS bodies and local authorities
“(1) Section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities) is amended as follows.
(2) In subsection (6), for the words from ‘consultation’ to the end substitute ‘the making of arrangements by virtue of this section’.
(3) Omit subsections (7A) to (7L).
(4) In subsection (8), at the appropriate place insert—
‘“local authority” includes—
(a) a combined authority,
(b) a combined county authority, and
(c) the Greater London Authority;’.”—(Karin Smyth.)
This enables combined authorities, combined county authorities and the Greater London Authority to enter into arrangements with NHS bodies under section 75 of the NHS Act 2006 in relation to any of their functions, replacing the current different and more limited provision about combined authorities and combined county authorities.
Brought up, read the First and Second time, and added to the Bill.
New Clause 21
Dispensing medical practitioners etc
“(1) The National Health Service Act 2006 is amended as follows.
(2) In section 132 (persons authorised to provide pharmaceutical services)—
(a) for subsection (1) substitute—
‘(1) Except as may be provided for by or under regulations, no arrangements may be made by an integrated care board with a person providing primary medical services under Part 4 to provide pharmaceutical services.’;
(b) in subsection (3), for ‘medical practitioners’ substitute ‘persons providing primary medical services under Part 4’;
(c) in subsection (4)—
(i) for paragraph (a) substitute—
‘(a) as to grounds on which an integrated care board may, or must, refuse to grant an application for inclusion in a list referred to in subsection (3),’;
(ii) in paragraph (aa) omit ‘of medical practitioners’;
(iii) in paragraph (b), for ‘NHS England by a medical practitioner’ substitute ‘an integrated care board by a person’;
(iv) omit paragraph (c).
(3) In section 134 (pilot schemes), in subsection (8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.
(4) In Schedule 12 (LPS schemes), in paragraph 1(8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.”—(Karin Smyth.)
This updates the legislation about the provision of pharmaceutical services by medical practitioners to conform with current law and practice whereby commissioning arrangements are generally made with the practice rather than individual doctors. It also removes a reference to dental practitioners that is not needed.
Brought up, read the First and Second time, and added to the Bill.
New Clause 22
Inadequate provision of pharmaceutical services
“(1) Section 133 of the National Health Service Act 2006 (inadequate provision of pharmaceutical services) is amended as follows.
(2) For subsection (1) substitute—
‘(1) Subsection (2) applies if the Secretary of State is satisfied that a situation or event has caused or is likely to cause a disruption resulting in the inadequate provision of pharmaceutical services in England or in an area within England.’
(3) In subsection (2)—
(a) after ‘Secretary of State’ insert ‘may by direction’;
(b) for paragraph (a) (but not the ‘and’ at the end) substitute—
‘(a) require an integrated care board to make other arrangements,’;
(c) in paragraph (b) omit ‘may’.
(4) After subsection (2) insert—
‘(3) A direction under subsection (2) must specify the period for which it has effect.
(4) The period must not be more than 6 months.
(5) But the Secretary of State may by further direction extend the period for which a direction under subsection (2) has effect by up to 6 months at a time.
(6) The Secretary of State must publish any directions under this section.’”—(Karin Smyth.)
The amendments made by this clause (among other things) relax the legal test for making alternative provision to address the inadequate provision of pharmaceutical services owing to a disruption of services.
Brought up, read the First and Second time, and added to the Bill.
New Clause 23
Pharmaceutical services: appeals etc
“Schedule (Pharmaceutical services: appeals etc) makes provision about the destination of appeals, and jurisdiction to determine certain matters, currently governed by Part 7 of the National Health Service Act 2006 (pharmaceutical services and local pharmaceutical services).”—(Karin Smyth.)
The clause introduces a Schedule which amends provisions about certain appeals etc to the First-tier Tribunal. Those appeals will be transferred to an NHS body determined by regulations. It is expected that initially this will be NHS Resolution.
Brought up, read the First and Second time, and added to the Bill.
New Clause 91
Regulations: reference to agreements and standards
“(1) The Medicines and Medical Devices Act 2021 is amended as follows.
(2) In section 2 (power to make regulations about human medicines), after subsection (4) insert—
‘(4A) Regulations under subsection (1) making provision in reliance on section 3, 4, 5 or 7 may refer to international agreements or standards relating to human medicines, including agreements or standards as they have effect from time to time.’
(3) In section 16 (manufacture, marketing and supply), after subsection (2) insert—
‘(3) Provision made in reliance on subsection (1)(a) may refer to United Kingdom standards that—
(a) relate to the marketing, putting into service or other supply of medical devices, and
(b) are specified in a list published by the Secretary of State from time to time.
(4) Regulations made under section 15(1) that contain provision made in reliance on subsection (1)(a) about relevant requirements (or exceptions from them) may include provision in relation to a medical device where—
(a) the device complies with regulatory requirements applicable somewhere outside the United Kingdom which is specified in regulations, and
(b) a description of the device and the regulatory requirements applicable to it are contained in a list published by the Secretary of State from time to time.
(5) In this section “United Kingdom standard” means a standard that is—
(a) set by the British Standards Institution, or
(b) primarily developed for use in the United Kingdom, or part of the United Kingdom.’”—(Karin Smyth.)
This new clause would amend the Medicines and Medical Devices Act 2021 to (a) enable regulations to refer to both international agreements and standards and standards developed in the United Kingdom and (b) enable the Secretary of State to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.
Brought up, and read the First time.
The Chair
With this it will be convenient to discuss the following:
Government new clause 92—Medical Devices Regulations 2002: mutual recognition agreements.
Government new clause 93—Consultation about medicines and medical devices regulations.
Government new clause 94—Medicines and medical devices regulations: parliamentary procedure.
Government new clause 95—Medical devices etc: parliamentary procedure for certain fees regulations.
Government amendments 80 to 82.
New clause 67—Secretary of State directions relating to early access to medicines—
“(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the implementation of a scheme providing early access to medicines to people with life-threatening or seriously debilitating conditions.
(2) The bodies are—
(a) integrated care board,
(b) NHS Trusts,
(c) NHS Foundation Trusts,
(d) NHS Advanced Foundation Trusts, and
(e) other health and social care bodies.”
This new clause would give the Secretary of State power to direct integrated care boards, NHS Trusts, NHS Foundation Trusts, and NHS Advanced Foundation Trusts to implement a scheme to provide early access to medicines to people with life-threatening or seriously debilitating conditions.
New clause 68—Review of the Early Access to Medicines Scheme—
“(1) The Secretary of State must, within six months of the passing of this Act, commission a review of the regime for early and accelerated access to medicines in England and Wales.
(2) The review conducted under subsection (1) must consider—
(a) the effectiveness of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP),
(b) the effectiveness of the early access outside of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP), and
(c) equality of access across England and Wales, with the aim of reducing geographical inequalities between different NHS trusts.
(3) The Secretary of State must lay a copy of the report and recommendations of the review before both House of Parliament.”
This new clause would require the Secretary of State to commission a review of regime for early and accelerated access to medicines.
Karin Smyth
I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.
These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.
New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.
Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.
The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.
The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.
New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.
New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.
Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.
In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.
Dr Johnson
New clause 91 would amend the Medicines and Medical Devices Act to enable regulations
“to refer to both international agreements and standards and standards developed in the United Kingdom”
and enable the Secretary of State
“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”
New clause 92 would amend the definition of “mutual recognition agreement” so that
“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”
New clause 93
“amends the duty to consult in relation to regulations about human medicines and medical devices.”
That means that instead of a public consultation, it
“gives the option of consulting such persons as the relevant authority considers appropriate”.
I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.
New clause 94
“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”
That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.
Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.
Karin Smyth
I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue.
Question put and agreed to.
New clause 91 accordingly read a Second time, and added to the Bill.
New Clause 92
Medical Devices Regulations 2002: mutual recognition agreements
“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.
(2) For regulation 1A (Schedules) substitute—
‘1A Schedule
Schedule 2A has effect.’
(3) In regulation 2 (interpretation), in paragraph (1)—
(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;
(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.
(4) Omit Schedule 2 (mutual recognition agreements).”—(Karin Smyth.)
This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.
Brought up, read the First and Second time, and added to the Bill.
New Clause 93
Consultation about medicines and medical devices regulations
‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.
(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.
(3) After subsection (1) insert—
“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—
(a) carry out a public consultation, or
(b) consult such persons as it considers appropriate.”
(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.
(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’—(Karin Smyth.)
This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation.
Brought up, read the First and Second time, and added to the Bill.
New Clause 94
Medicines and medical devices regulations: parliamentary procedure
‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—
“(3) Regulations under Part 1 are subject to the draft affirmative procedure.
(3A) Regulations under Part 2—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on section 6(1)(a) (fees);
(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);
(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—
• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),
• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),
• Schedule 15 (requirements for specific products subject to general sale),
• Schedule 16 (patient group directions and vaccine group directions),
• Schedule 17 (exemption for sale, supply or administration by certain persons),
• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),
• Schedule 19 (medicinal products for parenteral administration in an emergency), or
• Schedule 21 (medicinal products at high dilutions);
(iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;
(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);
(b) are subject to the made affirmative procedure if they—
(i) contain only provision that is made in reliance on section 7 (emergencies),
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and
(iii) are not within paragraph (a);
(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).
(3B) Regulations under Part 3—
(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and
(b) are subject to the draft affirmative procedure if they are not within paragraph (a).
(3C) Regulations under Part 4—
(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—
(i) provision made in reliance on—
• section 17(1)(a) (fees), or
• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);
(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;
(b) are subject to the made affirmative procedure if they—
(i) contain only provision made in reliance on section 18 (emergencies), and
(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;
(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’—(Karin Smyth.)
This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment).
Brought up, read the First and Second time, and added to the Bill.
New Clause 95
Medical devices etc: parliamentary procedure for certain fees regulations
‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—
(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.
(b) after sub-paragraph (1) insert—
“(1A) Provision falls within this sub-paragraph if it relates to—
(a) altering the amount of a fee or charge to reflect changes in the value of money,
(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or
(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).
(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—
(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or
(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,
as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’—(Karin Smyth.)
This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure.
Brought up, read the First and Second time, and added to the Bill.
New Clause 1
National Maternity Commissioner
“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.
(2) The functions of the National Maternity Commissioner are to—
(a) oversee NHS maternity services;
(b) act as an independent voice for women and families;
(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;
(d) promote consistency, safety and accountability across NHS maternity services; and
(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.
(3) The person appointed as Commissioner must—
(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;
(b) have first-hand experience of working in maternity services, so far as reasonably possible; and
(c) not be a sitting Member of Parliament.”—(Helen Morgan.)
This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment.
Brought up, and read the First time.
Dr Johnson
As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.
New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012, early 2013.
I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.
The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.
My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.
I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.
Karin Smyth
I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.
Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.
That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action.
As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.
I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.
The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.
As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.
Dr Johnson
We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?
Karin Smyth
I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.
On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.
Edward Argar
My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.
New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?
I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.
Karin Smyth
I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work.
I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience.
I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control.
We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins.
A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier.
Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually.
As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary.
Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.
I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose.
The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses.
Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.
Dr Chambers
I appreciate the Minister’s response and the comments of other Members, which were insightful as usual.
When we discussed whether carers could access parts of the single patient record, Members made very good points about privacy and historical health issues that a patient might not want a carer to know about. Those are very sensible concerns, but someone watching these proceedings or looking back over the record would think that there had been a lot more agonising over whether someone caring for a patient could access relevant information than over the potential systemic misuse of health information facilitated by private companies. A lot of people are worried about that when it comes to procurement, trust and sovereignty.
I thank the Minister for her comments on new clause 3. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 4
Duty on the Secretary of State to prioritise domestic suppliers
“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—
‘1CD Duty to prioritise domestic suppliers
(1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom.
(2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist.
(3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with—
(a) patient groups,
(b) national security experts, and
(c) staff unions,
on the proposed contract and lay a report on such a consultation before Parliament.
(4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for its agreement is negatived by either House of Parliament.
(5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.’”—(Dr Chambers.)
This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers.
Brought up, and read the First time.
Question put, That the clause be read a Second time.