Health Bill (Twelfth sitting)

Karin Smyth Excerpts

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[The Chair]

Thank you. That is a matter of record. Any other takers? No.

[The Minister for Secondary Care (Karin Smyth)]

Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State.

NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment.

That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals.

I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which.

To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures.

I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it.

To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations.

The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that.

Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.

[Helen Morgan]

I thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 58 ordered to stand part of the Bill.

Clause 59

Transfer of HSSIB’s functions to CQC

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

[The Chair]

With this it will be convenient to discuss the following:

Amendment 55, in schedule 8, page 110, line 23, at end insert—

“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—

(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or

(b) should not be exercisable in relation to certain specified premises for other purposes,

those powers are not exercisable in relation to those specified premises.

(7) In this section, ‘Crown interest’ means—

(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;

(b) an interest belonging to His Majesty in right of the Crown;

(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;

(d) an interest belonging to the Duchy of Cornwall.”

This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill.

Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9).

This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.

Amendment 5, in schedule 8, page 120, line 16, at end insert—

“(2A) After paragraph 6(8) insert—

‘(9) A committee of the Commission is to be appointed in accordance with regulations.

(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.

(11) The committee is to be operationally independent from the Care Quality Commission.

(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.

(13) A majority of the members of the committee must not be members of the Care Quality Commission.

(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.’”

This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC.

Schedule 8.

Clauses 60 and 61 stand part.

New clause 42—Funding for Care Quality Commission (CQC) investigations—

“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”

[Karin Smyth]

Clause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission.

Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services.

With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it embeds a comprehensive investigatory framework with an established statutory regulator.

The CQC will be one organisation with separate functions—a regulatory function and an investigative function—to preserve the integrity of each. Within the CQC, HSSIB will continue to operate as a discrete unit and retain its independence from providers, allowing it to identify learnings and take a no-blame approach.

[Janet Daby (Lewisham East) (Lab)]

The Minister will recall that in evidence, Dr Rosie Benneyworth, interim chief executive officer of HSSIB, spoke about the vital work of the organisation, especially with regard to investigations where vulnerable staff and workers do not feel confident about coming forward for fear of reprisal. HSSIB did great work in that area, and I am wondering whether the CQC will carry it on and take on board that learning.

[Karin Smyth]

I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.

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

What we are talking about is not so much the safety of staff when they come forward, but the safety of patients, and whether we genuinely believe that the proposed modification to the arrangement will improve patient safety. That is the underlying point. Although the safety of staff is important, it is the safety of patients that we must bear in mind.

[Karin Smyth]

Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.

My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.

The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.

We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions.

Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.

The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.

Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.

The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.

The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.

Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.

Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.

Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.

[Dr Johnson]

These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.

When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.

Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.

One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.

That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.

At the time that HSSIB was established, there was consensus about it. The General Medical Council said:

“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”

The British Medical Association told Parliament:

“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”

Similarly, NHS Providers told Parliament:

“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”

Indeed, the Minister for Secondary Care herself is on the record as having said:

“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.]

I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.

In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.

Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that

“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,

and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.

The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that

“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”