UK Medical Specialty Training Programmes: Prioritisation of Doctors

Karin Smyth Excerpts

Tuesday 15th September 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

We have now laid before Parliament the Medical Training (Prioritisation for Specialty Training Programmes) Regulations 2026. These regulations specify categories of person who will be prioritised for interviews and offers for UK medical specialty training programmes from 2027 onwards.

The Medical Training (Prioritisation) Act 2026 introduced a system of prioritisation for the allocation of postgraduate medical training places across the UK. It delivered the commitment in the Government’s “Fit for the future: 10 Year Health Plan for England” to prioritise UK medical graduates for foundation training and to prioritise UK medical graduates and other doctors with significant NHS experience for specialty training places.

The Act is designed to support a sustainable medical workforce that can meet population health needs, reducing the UK’s reliance on the international labour market, and ensuring we make best use of the substantial taxpayer investment in UK-based medical education and training. By creating a clear pathway from medical school to specialty training, we strengthen domestic talent and improve retention.

For specialty training, the Act prioritises graduates of medical schools in the UK or Ireland; international medical graduates who studied in Iceland, Norway, Liechtenstein and Switzerland, to reflect international agreements; and individuals who have completed or are completing the UK foundation programme or the relevant previous stage of a UK specialty training programme.

For specialty training offers made in 2026 only, the Act also prioritises individuals holding the following immigration statuses: British citizens; Irish citizens who do not require leave to enter or remain in the UK; Commonwealth citizens with the right of abode; individuals with indefinite leave to enter or remain in the UK; and those with EU settled and pre-settled status. These provisions were intended to act as a proxy to capture applicants most likely to have significant experience of working as a doctor in the NHS.

For specialty training places starting from 2027, the Act provides a power to specify by regulations groups to be prioritised, by reference to criteria indicating significant experience of working as a doctor in the NHS or health and social care in Northern Ireland, or described by reference to their immigration status, in a way that best delivers our policy intent.

During the Bill’s parliamentary passage, we committed to engaging with stakeholders on future regulations in this area. In spring 2026, NHS England undertook targeted stakeholder engagement on behalf of the four UK Governments. This included, among others, the medical royal colleges, bodies representing international medical graduates, trade unions including the BMA, NHS providers, the General Medical Council, think-tanks and medical schools. Most stakeholders favoured moving away from immigration status as the basis for prioritisation once NHS experience can be measured directly. Views on an appropriate minimum threshold for NHS experience were more mixed and based on limited evidence due to how recently prioritisation had been implemented, and we do not believe that we have a sufficiently robust evidence base to define alternative criteria setting a threshold for NHS experience in regulations at this stage.

The urgency of the Act meant that for 2026 it came into force after applications had closed and only introduced prioritisation for the offer of places. This meant that the evidence available from the 2026 recruitment round is necessarily limited, as prioritisation could have had little effect on applicants’ behaviour.

Having considered the available evidence, we have concluded that the immigration statuses that applied for specialty training offers made in 2026 remain the most appropriate basis for prioritisation at this stage. These statuses capture people with a permanent, unrestricted right to live and work in the UK and remain an effective proxy to capture doctors most likely to have significant experience working with the NHS. While we recognise this is not a direct measure of NHS experience, applicants with these immigration statuses are more likely to have worked in the NHS for a significant period of time or to remain working in the NHS for longer.

Using these immigration statuses from 2027 provides continuity with 2026 prioritisation arrangements while enabling evidence gathering from future recruitment rounds to support a fuller assessment of potential alternative approaches for future years.

These regulations do not amend the other categories of person already prioritised for specialty training places under the Act as set out above. These regulations also do not affect the prioritisation regime for foundation training under the Act.

[HCWS350]

Health Bill

Karin Smyth Excerpts

Report stage & 3rd reading
Tuesday 8th September 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

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

[Madam Deputy Speaker (Judith Cummins)]

With this it will be convenient to discuss the following:

Government new clause 95—Disclosure of information relating to medicines.

Government new clause 98—Disclosure of information relating to medical devices.

Government new clause 99—Further and consequential amendments relating to medical devices.

Government new clause 100—Power to amend meaning of “medical device”.

Government new clause 101—Power to restate medical devices law in Northern Ireland.

New clause 9—Powers for coroners and medical examiners to report suspected health system failings—

“(1) The Secretary of State must, by regulations, establish a standard mechanism for coroners and medical examiners to refer cases where they suspect failings in the provision of health care.

(2) A coroner or a medical examiner has a duty to report (a “duty to whistleblow”) using the mechanism established under subsection (1) if, in the course of their duties, they have reasonable grounds to suspect that a death or incident involved systemic failings in a health care setting.

(3) A referral under this section must be directed to any or all of the following bodies, as the coroner or medical examiner considers appropriate, based on the nature of the suspected failing—

(a) the chief officer of police for the relevant police area,

(b) the Care Quality Commission,

(c) the Department of Health and Social Care, and

(d) the Health Services Safety Investigations Body.

(4) Regulations under subsection (1) must specify—

(a) the information to be included in a referral,

(b) the timeframe within which a referral must be made following the formation of a suspicion, and

(c) guidance on the criteria for determining to which of the bodies listed in subsection (3) the referral must be directed.

(5) A disclosure made in fulfilment of the duty under subsection (2) is a protected disclosure for the purposes of Part 4A of the Employment Rights Act 1996 (protection for whistleblowing).

(6) The duties imposed by this section are in addition to, and do not affect, a senior coroner’s duty to make a report under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 (reports on action to prevent other deaths).”

This new clause requires the Secretary of State to create a standardised framework for them to formally refer suspected health system failings (including systemic issues) directly to the police, the CQC, the Department of Health and Social Care, and the HSSIB, with a duty on coroners to participate. It provides legal protection for those making such referrals.

New clause 10—Duty of NHS boards to report medical malpractice—

“(1) A member of the board of directors of an NHS trust or an NHS foundation trust in England must report any evidence or reports they have seen of systemic medical malpractice within the trust to—

(a) the Care Quality Commission,

(b) the Department of Health and Social Care, and

(c) the Health Services Safety Investigations Body.

(2) The board of directors of an NHS trust or NHS foundation trust in England has a collective duty to—

(a) refer the trust to the Care Quality Commission, and

(b) alert the Department of Health and Social Care and the Health Services Safety Investigations Body, if staff employed by, or acting on behalf of, the trust raise concerns of systemic medical malpractice.

(3) In this section, “systemic medical malpractice” means an action or omission in the provision of health care that falls below the expected standard of care and indicates a widespread, patterned, or recurring failure within the systems, processes, or governance of the trust.”

This new clause would introduce a mandatory individual duty for members of NHS and Foundation Trust boards to escalate evidence of systemic medical malpractice to the CQC, the Department of Health and Social Care, and the HSSIB. It also imposes a collective duty on the board to formally refer the trust to regulators if staff raise concerns regarding malpractice.

New clause 13—Medical Disinformation—

“(1) The Secretary of State must, within 6 months beginning on the day on which this Act is passed, publish a strategy on anti-vaccine and medical disinformation (“the Strategy”).

(2) The strategy must consider—

(a) support for medical professionals to build trust and engage with persons who are anti-vaccine,

(b) support for medical professionals and NHS leaders to engage with anti-vaccine councillors or officials in local authorities,

(c) investment in public messaging to combat medical disinformation, including engagement with trusted online influencers,

(d) outreach campaigns focused on communities who are sceptical about vaccinations,

(e) introducing criminal liability for those, including online influencers and politicians, who profit from medical disinformation,

(f) a new verification requirement for any social media account claiming to be a medical professional.

(3) The Secretary of State must lay a copy of this strategy before Parliament upon publication.”

This new clause places a duty on the Secretary of State to publish a strategy to combat anti-vaccine and medical disinformation.

New clause 14—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.

New clause 20—Cancer Survival Research—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must by regulations establish a Cancer Survival Research Programme.

(2) Regulations under this section must—

(a) require government co-ordination and funding for research into cancers with a five-year survival rate below 20%, and

(b) establish a fellowship programme for foreign academics in cancer research.

(3) Any programme established under paragraph 2(b) must make provision to waive visa fees for entry into the UK for participating academics.

(4) Regulations under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rate.

New clause 24—Strategy for provision of Minor Injuries Units and Urgent Treatment Centres in rural areas—

“(1) Within six months of the passage of this Act, the Secretary of State must prepare and publish a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas.

(2) The strategy under subsection (1) must be laid before both Houses of Parliament.

(3) The Secretary of State must lay a report before both Houses of Parliament on the implementation of the strategy every 12 months after the strategy has been published.”

This new clause would require the Secretary of State to prepare a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas and report on the implementation of the strategy annually.

New clause 26—Patient safety recommendations: national oversight—

“(1) The Secretary of State must establish a scheme relating to the oversight of patient safety recommendations (“the scheme”).

(2) The scheme must make provision for the monitoring and delivery of patient safety recommendations arising from—

(a) investigations,

(b) inquiries,

(c) reviews, and

(d) other patient safety bodies,

relating to patient safety.

(3) Within one year beginning on the day on which this Act is passed and every subsequent year, the Secretary of State must lay a report before Parliament on the progress of the scheme.”

New clause 27—Duty of candour and enforcement of standards of ethical conduct in DHSC—

“(1) In discharging its expected standards of ethical conduct, the Department of Health and Social Care (DHSC), must, in particular—

(a) set out the steps DHSC will take to ensure that legal services provided to NHS bodies and other relevant health-related organisations are consistent with the statutory duty of candour and the principles of openness, transparency and learning following patient safety incidents,

(b) set out which oversight body is responsible for ensuring the standards set out in DHSC code of ethical conduct are adhered to and enforced,

(c) set out provisions to allow a relevant oversight body to examine, on its own initiative, suspected serious or systemic breaches of DHSC’s code of ethical conduct,

(d) set out a mechanism for ensuring that any breaches of DHSC’s code of ethical conduct are recorded and that proper data is kept and published that records the extent to which complaints have been made regarding its ethical conduct and their outcome.”

New clause 28—Review of NHS neurodiversity policy—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review on—

(a) standards of NHS care for neurodiverse people,

(b) the effectiveness of current NHS trust policies regarding care for neurodiverse patients,

(c) the quality of training and guidance for frontline NHS staff in supporting neurodiverse patients, and

(d) health outcomes for neurodiverse patients at NHS trusts.

(2) The review under subsection (1) must be laid before both Houses of Parliament.”

New clause 30—Review into acute stroke support services in rural areas—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review of acute stroke support services in rural areas.

(2) The review under subsection (1) must include an evaluation of—

(a) decision making processes,

(b) evidence used to justify decisions,

(c) public consultation processes,

(d) health outcomes,

(e) travel times for access to services, and

(f) impact on the NHS workforces.”

New clause 41—Remit of the Human Tissue Authority—

“(1) The Secretary of State must, within six months of the passing of this Act, by order under section 14(4) of the Human Tissue Act 2004, amend the remit of the Human Tissue Authority to include the regulation of funeral directors, private mortuaries, direct cremation services and other organisations which transport or hold the bodies of deceased persons for the purposes of ensuring that the carrying out of their functions is consistent with the protection of public health.

(2) The Authority must establish and maintain a register of the bodies subject to its oversight under subsection (1).

(3) The Secretary of State may by regulations make further provision regarding the establishment and operation of the register under subsection (2).

(4) Regulations made under subsection (3) are subject to the affirmative procedure.”

This new clause would require the Secretary of State to extend the remit of the Human Tissue Authority to include regulation of funeral service providers to ensure their activities are consistent with the protection of public health; and to maintain a register of those bodies subject to its regulation.

New clause 42—Oversight of funeral service provider premises and practices connected to the storage, preparation and movement of human remains—

“(1) The Secretary of State may by regulations establish a body corporate, or confer functions on an existing public authority, ("the Regulator") to provide oversight of the premises and practices connected to the storage, preparation and movement of human remains by funeral service providers in England.

(2) The purpose of the Regulator is to ensure that the activities undertaken under subsection (1) are consistent with the protection of public health.

(3) The Regulator shall be independent in the exercise of its functions and shall not be regarded as a servant or agent of the Crown.

(4) Regulations under this section may, in particular, make provision for—

(a) a scheme for the registration of funeral service providers;

(b) the inspection of premises, vehicles and other facilities used by registered providers for the storage, preparation, care or transportation of deceased persons, or from which funeral services are arranged or conducted;

(c) the publication and enforcement of a code of practice for the funeral services sector; and

(d) the imposition of sanctions, including suspension or removal from the register, for breach of that code.

(5) Before making regulations under this section, the Secretary of State must consult—

(a) providers of funeral services;

(b) such persons representing the interests of bereaved people as the Secretary of State considers appropriate; and

(c) such other persons as the Secretary of State considers appropriate.

(6) Regulations under this section are subject to the affirmative procedure.”

New clause 45—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 47—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),

(b) the effectiveness of early access outside of the Early Access to Medicines Scheme (EAMS), 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 Houses of Parliament.”

This new clause would require the Secretary of State to commission a review of regime for early and accelerated access to medicines.

New clause 49—National Guardian’s Office—

“(1) Within three months beginning on the day on which this Act is passed, the Secretary of State must re-establish the National Guardian's Office.

(2) The Office established under subsection (1) must—

(a) hold any responsibilities held by the National Guardian's Office as of 29 June 2026; and

(b) be operationally independent.”

This new clause will re-establish the National Guardian’s Office.

New clause 52—Cancer treatment: waiting times—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision for every patient to have access to cancer treatment within 62 days following referral.

(2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS constitution for England for every patient to have access to cancer treatment within 62 days following referral.

(3) The Secretary of State must establish a scheme to support NHS hospital trusts in meeting the requirement under subsection (1).

(4) As part of the Scheme, the Secretary of State must expand the capacity of the Medicines and Healthcare products Regulatory Agency.

(5) The Secretary of State must make an annual statement to Parliament on progress made in meeting the requirement under subsection (1).

(6) Any statement made under subsection (5) should be made as close as reasonably practicable to 4 February.”

This new clause would give patients a right under the NHS constitution to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this. It also requires the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day.

New clause 63—Social Care—

“(1) Within 3 months beginning on the day on which this Act is passed, the Secretary of State must lay before Parliament detailed proposals for reform of the social care sector.

(2) Proposals under subsection (1) must include provision for—

(a) a respite care scheme;

(b) reform of carers allowance;

(c) free personal care; and

(d) a cap on care costs.”

This new clause would require the Secretary of State to lay before Parliament plans to reform the social care sector, including free personal care, a cap on care costs and that delivers for family carers.

New clause 68—Report on dementia care—

“(1) Within 12 months of the passage of this Act and every 12 months thereafter, the Secretary of State must publish and lay before both Houses of Parliament a report on—

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

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

(2) A report under subsection (1) must have regard to—

(a) any targets or standards set out in a national plan, guidance, or framework relating to dementia services, and

(b) any other information the Secretary of State considers appropriate.

(3) A report under subsection (1) must include—

(a) an assessment of variation in dementia services and outcomes between Integrated Care Board areas,

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

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

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

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

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

(g) dementia research activity in the NHS.”

This new clause would require the Secretary of State to publish an annual report on the provision of NHS care and social care in relation to dementia.

New clause 72—Provision of Minor Injuries Units in Rural Areas—

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish and implement a strategy to improve access to minor injuries units in rural communities.

(2) The strategy under subsection (1) must include measures to—

(a) expand, maintain and protect existing minor injuries units serving rural populations;

(b) ensure that integrated care boards assess local demand for urgent treatment services in rural constituencies and make provision accordingly, and

(c) promote the recruitment and retention of healthcare professionals required to staff such facilities.

(3) The Secretary of State must lay before Parliament an annual report on—

(a) the number and geographical distribution of minor injuries units in England;

(b) changes in patient access to urgent care services in rural areas; and

(c) progress made in implementing the strategy required under subsection (1).

(4) In this section, “rural constituency” means a parliamentary constituency designated as predominantly rural by the Office for National Statistics or such successor body as may be prescribed by regulations.”

This new clause would require the Secretary of State to expand and safeguard minor injuries units in rural communities with the aim of improving access to urgent care, reducing pressure on major hospitals, and ensuring equitable healthcare provision regardless of geography.

New clause 81—Family support duty following serious childhood diagnosis—

“(1) Where a child is diagnosed with cancer or another life-threatening condition, the responsible NHS provider must, within 14 days of diagnosis, ensure that the child’s family is offered appropriate information, support and coordination services.

(2) For the purposes of subsection (1), the responsible NHS provider must offer—

(a) access to a named family support coordinator;

(b) information regarding welfare benefits, financial support and relevant public services;

(c) information regarding employment rights and workplace support available to parents and carers;

(d) signposting to appropriate mental health and psychological support services;

(e) information regarding relevant local and national charities, support organisations and peer-support services;

(f) a written family support plan setting out the support available to the family during treatment; and

(g) notification and information sharing in accordance with subsection (3).

(3) The responsible NHS provider must provide the child’s registered general practitioner and where different, the registered general practitioners of the child’s parents or primary carers, with a Family Support Summary.

(4) A Family Support Summary must include—

(a) the child’s diagnosis;

(b) the proposed treatment plan;

(c) the expected duration and intensity of treatment, where known;

(d) information regarding the potential impact of the diagnosis and treatment on parents, carers and siblings; and

(e) any recommendations regarding wellbeing support, monitoring or referral for the family unit.

(5) Following receipt of a Family Support Summary, the relevant general practice shall be encouraged to consider the wellbeing needs of parents, carers and siblings and, where appropriate, provide information, assessment, referral or signposting to suitable support services.

(6) The Secretary of State must publish guidance for NHS providers on the discharge of duties under this section.

(7) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated as such by the Secretary of State in guidance.”

This new clause places a duty on NHS providers to offer practical information, coordination and support to families within 14 days of a child being diagnosed with cancer or another life-threatening condition.

New clause 82—Parent mental health and bereavement support duty—

“(1) Where a child is diagnosed with a life-threatening condition, the responsible NHS provider must ensure that the psychological wellbeing of parents, guardians, primary carers and siblings is considered as part of the child’s care pathway.

(2) Within 14 days of diagnosis, the responsible NHS provider must offer—

(a) a parental psychological wellbeing assessment;

(b) access to a designated family support practitioner, psychologist, counsellor or other appropriately qualified professional;

(c) information regarding the psychological impact of serious childhood illness, including trauma, anxiety, depression, stress and bereavement;

(d) a written Family Mental Health Support Plan;

(e) notification to the child’s registered general practitioner and, where different, the registered general practitioners of parents or primary carers.

(3) During active treatment, the responsible NHS provider must ensure that parents and primary carers are offered periodic psychological wellbeing reviews.

(4) The responsible NHS provider must offer an additional psychological wellbeing review following any—

(a) significant deterioration in the child’s condition,

(b) relapse,

(c) progression of disease,

(d) transition to palliative care, or

(e) other material change in prognosis.

(5) The responsible NHS provider must ensure that support under this section is offered proactively and must not be dependent upon a parent, guardian, carer or sibling requesting support, identifying their own need, or making a self-referral.

(6) Following the death of a child, the responsible NHS provider must—

(a) offer a bereavement wellbeing assessment to parents or primary carers;

(b) offer access to bereavement counselling, psychological support or equivalent specialist services;

(c) make proactive contact with the family within 14 days of the child’s death;

(d) offer further follow-up support at intervals specified in guidance issued by NHS England; and

(e) ensure that referral pathways are available where significant psychological distress, trauma, anxiety, depression or post-traumatic stress symptoms are identified.

(7) The responsible NHS provider must ensure that information regarding available support services is provided to siblings and that age-appropriate emotional support pathways are available where required.

(8) NHS England must publish guidance regarding—

(a) parental psychological wellbeing assessments;

(b) family mental health support following serious childhood diagnosis;

(c) bereavement support following the death of a child;

(d) support for siblings affected by serious childhood illness;

(e) referral pathways into specialist mental health services; and

(f) minimum standards for proactive family mental health support.

(9) NHS England must publish and lay before Parliament an annual report on compliance with this section.

(10) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated by the Secretary of State in regulations.

(11) The Secretary of State must, within three years of the commencement of this section, undertake a review of its operation and lay a report before Parliament.”

This new clause would establish a statutory duty on NHS providers to identify and support the psychological wellbeing of parents, carers and siblings following the diagnosis of a life-threatening childhood condition. It would create a proactive, opt-out family mental health pathway from diagnosis through treatment and, where applicable, bereavement.

New clause 83—Review of uncertain imaging findings in high-risk childhood illness—

“(1) Where imaging undertaken in relation to a child with a high-risk cancer or other life-threatening condition identifies findings that are—

(a) inconclusive,

(b) indeterminate, or

(c) suspicious,

the responsible NHS provider must ensure that the findings are reviewed by a consultant clinician responsible for the child's care.

(2) Following such a review, the responsible NHS provider must ensure that the child's parent, guardian or primary carer is informed—

(a) of the nature of the uncertainty identified;

(b) whether disease progression, relapse or recurrence can be confidently excluded;

(c) what further investigations or surveillance are being considered; and

(d) the risks and benefits associated with immediate further imaging, alternative imaging modalities, or continued observation.

(3) Where disease progression or relapse cannot be confidently excluded, the responsible NHS provider must consider whether additional imaging or investigation should be undertaken within 14 days or as soon as clinically practicable, whichever is sooner.

(4) The outcome of any discussion held under subsection (2), including the views expressed by the child's parent, guardian or primary carer, must be recorded in the child's medical records.

(5) NHS England must publish guidance on the operation of this section, including circumstances in which further imaging should be considered following uncertain or indeterminate findings.”

This new clause requires consultant review of uncertain imaging findings in children with designated high-risk conditions. It also aims to ensure that parents are informed of the uncertainty, the available options and the risks and benefits of those options before a decision is made.

New clause 86—Compassionate access to innovative treatments—

“(1) In exercising their functions in relation to the health service, the Secretary of State must by regulations make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in circumstances where conventional treatments have been unsuccessful, unsuitable, or unavailable.

(2) Regulations made under this section must make provision for the authorisation, supply, possession, administration and supervision of such treatments, notwithstanding any restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001, including provision for—

(a) appropriate clinical and regulatory safeguards;

(b) approval arrangements for participating clinicians, providers and pharmacies; and

(c) case-by-case decision-making having regard to clinical need, patient safety, and available evidence.

(3) For the purposes of this section, a serious or life-threatening condition is defined as a condition involving a substantial risk to life or serious impairment of health or functioning.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

This new clause would require the Secretary of State to make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in certain circumstances.

New clause 87—Research into innovative treatments involving controlled substances—

“(1) The Secretary of State must by regulations take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001.

(2) Regulations made under this section must make provision, for—

(a) the lawful possession, supply, administration, production and importation of such substances for the purposes of clinical trials or other research activities approved in accordance with regulations made by the Secretary of State, notwithstanding any prohibition or restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001; and

(b) proportionate and timely arrangements relating to the approval, licensing and oversight of authorised research activities under this section.

(3) Provision under subsection (2) applies to—

(a) approved research bodies,

(b) authorised researchers, and

(c) participating healthcare providers,

and specified substances used for approved research purposes, and does not alter the schedule or classification of a substance.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

This new clause would require the Secretary of State to take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001.

New clause 88—New Hospital Programme: publication of multi-criteria decision analysis (MCDA) reports—

“(1) Within three months beginning on the date on which this Act is passed, the Secretary of State must publish the MCDA reports used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme.

(2) The information published under subsection (1) must include—

(a) the multi-criteria decision support analysis tool used to prioritise schemes;

(b) the input data used in that analysis for each hospital in the New Hospital Programme;

(c) the scoring mechanism used in that analysis;

(d) any assessment of estate condition, including data from the NHS England Estate Return Information Collection;

(e) any assessment of patient safety, service disruption or maintenance backlog;

(f) any assessment of the presence of reinforced autoclaved aerated concrete;

(g) any assessment of the risks associated with delaying individual schemes; and

(h) any review of the appropriateness of the input data or scoring mechanism by NHS England or the Department of Health and Social Care.

(3) The Secretary of State may redact information published under this section where publication would—

(a) prejudice commercial negotiations,

(b) disclose personal data, or

(c) endanger the safety or security of patients, staff or NHS premises.

(4) Where information is redacted under subsection (3), the Secretary of State must publish a statement explaining the reason for the redaction.

(5) The Secretary of State must lay the reports and information published under this section before Parliament.”

This new clause requires the Secretary of State to publish the criteria, input data and scoring mechanism used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme. Whilst the input data was obtained from publicly available sources, the MCDA reports are currently not publicly available.

New clause 89—New Hospital Programme: estate failure—

“(1) Within six months beginning on the date on which this Act is passed, the Secretary of State must review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme.

(2) For the purposes of subsection (1), “significant estate failure” includes the closure, partial closure or restricted use of hospital buildings because of structural, safety or infrastructure failures.

(3) In prioritising schemes within the New Hospital Programme, the Secretary of State must ensure that hospitals experiencing significant estate failure are treated with the same urgency as hospitals affected by reinforced autoclaved aerated concrete.

(4) The Secretary of State must publish the outcome of the review in subsection (1).”

This new clause requires the Secretary of State to review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme, and to ensure that such hospitals are treated with the same urgency as RAAC-affected hospitals.

New clause 92—Duty to report on the regulation of cosmetic surgery—

“(1) Within three months of the passing of this Act, the Secretary of State must publish a report assessing the effectiveness and safety of current regulation of cosmetic surgery.

(2) The report under subsection (1) must investigate regulatory measures regarding professional checks on the providers of cosmetic surgery, including whether they—

(a) are registered medical practitioners;

(b) have completed recognised specialist surgical training; and

(c) hold Cosmetic Surgery Board Certification, or an equivalent certification, accreditation or qualification.

(3) The report must also consider the safety of current regulations of the premises where cosmetic surgery procedures are undertaken.”

This new clause would require the Secretary of State to prepare a report assessing the regulation of cosmetic surgery.

New clause 102—Report on impact on health of social media addiction—

“(1) The Secretary of State must, within six months of the passage of this Act, commission a report on the impact on health of social media addiction.

(2) The report under subsection (1) must consider and make recommendations concerning—

(a) the mental health effects of social media addiction;

(b) the physical health effects of social media addiction; and

(c) the effects of social media addiction on demand for NHS services.

(3) The Secretary of State must lay a copy of the report with proposed actions to minimise the health harms of social media addiction before both Houses of Parliament.”

This new clause would require the Secretary of State to commission a report considering the impact on health of social media addiction.

New clause 103—Communication with parents of critically ill children—

“(1) The Secretary of State must, within 12 months of the passing of this Act, issue guidance to integrated care boards on communication with parents of critically ill children, with particular reference to major decisions in the child’s treatment and care.

(2) Guidance issued under subsection (1) must—

(a) make provision for ensuring that parents have been fully consulted and are fully informed of decisions concerning the care or treatment of their child and the rationale behind such decisions;

(b) make provision, where potentially life-ending or life-changing decisions are to be made, to facilitate parents in accessing an independent specialist second opinion;

(c) make provision, where there is a disagreement between parents and clinicians on the care or treatment of a child, for the appointment of an independent mediator;

(d) make provision, following the advice of an independent specialist second opinion, for transfer of the child to another hospital, subject to appropriate clinical safeguards;

(e) make provision, prior to the death of a child, for family members to be given access to the child, whether in the hospital, a children’s hospice or the family home.

(3) Guidance issued under subsection (1) must have regard to Article 2 of the European Convention on Human Rights.”

This new clause would require the Secretary of State to issue guidance to integrated care boards concerning their role in communicating with parents of critically ill children, and involving them in decision-making.

New clause 107—Fracture liaison services: implementation framework—

“(1) The Secretary of State must, within six months of the passing of this Act, publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030.

(2) The framework must set out—

(a) the minimum standards expected of fracture liaison services;

(b) the steps to be taken to reduce unwarranted variation in access and quality between integrated care board areas;

(c) the respective responsibilities of integrated care boards and NHS trusts;

(d) the workforce, diagnostic, digital and data requirements necessary to support implementation; and

(e) arrangements for identifying people at risk of further fragility fractures and ensuring that they receive appropriate assessment, treatment and follow-up.

(3) The Secretary of State must make a statement to Parliament each year, until 2030, setting out progress towards universal access to fracture liaison services.”

This new clause would require the Secretary of State to publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030.

New clause 110—Rural access to child and adolescent mental health services—

“(1) Each integrated care board must make arrangements to ensure that children and young people in rural areas have reasonable access to child and adolescent mental health services.

(2) In exercising its functions under subsection (1), an integrated care board must have regard to—

(a) travel distances and travel times;

(b) the availability of public transport;

(c) the availability of locally accessible community facilities; and

(d) the particular needs of children and young people who may face barriers to travelling to a centralised service.

(3) The Secretary of State must provide appropriate support to integrated care boards and local authorities to develop community-based child and adolescent mental health services in rural areas.

(4) An integrated care board and a local authority may make arrangements for the use or repurposing of vacant or underused public buildings for the provision of child and adolescent mental health services.”

This new clause would improve access to CAMHS in rural areas by supporting locally delivered services and enabling vacant or underused public buildings to be repurposed for community mental health provision.

New clause 111—Child and adolescent mental health workforce and service capacity—

“(1) Each integrated care board must assess whether child and adolescent mental health services in its area have sufficient staffing and clinical capacity to meet the needs of children and young people.

(2) Where an assessment under subsection (1) identifies a significant shortfall, the integrated care board must prepare and implement a plan to address that shortfall.

(3) The plan must include measures to support the recruitment and retention of suitably qualified staff and, where clinically appropriate, the provision of specialist services including trauma assessment, dialectical behaviour therapy and art therapy.

(4) In preparing the plan, an integrated care board must have regard to—

(a) the number of children and young people receiving CAMHS services;

(b) waiting times for assessment and treatment;

(c) the number and complexity of cases managed by individual staff members; and

(d) the availability of specialist clinical services.”

This new clause would require integrated care boards to assess and address staffing and service capacity in CAMHS, including access to appropriate specialist services.

New clause 112—Review of child and adolescent mental health services in rural areas—

“(1) The Secretary of State must conduct, or arrange for the conduct of, reviews of the provision of child and adolescent mental health services in rural areas in England.

(2) Any review must consider—

(a) waiting times for assessment and treatment;

(b) access to interim support following referral;

(c) travel distances and access to public transport;

(d) staffing and specialist service capacity;

(e) the availability of community-based provision; and

(f) the use of vacant or underused public buildings for the delivery of services.

(3) A review must identify areas where the provision of child and adolescent mental health services is insufficient to meet local need.

(4) The Secretary of State must publish the findings of any review and an action plan setting out measures to address any significant deficiencies identified.

(5) The first review under this section must be completed within 12 months of the passing of this Act and subsequent reviews must be completed at intervals of not more than five years.”

This new clause would require a national review of CAMHS provision in rural areas, including access, waiting times, workforce capacity and the availability of community-based services.

New clause 113—Radiotherapy services: access and accountability—

(1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must set out nationally agreed metrics against which integrated care boards must measure and report their delivery of, and investment in, radiotherapy services.

(3) The metrics must include, but are not limited to, metrics relating to—

(a) waiting times for radiotherapy;

(b) access to radiotherapy services, including variation in radiotherapy treatment rates between integrated care board areas;

(c) the age, capability and replacement needs of radiotherapy equipment;

(d) radiotherapy capacity against assessed population need; and

(e) workforce capacity.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework and any steps proposed to address underperformance or unwarranted variation.

(7) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.”

This new clause would require the Secretary of State to publish a national framework for improving access to radiotherapy services. Integrated Care Boards would be required to report annually against national metrics on waiting times, access, equipment, capacity, workforce, investment and variation.

New clause 114—Radiotherapy services: access and waiting times—

“(1) Within six months of the passing of this Act, the Secretary of State must conduct and publish a review of access to radiotherapy services and waiting times for radiotherapy in England.

(2) The review must include an assessment of—

(a) variation in access to radiotherapy services between integrated care board areas;

(b) waiting times for radiotherapy services, including where radiotherapy is the first, second or subsequent cancer treatment received by a patient; and

(c) the extent to which capacity, equipment, workforce or investment constraints are affecting access to radiotherapy services or waiting times for radiotherapy.

(3) In conducting the review, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(4) The Secretary of State must lay the review before Parliament and set out any steps proposed to address identified gaps in access to radiotherapy services or waiting times for radiotherapy.

(5) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.”

This new clause would require the Secretary of State to review access to radiotherapy services and radiotherapy waiting times. The review would examine variation between ICB areas, delays where radiotherapy is a first or subsequent treatment, and the capacity constraints affecting patient access.

New clause 116—Access to medicinal cannabis for children: review and clinical trials—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a review on access to medicinal cannabis for children on the NHS.

(2) The review under subsection (1) must consider—

(a) variation between integrated care boards in the referral and prescribing of medicinal cannabis to children;

(b) the barriers preventing children from accessing medicinal cannabis through the NHS, including the number of patients who access private prescriptions as a result;

(c) the current evidence base for the clinical effectiveness of medicinal cannabis for children; and

(d) options for expanding that evidence base through clinical trials.

(3) The Secretary of State must take reasonable steps to support and facilitate clinical trials into the use of medicinal cannabis for children, with the aim of establishing a clearer evidence base to inform NHS prescribing guidance.

(4) The Secretary of State must lay a copy of the review before both Houses.”

This new clause would require the Secretary of State to review inconsistencies in NHS access to medicinal cannabis for children, including the extent to which patients are forced to rely on private prescriptions, and would place a duty on the Secretary of State to support clinical trials to strengthen the evidence base for prescribing.

New clause 117—Access to speech and language therapy—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a strategy for improving access to NHS speech and language therapy services in England.

(2) The strategy under subsection (1) must include—

(a) an assessment of waiting times for speech and language therapy across integrated care boards;

(b) an assessment of variation in access to speech and language therapy between different areas of England;

(c) an assessment of the speech and language therapy workforce, including current vacancy rates and future workforce need; and

(d) proposals to reduce waiting times and geographical variation in access.

(3) The Secretary of State must lay a copy of the strategy before Parliament.

(4) The Secretary of State must publish a further report reviewing progress against the strategy within eighteen months beginning on the day on which this Act is passed.”

This new clause would require the Secretary of State to publish a strategy to address waiting times and geographical inequality in access to NHS speech and language therapy, and to report on progress against that strategy.

New clause 123—NICE technology appraisal recommendation: accountability scheme—

“(1) The Secretary of State must establish by regulations an accountability scheme relating to the implementation of NICE technology appraisal recommendations (the "scheme").

(2) Under the scheme, Health and Social Care bodies must take all reasonable steps to implement a NICE technology appraisal recommendation within three months of receiving such a recommendation.

(3) Any Health and Social Care body that fails to meet the requirement set out in subsection (2) must—

(a) publish an explanation of the reasons for the failure;

(b) specify any circumstances which have prevented implementation; and

(c) publish a plan setting out the steps it will take to implement the recommendation.

(4) Regulations under this section are subject to the affirmative procedure.”

New clause 131—Activities of religious groups in medical settings—

“(1) The Secretary of State must, within six months of the passage of this Act, make regulations concerning the activities of religious groups in medical settings in England.

(2) Regulations made under subsection (1) must make provision for—

(a) clinical oversight of training provided by representatives of religious groups to healthcare professionals and students on the treatment of patients who hold religious beliefs that may influence their choice of treatment;

(b) ensuring that the contacting of any religious group on behalf of a patient, or for advice on care, is made only at the request of the patient;

(c) requiring opportunities for patients to indicate final treatment preference in the absence of religious representatives, and ensuring religious representatives cannot later verify a patient’s final treatment choice; and

(d) any other matter that the Secretary of State deems appropriate.

(3) Regulations made under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to make regulations governing the activities of religious groups in medical settings in England, to prevent medical coercion.

New clause 132—Non-therapeutic male circumcision—

“(1) The Secretary of State must, within six months of the passage of this Act, make regulations relating to non-therapeutic male circumcision (NTMC).

(2) Regulations made under subsection (1) must make provision for—

(a) a requirement that NTMC may only be performed by a suitably qualified healthcare professional and must be inspected by the Care Quality Commission;

(b) the inclusion of NTMC as a regulated activity under the Health and Social Care Act 2008;

(c) the creation of a statutory duty for integrated care boards to produce annual data on prevalence and complications of NTMC;

(d) a requirement that NTMC be included in the Single Patient Record; and

(e) any other matter that the Secretary of State deems appropriate.

(3) Regulations under this section are subject to the affirmative procedure.”

This new clause would require the Secretary of State to introduce regulation of non-therapeutic male circumcision, following several prevention of future death reports issued by coroners as a result of deaths arising from this procedure.

New clause 137—Cancer outcomes—

“(1) The National Health Service Act 2006 is amended as follows.

(2) After section 1GA insert—

“1GB Cancer outcomes

In exercising functions relating to the health service, the Secretary of State must treat objectives relating to cancer outcomes as having priority over any other objectives relating specifically to cancer.””

The Secretary of State is currently required to set cancer outcome objectives for NHS England, with those objectives taking priority over other cancer goals. The Health Bill removes this provision. This new clause would place a new duty on the Secretary of State to prioritise cancer outcomes such as survival by inserting a new section into Part 1 of the National Health Service Act 2006.

New clause 138—Report on occupational health screening for fire and rescue personnel—

(1) The Secretary of State must, within 12 months of the passing of this Act, publish a report on access to occupational health screening, including blood testing for biomarkers of exposure to carcinogens, for members of fire and rescue services in England.

(2) The report under subsection (1) must consider—

(a) the classification by the International Agency for Research on Cancer of occupational exposure as a firefighter as carcinogenic to humans;

(b) the current provision of occupational health screening for fire and rescue personnel by fire and rescue authorities, NHS bodies and integrated care boards;

(c) options for a national baseline entitlement to periodic health screening for fire and rescue personnel, informed by exposure risk;

(d) the resource and workforce implications of any such entitlement; and

(e) the interaction of any such entitlement with existing work by the Fire Brigades Union and the University of Central Lancashire on the UK Firefighters Cancer and Disease Registry.

(3) The Secretary of State must lay a copy of the report before Parliament.”

This new clause would require the Secretary of State to report on occupational health screening, including blood testing, for fire and rescue personnel, in recognition of their elevated risk of cancer arising from occupational exposure to carcinogens.

New clause 139—Duty on integrated care boards to share data with fire and rescue authorities concerning vulnerable persons—

“(1) An integrated care board must take reasonable steps to share, or to facilitate the sharing of, relevant data with a fire and rescue authority for the area, or part of the area, for which the integrated care board has responsibility, for the purpose of enabling the fire and rescue authority to identify and prioritise vulnerable persons in the event of an emergency.

(2) In this section, “relevant data” means data relating to a person’s vulnerability, including but not limited to age, disability or mobility, that is necessary and proportionate for the purpose in subsection (1).

(3) Data may only be shared under this section—

(a) in accordance with the requirements of the UK GDPR and the Data Protection Act 2018;

(b) subject to arrangements agreed between the integrated care board and the fire and rescue authority setting out the purpose, extent and security of the data sharing; and

(c) where a mechanism exists for a person to object to the sharing of their data under this section, save where doing so would be likely to endanger life.

(4) The Secretary of State must, within 12 months of this section coming into force, publish guidance for integrated care boards and fire and rescue authorities on the operation of this section.

(5) In this section, “fire and rescue authority” has the meaning given by section 1 of the Fire and Rescue Services Act 2004.”

This new clause would place a duty on integrated care boards to share relevant data concerning vulnerable residents with fire and rescue authorities, subject to data protection safeguards, to enable fire and rescue services to identify and prioritise vulnerable people in emergencies, including fires and flooding.

New clause 140—Corridor care—

“(1) The Secretary of State must end the practice of corridor care in NHS hospitals within one year of the passage of this Act.

(2) If the requirement under subsection (1) is not met, the Secretary of State must commission an independent inquiry into the Government's handling of corridor care.

(3) The inquiry under subsection (2) must—

(a) investigate the effectiveness of policies, funding and guidance relating to corridor care in the Department of Health and Social Care;

(b) assess the impact on patient safety and staff morale from the continued practice of corridor care; and

(c) recommend steps the Secretary of State should take to end the practice of corridor care.

(4) The inquiry under subsection (2) should be supported by patient safety professionals from the Health Services Safety Investigations Body and the Care Quality Commission.

(5) The inquiry under subsection (2) must be published and laid before Parliament as a final report within 6 months beginning on the day on which the inquiry is established.”

This new clause places a duty on the Secretary of State to end Corridor Care within 12 months, if they fail to do so they must order an independent inquiry into corridor care and the failure to eradicate the practice.

New clause 141—Suspension of Advice and Guidance pending HSSIB report and mitigation plan—

“(1) The Secretary of State must ensure that the operation and further rollout of Advice and Guidance services (including any targets, incentives, pathways or contractual requirements that treat Advice and Guidance as a prerequisite or preferred alternative to direct referral) are suspended until the conditions in subsection (2) are met.

(2) The conditions are that—

(a) the Health Services Safety Investigations Body (or, if its functions have already been transferred under section 63 of this Act, the Care Quality Commission exercising those functions) has laid its final report on Advice and Guidance services before Parliament, and

(b) the Secretary of State has published a written mitigation plan addressing the patient safety risks, harms and recommendations identified in that report (including any linked to patient deaths, near misses, treatment delays, resource and capacity gaps, workforce training, digital systems and incident reporting).”

New clause 142—Puberty blockers—

“(1) Within three months of the passage of this Act the Secretary of State must make regulations which ensure that puberty blockers may not be prescribed, dispensed or supplied to persons under 18 years of age for the purposes of treatment related to gender dysphoria, gender incongruence or a combination of both, in the United Kingdom.

(2) Regulations under this section must ensure that such drugs cannot be given out or used as part of clinical trials for the treatment of gender dysphoria, gender incongruence or a combination of both, unless that trial has specifically been approved by a resolution of both Houses of Parliament.

(3) For the purposes of this section, puberty blockers means—

(a) a “gonadotrophin-releasing hormone (“GnRH”) analogue” which means a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin, and

(b) any other drug which has the effect of suppressing or delaying puberty that the Secretary of State may by regulation appoint.”

This new clause would create a requirement for the Secretary of State to make regulations which prevent puberty blockers from being prescribed to persons under 18 years of age for the purposes of treatment related to gender incongruence, or being given in clinical trials related to gender incongruence unless specifically approved by Parliament.

New clause 143—Single sex facilities—

“(1) The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff,

(b) toilets and washing facilities for NHS staff,

(c) wards for NHS patients, and

(d) toilets and washing facilities for NHS patients.

(2) The Secretary of State may make exemptions to the duty in subsection (1)(c) and (1)(d) where necessary for—

(a) children,

(b) intensive care units,

(c) critical care, and

(d) specialist high observation areas such as resuscitation in Accident and Emergency and the initial recovery area in theatres.”

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients. It provides exemptions in certain circumstances.

New clause 146—Fracture liaison services: delivery plan and annual reporting—

“(1) The Secretary of State must, within 90 days of the day on which this Act is passed, publish and lay before both Houses of Parliament a delivery plan for securing universal provision of fracture liaison services across England by 2030.

(2) The plan under subsection (1) must include—

(a) a baseline assessment of current access to, and quality of, fracture liaison services in each integrated care board area, distinguishing clearly between services established before and after July 2024;

(b) annual milestones for the number of patients identified, assessed and treated through fracture liaison services, sufficient to reach the level required for universal coverage;

(c) the specific steps the Secretary of State will take to support integrated care boards to commission and sustain high-quality fracture liaison services, including any use of directions, guidance, financial incentives, capital funding or other mechanisms;

(d) workforce, diagnostic (including DEXA capacity), digital and data requirements, with associated funding assumptions;

(e) arrangements for independent monitoring and public reporting of progress against the milestones; and

(f) an estimate of the expected reduction in fragility fractures, hip fractures, associated deaths and NHS bed days, drawing on available evidence including that published by the Royal Osteoporosis Society.

(3) The Secretary of State must, within 12 months of publishing the plan under subsection (1) and every 12 months thereafter until 2030, lay before Parliament a report setting out—

(a) progress against each annual milestone;

(b) the number of new fracture liaison services established and the number of patients identified in the preceding year;

(c) any revision to the milestones or timetable, with the reasons for any such revision; and

(d) action being taken to address any shortfall.

(4) In this section “fracture liaison service” means a service for the systematic identification, assessment, treatment and ongoing monitoring of people who have sustained a fragility fracture, for the purpose of reducing their risk of further fractures.”

This new clause would require the Secretary of State to publish a plan to roll out fracture liaison services across England and publish reports of progress.

New clause 147—Plan to manage acquired brain injury—

“(1) The Secretary of State must, within 30 days of the day on which this Act is passed, publish a plan for the management of acquired brain injury across England.

(2) A plan under subsection (1) must include but shall not be limited to—

(a) proposed government actions to prevent acquired brain injuries;

(b) proposed government actions to improve acute treatment for acquired brain injuries;

(c) a statement of priorities regarding the Secretary of State’s approach for rehabilitation and long-term support for persons with acquired brain injuries across public services delivered by—

(i) the Department of Health and Social Care,

(ii) the Department for Education, and

(iii) the Ministry of Justice;

(d) proposals for data sharing between government departments, health care, and rehabilitation providers to improve patient—

(i) identification,

(ii) care, and

(iii) support;

(e) a commitment to providing 95% of people with complex needs with a personalised care plan by 2027;

(f) commitments for research into acquired brain injuries in sport;

(g) any proposed use of directions, guidance, financial assistance, incentives or other mechanisms to secure delivery of the plan’s objectives;

(h) workforce, diagnostic, digital and data requirements for implementation of the plan; and

(i) arrangements for monitoring, publishing and reporting progress against the plan.

(3) The plan under subsection (1) must be laid by the Secretary of State before both Houses of Parliament.

(4) The Secretary of State must, within 12 months of publishing a plan under subsection (1), and every 12 months thereafter until 2030, lay before Parliament a report on progress made against the proposals and commitments in the plan.”

This new clause would require the Government to publish their action plan to manage acquired brain injury within 30 days of the passing of this Act.

New clause 148—Radiotherapy cancer treatment services—

“(1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must include nationally agreed metrics against which integrated care boards must measure and report their investment in, and delivery of, radiotherapy services.

(3) The metrics must include provisions relating to—

(a) waiting times for radiotherapy, including time to definitive treatment;

(b) patient travel times to radiotherapy services, including defining an appropriate recommended travel time;

(c) the number of cancer patients receiving radiotherapy and the quality of such radiotherapy;

(d) the age, capability and replacement needs of radiotherapy equipment, including the proportion of linear accelerators that are more than 10 years old or otherwise beyond the recommended replacement age;

(e) access to modern radiotherapy techniques and technologies;

(f) radiotherapy capacity against population need and the projected increase in number of cancer patients;

(g) variation in access to radiotherapy services between integrated care board areas;

(h) provision of sustainable, flexible workforce that is equipped to harness advances in radiotherapy for patient benefit; and

(i) investment in radiotherapy services and the extent to which such investment reflects clinical need.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy which the Secretary of State considers appropriate.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework.”

This new clause would require the Secretary of State to publish and maintain a national framework for improving access to radiotherapy services in England.

New clause 149—Modern Service Framework for Respiratory Disease – prioritisation and reporting—

“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including respiratory disease), and

(b) lay before both Houses of Parliament a report on the prioritisation of respiratory disease for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of respiratory disease in England including—

(i) emergency admissions,

(ii) variation by integrated care board area,

(iii) outcomes;

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a respiratory Modern Service Framework could deliver;

(c) the status of existing work on respiratory pathways including for—

(i) pulmonary fibrosis,

(ii) pulmonary rehabilitation,

(iii) diagnostics,

(iv) early detection and lung cancer screening,

(v) supported self-management,

(vi) access to medicines;

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a respiratory Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation and emergency admissions attributable to respiratory disease pending any such decision.

(3) If the National Quality Board decides not to prioritise a respiratory Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving respiratory care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any respiratory Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in respiratory medicine, organisations representing people with respiratory disease, integrated care boards, and NHS providers of respiratory services.”

New clause 150—Modern Service Framework for Musculoskeletal Care – prioritisation and reporting—

“(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including musculoskeletal conditions), and

(b) lay before both Houses of Parliament a report on the prioritisation of musculoskeletal care for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of musculoskeletal conditions in England including—

(i) waiting times,

(ii) emergency admissions or unplanned care,

(iii) variation by integrated care board area,

(iv) impact on work and economic inactivity,

(v) outcomes,

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a musculoskeletal Modern Service Framework could deliver;

(c) the status of existing national programmes including—

(i) the Getting It Right First Time (GIRFT) MSK Community Delivery Programme;

(ii) any related elective recovery or neighbourhood health initiatives,

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a musculoskeletal Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation, waiting times and the impact of musculoskeletal conditions on patients and the wider economy pending any such decision.

(3) If the National Quality Board decides not to prioritise a musculoskeletal Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving musculoskeletal care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any musculoskeletal Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in musculoskeletal medicine and related professions, organisations representing people with musculoskeletal conditions, integrated care boards, and NHS providers of musculoskeletal services.”

New clause 151—Patient safety recommendations: Government response—

“(1) This section applies where the Secretary of State commissions a review or a report into a patient safety issue.

(2) The Secretary of State must—

(a) decide within six months whether they are going to implement each recommendation of the review;

(b) publish a response to each recommendation with a statement indicating whether each recommendation will be implemented; and

(c) publish a timeline for implementation of recommendations which will be implemented.”

This new clause requires the Secretary of State to respond to patient safety recommendations.

New clause 159—Mental health waiting time standards and reporting—

“(1) The National Health Service Act 2006 is amended as follows.

(2) Section 12F (expected mental health spending) is amended as follows—

(a) in subsection (1), after paragraph (a) insert—

“(aa) stating the Secretary of State's expectations for that year regarding performance against the waiting time standards published under section 12FA;”;

(b) in subsection (1), after paragraph (aa) insert—

“(ab) stating the Secretary of State's expectations for that year regarding the relationship between performance against those waiting time standards and expenditure on mental health services, and”;

(c) for subsection (1)(b) substitute—

“(b) explaining the reasons for the expectations stated under paragraphs (a), (aa) and (ab).”.

(3) After section 12F insert—

“12FA Mental health waiting time standards

(1) The Secretary of State must adopt target national waiting time standards covering mental health services, including community and urgent care.

(2) In determining standards under subsection (1) the Secretary of State must have regard to advice from the Chief Medical Officer about the standards necessary to ensure safe and effective mental health care.

(3) The Secretary of State must publish waiting time standards under this section within 12 months beginning on the day on which this Act is passed.

(4) The Secretary of State may make regulations under section 14Z45A to give effect to the waiting time standards published under this section.””

The new clause would require the Secretary of State to adopt and publish waiting time standards for mental services having regard to advice from the Chief Medical Officer. It would expand the Secretary of State’s existing annual reporting duties to parliament to include reporting the NHS performance in meeting the NHS waiting times standards.

New clause 161—Report into the availability and quality of data relating to dementia care—

“(1) The Secretary of State must publish a report on the availability and quality of data relating to dementia care within 12 months of the passing of this Act.

(2) The report must include an action plan to address gaps in dementia data across prevalence, the health and social care interface, the dementia care pathway, experience of care, and workforce.

(3) The action plan must, in particular, address the absence of key performance measures, including but not limited to—

(a) waiting times to assessment and diagnosis;

(b) non-medication related interventions; and

(c) care and treatment outcomes.”

Amendment 82, in clause 62, page 45, line 37, at end insert—

“(8B) Provision under (8A) about the period within which a recommendation is to be complied with must—

(a) only apply to individual recommendations in the case of exceptional circumstances,

(b) follow a process aligned with NICE's health technology evaluation procedures,

(c) be subject to engagement from industry stakeholders.”

Amendment 106, page 45, line 37, at end insert—

“(8B) Regulations under subsection (8) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.

(8C) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.”

This amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.

Amendment 1, page 45, line 39, leave out clause 63.

Amendment 2, page 46, line 3, leave out clause 64.

Amendment 3, page 46, line 39, leave out clause 65.

Amendment 4, page 47, line 36, leave out clause 66.

Amendment 7, page 48, line 15, leave out clause 68.

This amendment removes the clause abolishing Healthwatch England.

Amendment 5, page 48, line 18, leave out clause 69.

Government amendments 65 and 66.

Amendment 6, page 52, line 34, leave out clause 75.

Government amendments 67 to 69.

Amendment 89, in clause 80, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) has been met.

(3B) The condition is that the Secretary of State has published an impact assessment in respect of the abolition of NHS England that complies with subsection (3C) (a "qualifying impact assessment").

(3C) A qualifying impact assessment must include—

(a) a quantified estimate, expressed in monetary terms, of the total transition costs of abolishing NHS England, including in particular—

(i) redundancy costs;

(ii) the costs of integrating data, digital and information technology systems;

(iii) the costs of reorganising and rehousing staff and functions; and

(iv) productivity losses during the transition period;

(b) a quantified estimate, expressed in monetary terms, of the ongoing annual costs of the restructured Department of Health and Social Care following the abolition of NHS England, including any costs falling on integrated care boards as a result of the transfer of functions to them;

(c) a quantified estimate, expressed in monetary terms, of the estimated annual savings arising from the abolition, including savings from the elimination of duplicated corporate functions and reduced administrative costs;

(d) a quantified estimate, expressed in monetary terms, of the net present value of the abolition, being the difference between the total costs under paragraphs (a) and (b) and the total benefits under paragraph (c) over a period of not less than ten years;

(e) a statement of the key assumptions underlying the estimates in paragraphs (a) to (d) and an assessment of the sensitivity of those estimates to changes in those assumptions;

(f) an assessment of the risks to the delivery of the anticipated benefits, including the risk of disruption to NHS functions during the transition period; and

(g) a statement of the methodology used to produce the estimates, including any data sources relied upon.

(3D) Before publishing a qualifying impact assessment, the Secretary of State must submit it for independent scrutiny to the Regulatory Policy Committee (or any successor body) and must publish the Committee's opinion on the assessment alongside it.

(3E) The Secretary of State must lay the qualifying impact assessment and the Committee's opinion before both Houses of Parliament.

(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3G) A draft instrument under subsection (3F) may not be laid unless at least 60 sitting days have elapsed since the qualifying impact assessment was laid under subsection (3E).”

This amendment requires the Secretary of State to publish, and submit to independent scrutiny, an impact assessment on the abolition of NHS England, containing quantified cost and benefit figures, before making regulations to abolish the body.

Amendment 90, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) is met.

(3B) The Secretary of State must publish a plan setting out how health services provided by or under arrangements made by NHS bodies are to work alongside and be integrated with the social care system in England (the "health and social care integration plan").

(3C) Before preparing the health and social care integration plan, the Secretary of State must have regard to—

(a) the recommendations made by the Independent Commission on Adult Social Care (or any successor body undertaking that Commission's work) in any report published by the Commission; and

(b) the need to reflect any recommendations of the Independent Commission on Adult Social Care in the plan which are relevant to the interface between health services and adult social care.

(3D) The health and social care integration plan must include—

(a) a description of the structural and operational arrangements for joint working between NHS bodies and local authority social care services following the abolition of NHS England;

(b) proposals for how the transfer of NHS England's functions to the Secretary of State will affect the coordination of health and social care commissioning, including commissioning of services for people with complex needs spanning health and social care;

(c) arrangements for reducing delayed discharges from hospital attributable to the absence of suitable social care provision;

(d) proposals for how the funding flows between the NHS and the social care system, including NHS Continuing Healthcare, will be managed following the abolition;

(e) the workforce implications for the health and social care sectors arising from the abolition of NHS England and the steps to be taken to address them; and

(f) a timetable for implementing the arrangements described in the plan.

(3E) The Secretary of State must lay the health and social care integration plan before both Houses of Parliament.

(3F) Regulations to commence section (1) must be subject to the affirmative procedure.

(3G) A draft instrument under subsection (3F) may not be laid before either House of Parliament until at least 60 sitting days after the health and social care integration plan has been laid under subsection (3E).

(3H) In this section—

“NHS body” has the same meaning as in the National Health Service Act 2006;

“social care system” means the system for the provision of care and support under the Care Act 2014 and services provided by local authorities in the exercise of their functions relating to adult social care.”

This amendment requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using their powers for its abolition. The plan must address joint commissioning, funding flows (including NHS Continuing Healthcare), delayed hospital discharges, and workforce.

Amendment 25, page 112, line 18, leave out schedule 9.

Amendment 12, in schedule 9, page 130, 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.

Amendment 8, page 134, line 20, leave out schedule 10.

This amendment removes the schedule abolishing Healthwatch England.

Amendment 9, page 136, line 1, leave out schedule 11.

This amendment removes the schedule abolishing Local Healthwatch organisations.

Amendment 78, schedule 11, page 137, line 2, at end insert—

“(2A) In making arrangements under subsection (2), an integrated care board must have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions.”

This amendment would require an integrated care board, in making arrangements for gathering patient views, to have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions.

Government amendment 72.

Amendment 100, in schedule 12, page 155, line 5, at end insert—

“(10) An order under this section that establishes, varies the area of, abolishes or merges an integrated care board may not be made unless a draft of the order has been laid before, and approved by a resolution of, each House of Parliament.”

Amendment 33, in schedule 12, page 156, line 28, at end insert—

“(c) must publish any evidence the Secretary of State has received in respect of the impact of the proposal.”

Government amendments 73 to 75.

[Karin Smyth]

I know that many hon. Members want to talk about the provisions in the Bill covering many important issues. I will therefore speak briefly about two Government amendments relating to medical device licensing and information sharing.

I will first address new clause 94 regarding medical devices licensing, and consequential amendments new clauses 99 to 101 regarding medical devices disclosure. These amendments are about ensuring that Great Britain’s medical devices regulatory framework remains fit for the future. As we know, medical technology is evolving rapidly, particularly in areas such as software and artificial intelligence, while our current framework was designed for a very different technological landscape. This set of amendments establishes the statutory foundation for a future medical device licensing regime, applying to Great Britain only. EU medical devices legislation will continue to apply in Northern Ireland.

Such a regime would require medical devices to be licensed and certain persons operating within the supply chain to hold a licence. By placing the detail in the regulations, the amendment allows us to work with patients, healthcare professionals and the medical device sector to create a regulatory framework that protects patients, supports innovation and strengthens the UK’s life sciences sector.

[Jim Allister (North Antrim) (TUV)]

In the aftermath of the Windsor framework and the damage done to intra-UK trade, section 45B of the United Kingdom Internal Market Act 2020 was passed, which was said to promise that there would be no further export procedures that could impact adversely on trade from Northern Ireland to Great Britain. Yet, in new clause 94, we have such constraints in the imposition of a licensing programme, whereby to bring—I will not say “export”, as it is an internal market—a medical device from Northern Ireland to Great Britain, a licence is needed by the recipient. How is that compatible with section 45B of the United Kingdom Internal Market Act?

--- Later in debate ---

[Karin Smyth]

As the hon. and learned Gentleman knows—we have spent many long hours in this place discussing the arrangements with regard to our leaving the European Union—there are different regulations, as a result of Brexit, between Great Britain and Northern Ireland. As is currently the case, due to the Windsor framework, that results in Northern Ireland following the EU device regulations. This has been discussed with the Northern Ireland and Windsor framework taskforce in the Cabinet Office, and we are content that the provisions are right, given the framework’s application. I know and understand the point that the hon. and learned Gentleman makes, and I am sure that he will pursue it with the Government in other areas.

New clauses 95 and 98 update and clarify the Secretary of State’s information-sharing powers for medicines and medical devices. They provide a clearer legal framework for the Medicines and Healthcare products Regulatory Agency to share information with UK health systems, organisations and trusted international partners. The current legislative framework does not always provide the MHRA with the powers or clarity it needs to share information quickly and effectively, and this creates barriers to collaboration, including with the NHS. The new clauses will address these challenges, providing a clear statutory basis for information sharing.

There is currently no explicit statutory domestic information-sharing power for medicines, whereas there is for medical devices. The new clauses bring information-sharing powers about medicines in line with those for medical devices and updates the list of statutory purposes for which the MHRA may share information. Importantly, these reforms do not weaken existing safeguards. Patient information will not be shared internationally without consent, and domestic protections under the Data Protection Act 2018 and the UK General Data Protection Regulation remain unchanged. These new clauses and amendments will act in the interests of patients, and I commend them to the House.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Will the Minister give way?

--- Later in debate ---

[Sir Bernard Jenkin]

I would very much have liked to have discussed the medical devices questions arising from the Bill. The Minister made an incredibly short speech about that important matter. It is quite clear that these provisions are part of the covert dynamic alignment with the EU and the covert rejoin agenda being pursued by the Government. It raises all sorts of constitutional questions, but those are not for today.

I will concentrate on HSSIB. I rise to support amendments 1 to 4, which would remove the abolition of HSSIB from the Bill. The Government have singularly failed to make the case for removing this crucial safety investigation function. It did not exist until recently, and now they want to scrub it out. I suspect that is because too many people in the health system do not like being held to account by an independent investigative body.

[Karin Smyth]

indicated dissent.

[Sir Bernard Jenkin]

The Minister shakes her head, but she is yet to give a good reason as to why this measure is in the Bill.

When we had an Adjournment debate in July with the then Minister for patient safety, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), she could not answer the question of who would conduct independent safety investigations in the NHS after the abolition of HSSIB. She said that safety investigations would be conducted by the Care Quality Commission, but she could not actually claim that they would be independent; as my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) demonstrated, they would not be.

If, as it seems, it is intended that safety investigations should be carried out by the CQC unaffected by the transfer, why make the transfer at all? How much is this transfer going to cost? I asked the Minister, in a letter I sent her after the debate in July, to give us the information on how much the transfer of all this would cost. Nothing has arrived. I never had a reply to the letter. Of course, the Government have changed the Minister and the new Minister for patient safety, the right hon. Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), is not in the House today. I rather suspect that she is more sympathetic to this argument than the Minister sitting on the Front Bench today.

In our earlier exchanges we discovered and once again exposed how the safe space will be brutally compromised by the fact that it will be housed in a regulator with, inevitably, other ulterior motives. The chief executive of the CQC is wantonly conflicted in terms of looking after the safe space, so he cannot be the one left in charge of that function.

The real point here is that we are missing the opportunity to save so much money. Governments keep having public inquiries. The EPUT—Essex Partnership University NHS Foundation Trust—public inquiry, affecting my constituency, cost in its first year £5 million, and in its second year it is costing another £5 million. The whole budget for HSSIB was only £6.3 million a year, yet it does scores of investigations, not just one inquiry. The Ockenden inquiry cost £14 million. If we could save just a fraction of the cost of medical negligence, which is £3.6 billion a year, HSSIB would pay for itself.

--- Later in debate ---

[Madam Deputy Speaker (Caroline Nokes)]

That brings us to the Front Bench. I call the Minister.

[Karin Smyth]

We have genuinely had a wide-ranging and thoughtful debate, and I want to try to address all the points that have been raised. I think there is broad agreement across the House on the goals that we are seeking to achieve with the Bill: safer care, better outcomes and a stronger voice for patients. Every patient deserves safe and high-quality care, every community deserves to have its voice heard, and everyone should be able to access the care they need, when they need it. The question before us is how best to deliver those ambitions.

In general, we do not believe that the current landscape works, and that better outcomes are always achieved through new reporting requirements, additional layers of statutory process or more bureaucracy. Instead, we are committed to devolving responsibility and to empowering leaders in the NHS, while also holding them directly accountable, so that the NHS is focused on delivery and improving care.

I will begin with Healthwatch. I think there is broad consensus that we want to see patient voices heard strongly at every level of the healthcare system—it is something that all MPs feel strongly about, dealing with constituents as we do. Hearing the patient and user voice results in better decisions in a system that is designed around them—a system that is better able to correct when things go wrong.

Our ambition is to ensure that insight and experience from patients, service users and communities is part of commissioning and service planning decisions, rather than being held at arm’s length and outsourced. Our ambition is that this is done effectively everywhere. It is about strengthening the power of patients’ voices inside the NHS, where decisions are taken, not silencing criticism of those decisions. Within our approach, integrated care boards and local authorities will be expected to engage with people in their areas and will have a statutory duty to obtain their views.

That is a core part of the new strategic role of ICBs, and it involves transparency about what people have told the system, what the system has done in response and how learning is shared across partners. ICBs will be held to account if they do not demonstrate those elements. However, we have heard the strength of feeling in this place and in Committee, and as the Bill moves to the other place, I can commit to working closely with colleagues across this House and in the other place in order to review these provisions and ensure that our approach sufficiently empowers and devolves to local populations. We all want to ensure that the changes deliver for patients and service users, building public trust and ensuring that their voice is embedded in the care they receive.

[Adrian Ramsay (Waveney Valley) (Green)]

The CEO of Healthwatch Norfolk said today:

“To cease the statutory functions of Healthwatch without a suitable alternative in place…is to risk another major failing in patient safety and scrutiny of the health system.”

Did the Minister’s remarks just now suggest that the Government may be reviewing the plans to scrap Healthwatch?

[Karin Smyth]

It will not be a surprise to the hon. Gentleman that I do not agree with his proposition, although I commend the work that many people have done in Healthwatch. We want to work with people in the other place to make sure that this is the right way forward.

I am sorry that we do not have more time to debate HSSIB, because it requires more discussion, although we had a good debate in Committee. We have heard many discussions today. I have met the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and I hear what he is saying; I will ensure that he gets a response to his letter from the new Minister for Patient Safety—asap, as they say.

It is an issue that we need to get absolutely right. We all know, from our experience with patients and families, about the importance of creating a culture in which concerns can be raised without fear and lessons are learned effectively. The Government fully agree with those objectives. Our view is that patient safety, in line with the Dash review, is best served by clear lines of accountability, effective independent scrutiny, and a relentless focus on learning and improvement. We are therefore transferring HSSIB’s functions to the CQC to ensure that learning from investigations can more readily inform improvement activity across the system.

We recognise the importance of ensuring that the investigation arm has the autonomy to investigate the qualifying incidents that it deems appropriate free from interference, and I can give the House the assurance that we will work with the executive of HSSIB and the CQC to ensure that their operating model upholds this operational independence.

In response to the Chair of the Health Committee, who is not in her place, let me say that there is obviously no one single metric by which to judge the suitability of the CQC. It is usual in the Department’s oversight of arm’s length bodies and independent regulators to look at things like stable leadership, IT capability, governance and operational effectiveness. This is something I am sure the Select Committee can help with.

[Sir Bernard Jenkin]

Will the Minister give way?

[Karin Smyth]

I apologise, but I am going to press on. There is a lot to get through.

We are committed to tackling health inequalities wherever they arise. There are strong duties on both ICBs and the Secretary of State to tackle these inequalities, and we remain firmly committed to doing so. We continue to drive forward improvement plans including the national cancer plan and the mental health strategy, which will transform mental health care into a system that responds and intervenes early, reduces waiting times for support, and ultimately supports people to participate fully in education. I note in particular that the Government are already making record investment in mental health. All ICBs are expected to meet the mental health investment standard over the next three years, and all are forecast to meet it for 2026-27.

We are also committed to delivering the national cancer plan and focused on driving improvements, including on diagnostic capacity, which is key to addressing waiting times and tackling variation in access to better treatment, as we have heard today from my hon. Friends the Members for Easington (Grahame Morris), whose work in this area I commend, and for Blaydon and Consett (Liz Twist).

[Freddie van Mierlo (Henley and Thame) (LD)]

Will the Minister give way?

[Karin Smyth]

I am going to press on a little bit, if I may.

I remind the House that we are doing this within the existing legal structures, and that our approach is not to put in place additional duties and layers of detail and specificity in primary legislation. I think we should avoid the temptation to create separate statutory obligations for each condition or patient group, particularly in an age where people are living longer and very often with more than one health condition. Instead, we should commit ourselves to tackling inequalities for everyone, everywhere.

We have again heard from the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), about corridor care. The Government have been consistently clear that corridor care is not an acceptable standard of care and should not be normalised, and it is our intention to reduce and ultimately eradicate it. I think it is worth reminding the House that corridor care does not occur everywhere; some places have made huge steps to avoid it, and we want to share that learning. I particularly commend Barnsley foundation trust, South Warwickshire foundation trust and the Dudley group foundation trust, where there have been zero incidents in the last reporting. We must recognise that corridor care is one of the most visible and distressing symptoms of systemic pressures across the urgent and emergency care pathway, and our focus is on taking action now to tackle those underlying pressures.

We are improving patient flow, strengthening discharge arrangements, investing in urgent and emergency care services, and providing targeted support to the systems and trusts facing the greatest challenges from corridor care, so that improvements can be delivered where they are needed most. To ensure that we can understand where these challenges are, we have already introduced a national definition of corridor care, and strengthened reporting and oversight arrangements.

[Deirdre Costigan (Ealing Southall) (Lab)]

I thank the Minister for giving way and wish her a happy birthday, too. The NHS trust in north-west London was recently found to be one of the most improved in London in terms of reducing waiting lists. Does she agree that all the changes that she is bringing in through the Bill, including those discussed today, will help us to bring down those waiting lists even further and address the issues with corridor care that she has outlined?

[Karin Smyth]

I thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients. As I have said, corridor care is a sign of systemic failure in the system and is unacceptable. I think we have all witnessed it in our local trusts, but it is coming down in places, and we want to continue to see it eradicated.

I pay tribute to my hon. Friend the Member for North East Hertfordshire (Chris Hinchliff) for his championing of the families of children suffering from life-threatening illnesses. I know that Members on both sides of the House recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their family. It is vital that all these families feel supported, informed and cared for, and I wholeheartedly recognise that the support that they are offered now is often not proactive or joined up, with the onus, as he said, being on families to navigate the system and seek support themselves.

With that in mind, the Government commissioned a report on the mental health impacts of life-threatening childhood illness on families, named in the memory of Hugh Menai-Davis. I pay tribute to Hugh’s parents for their campaigning and offer them my deepest condolences.

The report process is progressing well, and I can commit to the report being published in this Parliament, with a full Government response issued within three months of publication. For too long, children’s health has not been a priority, which is why my right hon. Friend the Secretary of State for Health and Social Care has directed the Department to make maternal and child health central to its work. We know that a child’s health has ramifications for the wellbeing of the whole family, and there must be better solutions to join up support for parents of unwell children.

The new cross-Government mental health strategy will also address how we better support parents and families, and the Government intend to work closely with parents, families and campaigners to identify workable solutions and make available more proactive support.

I turn now to the Opposition amendments, starting with new clause 142, in the name of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson).

[Rachel Taylor]

Will the Minister give way?

[Karin Smyth]

I will carry on.

As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care. The Cass review recommended a clinical trial to provide high-quality comparative evidence on the potential benefits and risks of the medicines. That is now under way.

I agree with the comments from the hon. Member for North Shropshire, but I have to disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, access to these types of medicines must be subject to the scrutiny and approval of Parliament. I think that, as a clinician, she understands that.

I would also like to address new clause 143. As the hon. Member for Sleaford and North Hykeham knows, the EHRC’s updated code of practice for services, public functions and associations commenced on 5 August. It provides guidance on how sex-based distinctions in the Equality Act can be applied, including in the NHS. This new clause is unnecessary. This legislation is the law and the law is clear. The NHS will obviously follow the law. New guidance has been drafted and will be published imminently. For the record, I am due next week to meet the Darlington nurses who she spoke for. I agree that they were brave; they should not have had to go through what they went through.

I want to address new clauses 41 and 42 on funeral regulation in the name of the hon. Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon. Friend the Member for Leeds South West and Morley (Mark Sewards).

The Government were appalled by the offences committed by Robert Bush and the profound harm caused to bereaved families. Every deceased person must be treated with care, respect and dignity. We are undertaking urgent work to develop comprehensive proposals, including formal regulation of the funeral sector to drive out rogue operators and strengthen protection for bereaved families. As the hon. Member for Gosport said, operators that work well will also want to see this. We will begin sharing proposals shortly, and I am very happy to include hon. Members in the discussions.

[Mark Sewards (Leeds South West and Morley) (Lab)]

Does the Minister accept that the Prime Minister said in July that the sector needed to be regulated and that this continues to be a priority for his Government?

[Karin Smyth]

Absolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House.

I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines. I hope that I reassured him—from his speech, I think that I did—that the Government do support well-designed research into innovative treatments using controlled drugs, where this is conducted safely and appropriately. We also understand the complexities involved, including the need to minimise the risk of harm and misuse. That is why we are working across government to consider how to implement the recommendations from the Advisory Council on the Misuse of Drugs to reduce barriers to research with schedule 1 controlled drugs. I committed to write to my hon. Friend to set that out further; I will do.

A number of hon. Members tabled amendments on issues with their local infrastructure. We have already published the capital plan and improved long-term capital planning to improve local infrastructure.

I think that I have addressed most things—

[Rachel Taylor]

Will my hon. Friend give way?

[Karin Smyth]

I am so sorry; I will to talk to my hon. Friend later. The debate has been wide ranging. If there are things that I have missed, I commit to getting back to hon. Members. I know that my noble Friend Baroness Merron is committed to working co-operatively with all Members as the Bill proceeds through the other House.

Health Bill

Karin Smyth Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

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

[Madam Deputy Speaker (Ms Nusrat Ghani)]

With this it will be convenient to discuss the following:

Government new clause 97—Care and support: involvement of others and visitors.

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.”

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.

New clause 2—Assessment of risks posed by contracts with non-UK based suppliers—

“(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.

(2) In conducting an assessment under this section, the Secretary of State must—

(a) pay particular regard to contracts which provide technology companies with access to confidential patient data;

(b) consult national security experts on the risks posed to UK sovereignty by such contracts;

(c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK;

(d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and

(e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations.

(3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.”

This new clause would require the government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK.

New clause 3—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.”

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.

New clause 4—NHS Digital Sovereignty Strategy—

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (“an NHS Digital Sovereignty Strategy”) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by—

(a) assessing, managing and mitigating risks—

(i) associated with foreign interference,

(ii) arising from reliance on foreign-supplied technologies, and

(b) preventing over-reliance on foreign providers by building domestic capacity.

(2) For the purposes of this section, a “relevant information system” is an information system with access to NHS patient data.

(3) An NHS Digital Sovereignty Strategy published under this section must—

(a) include risks associated with—

(i) hardware,

(ii) software,

(iii) supply chains, and

(iv) procurement processes;

(b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;

(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies;

(d) recommend steps to support and develop sufficient domestic capability where it does not currently exist;

(e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.”

This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

New clause 5—Health Data Charter—

“(1) The Secretary of State must, within 6 months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter.

(2) The membership of the Trust should include—

(a) people with a diverse range of backgrounds; and

(b) health data experts, clinicians and patient representatives.

(3) The Charter must—

(a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS;

(b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data;

(c) ensure patients have control of their data, including providing relevant opt-outs;

(d) provide that all health data is held anonymously and accessed through a trusted research environment;

(e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS;

(f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS.

(4) The Sovereign Health Data Trust will—

(a) hold continuous oversight of all health data and oversee the trusted research environment;

(b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit;

(c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available;

(d) publish detailed minutes of all meetings discussing potential uses of health data; and

(e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”

New clause 6—Maternity Safety—

“(1) The Secretary of State must ensure that every NHS maternity unit is rated “good” or

“outstanding” by the CQC.

(2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes—

(a) 24/7 consultant obstetrician cover on every labour ward,

(b) one-to-one midwifery care,

(c) a Director of Midwifery in every maternity service,

(d) ringfenced maternity service development funding, and

(e) a dedicated neonatal workforce plan.

(3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.”

This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.

New clause 7—Healthy life expectancy target—

“(1) Within six months of the passage of this Act, the Secretary of State must—

(a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and

(b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved.

(2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament.

(3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).”

This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved.

New clause 8—Impact of trade deals on the NHS—

“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”

This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

New clause 11—Duty as respects waiting times for women’s health—

“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—

“1CD Duty as respects waiting times for women’s health

The Secretary of State must exercise functions in relation to the health service with a view to ensuring that average waiting times for the diagnosis and elective treatment of conditions primarily affecting women do not exceed the overall average waiting times for NHS diagnosis and elective treatment.””

This new clause would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues do not exceed the average wait time for wider NHS elective treatment.

New clause 12—Inquiry into women’s health outcomes—

(1) The Secretary of State must, within six months of the passing of this Act, commission an independent inquiry into women’s health provision and outcomes in England.

(2) Any inquiry established under subsection (1) must consider—

(a) the causes of—

(i) poorer health outcomes, and

(ii) disparities in patient safety,

for women;

(b) the effectiveness of existing commissioning arrangements in meeting the needs of women, and

(c) recommendations to assist the Secretary of State in discharging the duty to reduce inequalities in health outcomes under section 1C of the National Health Service Act 2006.

(3) The Secretary of State must lay a report on the findings of the inquiry before Parliament within the period of 12 months beginning with the day on which this Act is passed.”

This new clause would establish an inquiry into the poorer health outcomes faced by women.

New clause 15—Public Health Committee—

(1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.

(2) The Public Health Committee under subsection (1) must—

(a) include at least one minister from each government Department in its membership,

(b) include all cabinet ministers in its membership,

(c) be chaired by the Prime Minister,

(d) meet once in each annual quarter.

(3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.

(4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments.

(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.

(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”

This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.

New clause 16—Duty to promote public health—

“All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.”

This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties.

New clause 17—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing—

“(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—

(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and

(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.

(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”

This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.

New clause 18—Access to dental provision: Dental deserts—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (“the Scheme”).

(2) The purpose of the Scheme is to end dental deserts.

(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.

(4) The Scheme must make provision to support integrated care boards to—

(a) guarantee emergency access to an NHS dentist,

(b) provide free dental check-ups for—

(i) children,

(ii) mothers within one year of having given birth,

(iii) pregnant women, and

(iv) low-income households,

(c) guarantee dental appointments for persons commencing—

(i) surgery,

(ii) chemotherapy, or

(iii) transplant procedures.

(5) The Secretary of State must, before publishing the Scheme, issue a reformed dental contract.

(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”

This new clause would establish a scheme to support integrated care boards to end dental deserts.

New clause 21—GP representation on integrated care boards—

“(1) An integrated care board must include as a member at least one individual who—

(a) is a registered medical practitioner, and

(b) has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

(2) In appointing a member under subsection (1) an integrated care board must have regard to the member’s potential contribution to improving—

(a) patient journeys across services,

(b) coordination and continuity of care,

(c) prevention and population health management, and

(d) integration of services at neighbourhood level.”

This new clause would ensure that each integrated care board includes at least one member who is a registered medical practitioner, and has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

New clause 22—Duty to engage primary care providers in integrated care boards—

“(1) An integrated care board must take all reasonable steps to secure the meaningful involvement of primary care providers in the exercise of its functions relating to—

(a) service redesign,

(b) integration of health services,

(c) development of neighbourhood health services, and

(d) population health planning.

(2) In this section, “primary care providers” includes—

(a) providers of primary medical services,

(b) community pharmacy contractors,

(c) providers of primary dental services, and

(d) providers of ophthalmic services.

(3) Under subsection (1), “meaningful involvement” includes—

(a) involvement at an early stage in the development of ICB proposals,

(b) provision of sufficient information to enable informed participation of primary care providers in ICB functions,

(c) opportunities for primary care providers to influence ICB decision making, and

(d) opportunities for primary care providers to deliver feedback on how their views have been taken into account in the delivery of ICB functions.

(4) An integrated care board must publish an annual statement describing—

(a) how it has complied with this section, and

(b) the impact of primary care providers’ involvement on decisions taken by the ICB.

(5) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.”

This new clause ensures a certain range of primary care providers are consulted by integrated care boards in the development of their healthcare plans.

New clause 23—Duty of care for victims of domestic abuse and violence against women and girls—

“The Secretary of State and integrated care boards have a duty of care to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.”

This new clause would place a duty of care on the Secretary of State and integrated care boards to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.

New clause 25—Continuity of care and clinical responsibility—

“(1) The Secretary of State must by regulations ensure that every patient has access to a named NHS General Practitioner.

(2) Regulations under this section must make provision for pregnant women to have access to a named clinician for the period of their pregnancy.

(3) Regulations under this section are subject to the affirmative procedure.”

New clause 29—Senior leadership training at NHS trusts—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review on the effectiveness of training for senior leadership in NHS trusts on—

(a) workplace culture standards,

(b) addressing bullying, and

(c) addressing discrimination on the basis of—

(i) sex,

(ii) race, and

(iii) any other protected characteristic which the Secretary of State considers appropriate.

(2) Within one month of the publication of the review under subsection (1), the Secretary of State must publish guidance based on the review for the Department of Health and Social Care to administer to NHS trusts.”

New clause 32—Privacy by design in NHS Single Patient Record and Federated Data Platform architecture—

“(1) The Secretary of State must ensure that there is privacy by design as part of the delivery of the NHS Federated Data Platform architecture.

(2) For the purposes of subsection (1), privacy by design includes—

(a) patient data anonymisation outside its usage by clinicians and within the National Data Integration Tenant; and

(b) patient consent for the processing of personal information by NHS.”

New clause 33—NHS ownership of connection software—

“(1) The Secretary of State must ensure that there is NHS ownership of any data connector software architecture used as part of the delivery of the NHS Single Patient Record or Federated Data Platform.

(2) In this section, a data connector means an interface or connection between the NHS Federated Data Platform and any other health system.”

New clause 34—Retendering of contract for the NHS Federated Data Platform—

“The Secretary of State must, before February 2027, commence a competitive retendering for the contract to provide the NHS Federated Data Platform.”

New clause 35—NHS contracting for IT or data services—

“(1) The Secretary of State must, within six months of the passing of this Act, by regulations establish a governance framework for the contracting of any IT or data services by the Department of Health and Social Care or any NHS organisation.

(2) The framework established under subsection (1) must include the following provisions—

(a) a party may not bid for any contract for services where such services have previously been provided by the party on a free trial basis;

(b) the automatic extension of contracts should be subject to audit by the National Audit Office;

(c) contract terms must include provision for the department or NHS organisation to take ownership of any bespoke system built or developed by the contractor during the delivery of the contract;

(d) the department or NHS organisation must, at the end of the contract period (or following any extensions) conduct a competitive retendering process; and

(e) where a retendering process takes place under subsection (2)(d), the contractor may not assist in the preparation of the contract specification.

(3) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

New clause 36—Transition strategy for the abolition of NHS England—

“(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the "strategy").

(2) The strategy must—

(a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities;

(b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England;

(c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and

(d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services.

(3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy.

(4) A report under subsection (3) must include—

(a) progress on workforce retention;

(b) arrangements for the transfer of knowledge, expertise and institutional capability; and

(c) any identified gaps in capability and the steps being taken to address them.”

This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy.

New clause 38—General Ophthalmic Services: national framework, tariff and protected funding—

“(1) The Secretary of State must by regulations establish and maintain a national service specification for the primary ophthalmic services referred to in section 115 of the National Health Service Act 2006 (in this section referred to as general ophthalmic services, "GOS"), setting out the minimum standards of access and provision that integrated care boards are required to secure.

(2) Regulations under subsection (1) must establish and maintain a national tariff for GOS, setting out the prices at which GOS must be commissioned by integrated care boards.

(3) An integrated care board must commission GOS in accordance with the national service specification and national tariff established under subsections (1) and (2), and may not exercise any discretion to vary, restrict or reduce provision below the standards so specified.

(4) The Secretary of State must ensure that funding for GOS is allocated to integrated care boards as a ring-fenced, protected funding stream, which—

(a) may not be applied by an integrated care board to purposes other than GOS; and

(b) may not be reduced by an integrated care board in order to meet expenditure requirements in respect of other services.

(5) In determining any expenditure limits or resource allocations for integrated care boards under the National Health Service Act 2006, the Secretary of State must calculate and separately identify the GOS component of each board's allocation.

(6) The Secretary of State must lay before Parliament a report in each calendar year assessing the extent to which integrated care boards have complied with their obligations under this section.”

New clause 39—Community equipment and wheelchair services: standards, performance and outcomes—

“(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services.

(2) Each integrated care board must monitor its performance against the standards under subsection (1).

(3) Each integrated care board must publish an annual report including—

(a) performance against the standards under subsection (1),

(b) waiting times for the assessment for and supply of community equipment and wheelchair services,

(c) the number and proportion of people waiting longer than 18 weeks for such equipment or services,

(d) outcomes achieved for people by the provision of community equipment and wheelchair services, and

(e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services.

(4) For the purposes of this section—

“community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”

This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards.

New clause 40—Regulation of online fertility services—

“(1) The Human Fertilisation and Embryology Act 1990 is amended as follows.

(2) After section 5 insert—

“5A. Regulation of online fertility services

(1) The Human Fertilisation and Embryology Authority shall be responsible for the licensing of organisations providing online fertility services in England and Wales.

(2) The Secretary of State may by regulations make further provision regarding the arrangements for the licensing of organisations under subsection (1).

(3) Regulations made under subsection (2) are subject to the affirmative procedure.””

This new clause would implement a recommendation of the Human Fertilisation and Embryology Authority to extend its regulatory remit to include organisations providing online fertility services.

New clause 43—Duty to reduce variation in clinical research funding—

“In exercising functions in relation to the health service, the Secretary of State must have regard to the need to—

(a) reduce inequalities between the people of England with respect to their ability to access clinical research opportunities and participate in clinical trials, and

(b) reduce regional variation in the distribution of clinical research funding across England.”

This new clause would require the place a duty on the Secretary of State to reduce inequalities across England with respect to access to clinical research opportunities and participate in clinical trials and the distribution of clinical research funding across.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

This amendment is consequential on NC67.

New clause 48—National Maternity and Neonatal Investigation final report and recommendations—

“(1) The Secretary of State must, within six months of the passing of this Act, publish a response to the final report and recommendations of the National Maternity and Neonatal Investigation.

(2) The response under subsection (1) must include an action plan covering each of the recommendations of the Investigation.

(3) The action plan must have regard for hospitals—

(a) where negligent care has been identified in the provision of maternity and neonatal services, or

(b) where risk factors have been identified that are associated with potential negligent care in the provision of maternity and neonatal services.

(4) The Secretary of State must report to Parliament each year on the progress made in delivering the action plan.”

This new clause would require the Secretary of State to produce an action plan in response to the final report and recommendations of the National Maternity and Neonatal Investigation.

New clause 50—Independence of appointments—

“The Secretary of State must make provision to ensure that operational decisions regarding the appointment, suspension or removal of—

(a) chairs and directors of NHS trusts and NHS foundation trusts, and

(b) chief executives of integrated care boards,

are made exclusively by persons employed in the civil service, upon strictly merit-based criteria.”

This new clause would ensure that any decisions over NHS trusts and ICB leadership are made by civil servants, rather than the Secretary of State, to ensure appointments are made on merit.

New clause 51—Accident and Emergency: waiting times”

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.

(2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS Constitution for England for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.

(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2).

(4) The Scheme must consider—

(a) creating safety-net social care beds,

(b) increasing step-down care,

(c) publishing a dedicated accident and emergency care workforce plan, and

(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.

(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”

This new clause gives patients a new right in the NHS constitution to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.

New clause 53—Right to a GP appointment—

“(1) The Secretary of State must by regulations, within six months of the passing of this Act, establish a scheme to provide every patient with the right to a GP appointment within seven days of seeking one, or 24 hours if urgent.

(2) The Secretary of State must amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to make the right under subsection (1) a right in the NHS constitution.

(3) The Secretary of State may review the scheme every three years from the day on which this Act is passed and amend it through regulations made by statutory instrument.

(4) A statutory instrument under this section may not be made unless a draft has been laid before and approved by a resolution of each House of Parliament.

(5) For the purposes of this section—

“GP appointment” means an appointment with an appropriate clinician within a GP practice.

“Urgent” means the current definition under GP triaging protocols.”

This new clause requires the Secretary of State to give patients a new right in the NHS constitution to receive a GP appointment within 7 days, or 24 hours if urgent, and establishes a scheme to deliver this.

New clause 54—Duty to identify and record unpaid carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to identify and record unpaid carers

(1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers.

(2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area—

(a) maintain appropriate systems for recording whether a person is an unpaid carer,

(b) use consistent coding standards for the recording of unpaid carers in health records,

(c) review and update records relating to unpaid carers at appropriate intervals, and

(d) ensure that the identification and recording of unpaid carers forms part of—

(i) primary care registration processes,

(ii) hospital discharge procedures,

(iii) care planning processes, and

(iv) other relevant patient contact pathways.

(3) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services.

New clause 55—Duty to promote the health and wellbeing of carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to promote the health and wellbeing of carers

(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.

(2) In exercising its duties under this section, an integrated care board must have regard to—

(a) reduction of health inequalities experienced by carers,

(b) prevention of deterioration in carers’ physical and/or mental health,

(c) involvement of carers in decisions relating to the care of persons for whom they provide care, and

(d) the need to ensure carers are able to access appropriate preventative and other health services and support.

(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—

(a) consider the health and wellbeing needs of carers in care planning and discharge processes,

(b) involve carers appropriately in decisions relating to care and treatment, and

(c) provide carers with information about support available to them for their health and wellbeing.

(4) In preparing a Joint Forward Plan, an integrated care board must include—

(a) an assessment of the health and wellbeing needs of carers within its area,

(b) steps the integrated care board proposes to take to improve outcomes for carers, and

(c) measures for reducing inequalities experienced by carers.

(5) For the purposes of this section, “unpaid carer"” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.

New clause 56—National Respite Care Scheme—

“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.

(2) The scheme under subsection (1) must make provision for—

(a) where a local authority carries out an assessment of the needs of an unpaid carer, under any enactment for the time being in force in England, it must assess whether the unpaid carer is able to take sufficient breaks from their caring responsibilities,

(b) unpaid carers to receive support to take breaks from their caring responsibilities to—

(i) maintain their physical and mental health and emotional wellbeing,

(ii) participate in work, education, training or recreation, and

(iii) participate in family and community life,

(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.

(3) Under subsection (2), “support” may include—

(a) replacement care for the cared-for person;

(b) respite services;

(c) any other steps a local authority considers appropriate as support.

(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.

(5) For the purposes of this section—

“unpaid carer” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work;

“parent carer” has the same meaning as in section 17ZD of the Children Act 1989;

“young carer” has the same meaning as in section 96 of the Children and Families Act 2014.”

New clause 57—Integrated Care Boards: Scrutiny Committee—

“(1) Each integrated care board must establish a Scrutiny Committee.

(2) Each Committee established under subsection (1) must—

(a) oversee the operation of the integrated care board,

(b) ensure accountability of the integrated care board with regards to—

(i) allocation of resources;

(ii) grievance and complaint management;

(iii) innovation and service redesign in line with Government objectives;

(iv) delivery of services;

(v) integration with social care;

(vi) advancing public health objectives;

(vii) issues relating to workforce or estate; and

(viii) any other issues as designated by the Secretary of State.

(c) have the power to undertake inquiries into innovation on services delivery and outcomes.

(3) The Committee must comprise—

(a) Members of Parliament representing constituencies in the area covered by the integrated care board,

(b) Chairs of local government health and social care committees in the area covered by the integrated care board,

(c) representatives from Healthwatch England or any patient participation network designated by the Secretary of State, and

(d) Representatives from trade unions including—

(i) two representatives from unions involved in negotiations on Agenda for Change, and

(ii) one representative from a trade union representing doctors or dentists.

(4) The Committee must meet six times each year.

(5) The Chair of the Committee must be elected at an annual general meeting of the Committee.

(6) The Committee must report to the Board of the integrated care board.

(7) The Chair and Chief Executive of each integrated care board and leaders of health providers and services must attend a meeting of a Committee when requested to do so.

(8) Each Committee will report to the Secretary of State for Health and Social Care.”

New clause 66—Maternity services: safe staffing levels—

“(1) The Secretary of State must ensure that maternity staffing levels are sufficient to ensure all residents in England can access a staffed maternity unit within 45 minutes of their home.

(2) The Secretary of State must ensure adequate workforce planning, including through delivery of a consultant obstetrician and gynaecologist recruitment and retention plan, to ensure that maternity units are not required to close as a result of staffing issues.

(3) The Secretary of State must lay before Parliament an annual report on the progress made on national maternity staffing levels under this section.”

This new clause would ensure that no maternity units are forced to close as a result of staffing issues and that every person in England has access to a maternity unit within 45 minutes of their home.

New clause 67—Workforce planning and supply—

“(1) After section 1 of the National Health Service Act 2006 insert—

“1ZA Secretary of State’s duty as to workforce planning and supply

(1) The Secretary of State must promote in England a comprehensive system of workforce planning and supply designed to secure that there are sufficient people with the necessary skills and experience to provide services as part of the health service.

(2) In meeting the requirement under subsection (1), the Secretary of State must exercise the functions conferred by this Act so as to secure that the workforce needs of the health service are assessed and met.

(3) The Secretary of State retains ministerial responsibility to Parliament for workforce planning and supply for the health service in England.”

(2) For section 1GA of the National Health Service Act 2006 substitute—

“Workforce strategy

(1) The Secretary of State must prepare and publish a strategy setting out how the Secretary of State proposes to discharge the duty under section 1ZA.

(2) The strategy must include—

(a) an assessment of the current workforce of the health service;

(b) projections of the workforce required to meet the needs of the health service over periods of five, ten and fifteen years beginning with the day on which the strategy is published;

(c) an assessment of the expected supply of people available to meet those requirements;

(d) an assessment of any difference between the projected workforce requirements and expected workforce supply;

(e) the measures that the Secretary of State proposes to take to address any such difference; and

(f) an assessment of the financial and other resources required to implement those measures.

(3) In preparing or revising the strategy, the Secretary of State must consult—

(a) integrated care boards;

(b) NHS trusts and NHS foundation trusts;

(c) persons providing services as part of the health service;

(d) trade unions representing persons employed or otherwise engaged in the provision of those services;

(e) professional bodies and professional regulators;

(f) persons concerned with the provision of education and training for the workforce;

(g) persons representing patients; and

(h) such other persons as the Secretary of State considers appropriate.

(4) The first strategy under this section must be published before the end of the period of 12 months beginning with the day on which this section comes into force.

(5) The Secretary of State must—

(a) review the strategy before the end of the period of five years beginning with the day on which it was last published, and

(b) following each review, publish a revised strategy.

(6) The Secretary of State may revise the strategy before the end of that period if the Secretary of State considers it appropriate to do so.

(7) The Secretary of State must lay before Parliament a copy of each strategy published under this section.

(8) The Secretary of State must have regard to the strategy when exercising functions in relation to the health service.””

This new clause places responsibility for workforce planning and supply for the health service in England on the Secretary of State, including ministerial responsibility to Parliament. It also requires the Secretary of State to publish a strategy setting out projected workforce requirements and supply, and the measures and resources needed to meet those requirements.

New clause 69—Self-care—

“In the National Health Service Act 2006, after section 1C insert—

“1CA Duty as to self-care

In exercising functions in relation to the health service, the Secretary of State must have regard to the importance of—

(a) promoting self-care and improving health literacy as part of the prevention of illness and the improvement of health and wellbeing;

(b) supporting people to manage self-treatable conditions independently where appropriate; and

(c) the role of community pharmacy in supporting self-care and prevention and helping people to access appropriate care.””

This new clause would require the Secretary of State, when exercising functions in relation to the health service, to have regard to the importance of promoting self-care and improving health literacy, supporting people to manage self-treatable conditions, and the role of community pharmacy in supporting self-care and prevention.

New clause 74—Protection of pharmacy staff during provider failure—

“(1) The Secretary of State must establish arrangements to protect the pay and essential employment protections of staff employed by a provider of pharmaceutical services where the provider—

(a) becomes insolvent,

(b) ceases to provide pharmaceutical services,

(c) has its arrangements for providing pharmaceutical services suspended or terminated, or

(d) is otherwise unable to meet its obligations to its employees.

(2) Arrangements under subsection (1) must provide for—

(a) the continuation, so far as reasonably practicable, of payment of wages to affected staff,

(b) the preservation of essential employment protections during the period of emergency intervention,

(c) the maintenance of staffing necessary for the safe provision of pharmaceutical services, and

(d) the transfer, continuation or replacement of employment arrangements where necessary to secure continuity of pharmaceutical services.

(3) The Secretary of State may make payments to, or in respect of, affected staff for the purposes of this section.

(4) The Secretary of State may recover from the failed provider any sums paid under subsection (3).

(5) Arrangements under this section must be capable of operating at the same time as arrangements made under section 133 of the National Health Service Act 2006 to secure alternative provision of pharmaceutical services.

(6) The Secretary of State must publish guidance about the operation of arrangements under this section.”

This new clause would protect pharmacy staff's pay and essential employment rights when a provider fails, while supporting continuity of services.

New clause 75—Integrated primary care teams—

“(1) Each integrated care board must make arrangements to promote the provision of joined-up primary care services across general practice, primary dental services and pharmaceutical services.

(2) Arrangements under subsection (1) must, so far as reasonably practicable, provide for—

(a) general practitioners, dentists, pharmacists and other relevant primary care professionals to work together as part of integrated local primary care teams;

(b) the sharing of relevant patient information between those professionals through secure and interoperable digital systems;

(c) the use of common or interoperable care records, so that relevant clinical information can be accessed by an authorised professional involved in a patient's care;

(d) appropriate mechanisms for referral and communication between general practice, dental practices and community pharmacies;

(e) the reduction of duplication in assessments, prescribing, referrals and administrative processes; and

(f) improved continuity and coordination of care for patients with multiple or ongoing health needs.

(3) In exercising its functions under this section, an integrated care board must have regard to the need to ensure that patients can move between general practice, primary dental services and pharmaceutical services without unnecessary duplication, delay or loss of relevant clinical information.

(4) The Secretary of State may by regulations make provision about—

(a) minimum interoperability standards for systems used by providers of primary medical, dental and pharmaceutical services;

(b) standards for the secure exchange of patient information;

(c) common data standards and clinical terminology;

(d) electronic referrals and communications between providers; and

(e) such other matters as the Secretary of State considers necessary to support integrated primary care.

(5) Regulations under subsection (4) must include appropriate safeguards for patient confidentiality, information governance and the lawful processing of personal data.

(6) In this section—

“primary care team” means a group of health professionals and providers working together to provide or coordinate primary care services;

“primary dental services” has the meaning given by section 98C of the National Health Service Act 2006; and

“pharmaceutical services” includes services provided under Part 7 of that Act.”

This new clause would promote joined-up working between GPs, dentists and pharmacists to improve coordination and continuity of care.

New clause 79—Voluntary sector role in neighbourhood health plans—

“(1) In preparing a neighbourhood health plan, a responsible local authority and integrated care board must take and demonstrate reasonable steps to ensure the plan is co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in that area, including the development, design, implementation, monitoring and evaluation of the plan.

(2) In meeting the requirement under subsection (1) a local authority and integrated care board must in particular have regard to—

(a) organisations representing people with lived experience of health conditions;

(b) organisations working with underserved or marginalised populations; and

(c) the role of voluntary, community and social enterprise organisations in delivering community-based services.

(3) The responsible local authority and integrated care board must demonstrate how they have ensured ongoing and meaningful representation of voluntary, community and social enterprise organisations across the governance, decision-making and commissioning arrangements relating to neighbourhood health plans at all stages of the planning process.”

This new clause would require local authorities and integrated care boards to take and demonstrate reasonable steps to ensure neighbourhood health plans are co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in the local area.

New clause 80—Power to enable reservation and prioritisation of contracts for the voluntary, community and social enterprise sector—

“(1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services.

(2) The Secretary of State must through regulations enable integrated care boards to reserve and/or prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process.

(3) Circumstances in which contracts may be appropriate to be reserved or prioritised under subsection (2) include—

(a) services that are, or could be, community-based;

(b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities; or

(c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred and/or culturally competent care.

(4) In exercising functions under this section, integrated care boards must have regard to—

(a) the need to reduce health inequalities;

(b) the importance of securing equitable access to services across different areas; and

(c) the sustainability of voluntary, community and social enterprise provision.”

This new clause would require integrated care boards to take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services through the ICB commissioning process.

New clause 85—Duties on integrated care boards regarding education, health and care plans—

“(1) The Secretary of State must exercise the powers in Part 3 of the Children and Families Act 2014 (children with special education needs) with a view to securing that integrated care boards (“ICBs”) are subject to the same relevant requirements as local authorities in relation to the duty to secure the specified special educational provision for a child or young person in the preparation of education, health and care plans (“EHC plans”) under that Part.

(2) For the purposes of subsection (1), the relevant requirements are—

(a) that the special educational provision set out in section F of an EHC plan meets the needs identified by an EHC needs assessment;

(b) that ICBs can be required to provide such special educational provision;

(c) that ICBs must provide such special educational provision from the date the EHC plan is finalised or issued;

(d) that ICBs are subject to appeals to the First-tier Tribunal in accordance with section 51 of the Children and Families Act 2014; and

(e) that any duty on ICBs to provide such special educational provision does not impact upon an ICB’s duty to arrange health care provision, where this is required by an EHC plan.”

This new clause would require the Secretary of State to make regulations placing a statutory duty on integrated care boards to ensure that where an EHC plan specifies special education provision, they are subject to the same duty as local authorities to ensure that this is arranged for the child or young person.

New clause 90—Duty to reduce health inequalities—

“(1) Section 2B of the National Health Service Act 2006 (functions of local authorities and Secretary of State as to improvement of public health) is amended as follows.

(2) In the heading, after “health” insert “and reduction of health inequalities”.

(3) In subsection (2)—

(a) for “may” substitute “must”; and

(b) after “England” insert “and reducing health inequalities between the people of England”.

(4) In subsection (3), after paragraph (g) insert—

“(h) collaborating with any government department or local authority.”

(5) After subsection (5) insert—

“(6) In this section, “health inequalities between the people of England” means health inequalities between persons, or persons of different descriptions, living in England or in different parts of England.

(7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.

(8) In subsection (7), “general health determinants” include—

(a) standards of housing, transport services or public safety;

(b) environmental factors, including air quality and access to green space and bodies of water;

(c) employment prospects, earning capacity and any other matters that affect levels of prosperity;

(d) the degree of ease or difficulty with which persons have access to public services;

(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health; and

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.

(9) In subsection (2), the reference to reducing health inequalities includes mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.””

New clause 91—Health improvement and health inequalities strategy—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a health improvement and health inequalities strategy.

(2) In preparing the strategy, the Secretary of State must consult such persons as the Secretary of State considers appropriate.

(3) The strategy must include—

(a) long-term targets relating to health improvement and the reduction of health inequalities in England throughout a person's life;

(b) provision for the establishment of a public authority with functions relating to the additional monitoring of, and reporting on, progress towards the targets included in the strategy in accordance with paragraph (a); and

(c) such other provision as the Secretary of State considers appropriate.

(4) The long-term targets included in the strategy in accordance with subsection (3)(a) must include—

(a) at least one target relating to the improvement of the health of persons under the age of 18 in England; and

(b) at least one target relating to the improvement of the health of persons aged 18 or over in England.

(5) A Minister of the Crown must, in exercising the Minister’s functions, have regard to the strategy.

(6) The Secretary of State must prepare and publish a report on the implementation of the strategy—

(a) within 12 months of the publication of the strategy; and

(b) at intervals of no more than 12 months thereafter.

(7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.”

New clause 93—State of NHS Dentistry report—

“(1) The Secretary of State must publish and lay before Parliament a report on the state of NHS dentistry in England (“the State of Dentistry Report”) at least once every two years.

(2) The State of Dentistry Report must include an assessment of—

(a) access to NHS dental services and levels of unmet need;

(b) the adequacy, distribution and sustainability of the NHS dental workforce, including general dental services, community dental services, hospital dental services, dental public health consultants and dental academia;

(c) geographical inequalities in access to NHS dental services and oral health outcomes;

(d) inequalities in access to NHS dental services and oral health outcomes between different socioeconomic groups and populations, including but not limited to people living in care homes and people experiencing homelessness;

(e) demand and waiting times for dental treatment in community dental services and secondary care;

(f) the extent to which inadequate access to NHS dental services contributes to avoidable pressure on other parts of the NHS, including primary medical care, urgent and emergency care, hospital services and the prescribing of medicines; and

(g) the measures required to address any deficiencies or inequalities identified under paragraphs (a) to (f).

(3) The report must include such indicators as the Secretary of State considers appropriate for assessing each of the matters set out in subsection (2), and those indicators must, wherever appropriate, be presented in a manner that enables comparisons to be made between different areas and populations and over time, including by reference to population size, full-time equivalent workforce and other relevant measures.

(4) In preparing the report, the Secretary of State must have regard to the need to ensure that NHS dental services are sufficient to meet the current and projected need for dental care in England.

(5) The Secretary of State must, within six months of publishing a State of Dentistry Report, set out the measures the Government intends to take in response to the findings of the report.

(6) The Secretary of State must make arrangements for each State of Dentistry Report, and the Government's response to it, to be debated in each House of Parliament.

(7) The first State of Dentistry Report must be published within 12 months of the passing of this Act.”

This new clause would require the Secretary of State to publish and lay before Parliament a regular report on the state of NHS dentistry in England, assessing access to and unmet need for NHS dental services, workforce capacity and distribution, geographical and wider inequalities, and the pressure that inadequate access to NHS dental services places on other parts of the NHS. It would also require the Government to respond to each report and ensure that both the report and response are debated in Parliament.

New clause 104—NHS-funded In Vitro Fertilisation—

“(1) Within six months of the passage of this Act, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded In Vitro Fertilisation (IVF).

(2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF.

(3) Requirements under subsection (2) include—

(a) standardisation of the minimum number of rounds of IVF available to one individual, and

(b) standardisation of the maximum and minimum age at which an individual can access IVF.”

This new clause would require the Secretary of State to make regulations standardising NHS-funded IVF provision across all integrated care boards in England, in accordance with existing NICE guidelines, including the number of rounds available to an individual and the age limits for access.

New clause 106—Report on the duty to co-operate—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must lay a report before both Houses of Parliament on—

(a) the operation of the duty to co-operate under section 72 of the National Health Service Act 2006 (co-operation between NHS bodies) and section 82 of that Act (co-operation between NHS bodies and local authorities), and

(b) the impact of those duties on the integration of health and social care in England.

(2) The report under subsection (1) must consider co-operation between—

(a) relevant NHS bodies, and

(b) relevant NHS bodies and local authorities,

in the delivery and commissioning of health and social care.

(3) Within six months of the report under subsection (1) being laid, the Secretary of State must—

(a) make provision to update guidance on the duty to co-operate, and

(b) implement actions to strengthen integration in the report which the Secretary of State considers most appropriate.”

This new clause would place a requirement on the Secretary of State to report to Parliament, within six months of the Act passing, on how well NHS bodies and local authorities are working together to integrate health and social care in England. It would also place a requirement on the Secretary of State to update the related guidance and take action to strengthen this cooperation six months later.

New clause 108—NHS ethical and sustainable procurement framework—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must conduct a review of the NHS’s ethical and sustainable procurement framework.

(2) Following the review under subsection (1), the Secretary of State must by regulations ensure that contracting authorities can exclude companies from bidding for a tender on the basis of any proven—

(a) involvement in violations of international law and/or,

(b) breaches of internationally accepted standards of business conduct including—

(i) the UN Guiding Principles and,

(ii) OECD Guidelines for Multinational Enterprises.”

New clause 109—Artificial intelligence governance and auditing—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must publish guidance on the—

(a) governance,

(b) monitoring,

(c) assurance, and

(d) audit of artificial intelligence (AI) systems used in health and care settings.

(2) The guidance under subsection (1) must include—

(a) requirements for healthcare organisations to maintain an inventory of AI systems used in clinical and operational processes,

(b) requirements for proportionate monitoring, by the healthcare organisations, of AI systems throughout their operational lifecycle, including safety, performance and effectiveness,

(c) processes for identifying, investigating and responding to material deterioration in AI system performance,

(d) arrangements for documenting accountability and decision-making responsibilities relating to AI deployment and use,

(e) expectations regarding transparency, reporting, and ability to audit AI enabled services.

(3) Each health and care setting required to implement guidance under this section must designate a senior individual who is responsible for—

(a) the monitoring, assurance and audit of AI systems under subsection (1) in their health or care setting;

(b) supporting AI providers and vendors to perform their post market surveillance as required;

(c) addressing the governance of legacy AI systems; and

(d) addressing the governance and impact of decommissioning of AI systems.

(4) The Care Quality Commission must have regard to the guidance published under subsection (1) when exercising its functions.

(5) The Care Quality Commission should assess whether providers have appropriate arrangements in place for the—

(a) governance,

(b) monitoring, and

(c) safe use of artificial intelligence systems, and may require evidence that such arrangements are operating effectively.”

New clause 119—Report into digital health services in rural and coastal areas—

“(1) The Secretary of State must publish a report on the equality of access to and quality of digital health services in rural and coastal areas within 12 months of the passing of this Act.

(2) The report under subsection (1) must include an action plan to ensure rural and coastal practices are able to provide remote consultations and electronic prescription services.”

This new clause would require the Secretary of State to publish a report on equality of access to and quality of digital health services in rural and coastal areas.

New clause 120—Farmer friendly accredited general practice scheme—

“(1) The Secretary of State must create a farmer friendly accredited general practice scheme to recognise and resource GP practices that proactively reach farming communities.

(2) The scheme under subsection (1) should be modelled on Royal College of GPs’ Veteran Friendly Accreditation scheme.

(3) The Secretary of State must instruct the CQC to develop clear guidance for the farmer friendly accredited general practice scheme which supports delivery of care in non-clinical community settings with proportionate hygiene protocols that reflect the setting.”

This new clause places a duty on the Secretary of State to create a farmer friendly accredited general practice scheme.

New clause 121—Continuity of specified national diabetes programmes—

“(1) The Secretary of State must secure that the programmes listed in subsection (2) continue to be provided, to at least the same extent as immediately before the abolition of NHS England.

(2) The programmes referred to in subsection (1) are—

(a) the NHS Diabetes Prevention Programme;

(b) the NHS Type 2 Diabetes Path to Remission Programme;

(c) national provision for continuous glucose monitoring (CGM) for people with diabetes;

(d) the national roll-out of hybrid closed loop (“artificial pancreas”) technology for people with type 1 diabetes;

(e) the National Diabetes Audit programme, including the National Diabetes Footcare Audit and the National Diabetes Inpatient Safety Audit;

(f) any other programme specified for the purposes of this section in regulations made by the Secretary of State.

(3) Before making a scheme under section 2 for the transfer of property, rights or liabilities relating to a programme listed in subsection (2) the Secretary of State must publish a statement explaining how continuity of that programme is to be maintained.

(4) Before the end of the period of 12 months beginning with the day on which this section comes into force, and at least once every subsequent period of 12 months, the Secretary of State must lay before Parliament a report on the provision of the programmes listed in subsection (2), including information on patient access, waiting times and outcomes.

(5) Regulations under subsection (2)(f) are subject to annulment in pursuance of a resolution of either House of Parliament.”

This new clause would require the Secretary of State to maintain existing national diabetes prevention, treatment and audit programmes following the abolition of NHS England, to explain how continuity will be secured before transferring related functions, and to report annually to Parliament on their provision.

New clause 122—Report on effect of abolition of NHS England on diabetes services—

“(1) Before the end of the period of 12 months beginning with the day on which section 1 comes into force, and no less frequently than every 12 months thereafter for the following 3 years, the Secretary of State must publish and lay before Parliament a report assessing the effect of the abolition of NHS England on the planning, funding and delivery of diabetes prevention, treatment and care services in England.

(2) A report under subsection (1) must include an assessment of—

(a) any change in funding allocated to diabetes prevention, treatment and care programmes;

(b) any change to the operation or continuation of national clinical audits relating to diabetes;

(c) the impact on patient access to diabetes technology, including glucose monitoring and insulin delivery systems;

(d) the impact on workforce capacity in specialist diabetes services.”

This new clause would require the Government to monitor and report to Parliament on the impact of NHS England's abolition specifically on diabetes services.

New clause 133—England and Wales cross-border healthcare: statement of values and principles—

“(1) The Secretary of State and each integrated care board must, in exercising functions relating to the provision or commissioning of health services to persons residing in an area of England or Wales close to the border between England and Wales, have regard to the 2018 England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) For the purposes of this section, “the England / Wales Cross-border Healthcare Services: Statement of Values and Principles” means the statement published by NHS England and the Welsh Ministers on 6 November 2018, or a revised statement designated by regulations under subsection (3).

(3) The Secretary of State may by regulations designate a revised version of the Statement for the purposes of this section.

(4) Before making regulations under subsection (3), the Secretary of State must consult—

(a) the Welsh Ministers;

(b) each integrated care board whose area is close to the border between England and Wales;

(c) each Local Health Board whose area is close to the border between England and Wales; and

(d) such organisations representing patients affected by cross-border healthcare arrangements as the Secretary of State considers appropriate.

(5) Regulations under subsection (3) are to be made by statutory instrument.

(6) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This new clause would require the Secretary of State and integrated care boards to have regard to the England / Wales Cross-border Healthcare Services: Statement of Values and Principles when exercising relevant functions in areas close to the England-Wales border. It would also enable the Secretary of State to designate a revised version of the Statement, following consultation with the Welsh Ministers, relevant integrated care boards and Local Health Boards, and organisations representing patients affected by cross-border healthcare arrangements.

New clause 134—England and Wales cross-border healthcare arrangements—

“(1) The Secretary of State must, within 18 months of the passing of this Act, seek to agree with the Welsh Ministers a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) In preparing the revised Statement under subsection (1), the Secretary of State must consider—

(a) the effectiveness of existing arrangements for the provision and commissioning of cross-border health care services;

(b) the interests of patients who live in England or Wales and receive, or may receive, health services on the other side of the border;

(c) arrangements for the commissioning and funding of cross-border healthcare services;

(d) arrangements for resolving disputes between relevant bodies in England and Wales; and

(e) the appropriate means of placing the principles governing England and Wales cross-border health care services on a statutory footing.

(3) The Secretary of State must, within two years of the passing of this Act—

(a) publish the revised Statement agreed under subsection (1), or, where no revised Statement has been agreed, publish a report setting out the steps taken to seek such agreement and the reasons why agreement has not been reached;

(b) lay the revised Statement or report before Parliament; and

(c) lay before Parliament proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.”

This new clause would require the Secretary of State to seek agreement with the Welsh Ministers on a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles within 18 months of the passing of the Act. It would also require the Secretary of State, within two years, to lay the revised Statement, or a report where agreement has not been reached, before Parliament and to bring forward proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.

New clause 135—Reporting on mortality inequalities for autistic people and people with learning disabilities—

“(1) Within 12 months of the passage of this Act, the Secretary of State must prepare and publish a report on the mortality inequalities experienced by autistic people and people with a learning disability.

(2) The report under subsection (1) must specify targets for reducing mortality inequalities between people without a learning disability and autistic people and people with any learning disability.

(3) Within 3 months of the publication of the report under subsection (1) the Secretary of State must make regulations which require ICBs to publish an annual report which includes—

(a) mortality rates for—

(i) autistic people,

(ii) people with any learning disability,

(iii) people without a learning disability.

(b) identification of any areas in which data collection on mortality inequalities experienced by autistic people and people with learning disabilities is inadequate,

(c) a review of the reasons for any inequalities in mortality rates,

(d) a plan for reducing inequalities in mortality rates between people without a learning disability and autistic people and people with any learning disability.

(4) Regulations under subsection (3) must make provision for the annual reports to continue for as long as mortality inequalities between people without a learning disability and autistic people and people with any learning disability exist.

(5) The Secretary of State must publish an annual report summarising the information in the ICB reports under subsection (3), identifying national trends in—

(a) mortality rates,

(b) reasons for inequalities in mortality rates,

(c) potential actions to reduce inequalities in mortality rates.”

This new clause would require the Secretary of State to publish a report on the mortality inequalities experienced by autistic people and people with a learning disability and make provision for ICBs to publish annual reports on such inequalities in their area and proposed actions for remedying such inequalities.

New clause 136—North Cornwall: Dental appointments—

“(1) Within one year beginning on the date on which this Act is passed, the Secretary of State must ensure that there is adequate provision of NHS dentistry in North Cornwall.

(2) Adequate provision under subsection (1) means—

(a) access to urgent dental appointments for any person with an urgent need, and

(b) improved access to routine dental appointments.

(3) The Secretary of State must explain any failure to meet the requirement set out in subsection (1) at a public event in the local area.”

This new clause places a duty on the Secretary of State to ensure there is adequate provision of NHS dental appointments in North Cornwall.

New clause 144—Prioritising British citizens for the UK foundation programme—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 4, after subsection (4) insert—

“(4A) A person is within this subsection if they—

(a) are a British citizen, and

(b) hold a primary medical qualification from an international branch campus of a higher education institution in the United Kingdom.””

This new clause amends the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places.

New clause 145—Response to the Hughes Report: options for redress for those harmed by valproate and pelvic mesh—

“The Secretary of State must, within 30 days of the day on which this Act is passed, publish the Government’s response to the Hughes Report.”

This new clause would require the Secretary of State to publish the Government’s response to the Hughes Report within 30 days of this Act being passed.

New clause 152—Requirement for merit-based job allocations for doctors—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 1, at end insert—

“(2) Applicants eligible under this section shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.”

(3) In section 2, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.”

(4) In section 3, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(c) clinical experience,

(d) skills, and

(e) ability to perform the duties of the post.””

New clause 153—Redundancies—

“The Secretary of State must publish, within 12, 24, and 48 months of the passage of this Act, the number of persons—

(a) employed by the Department for Health and Social Care, and

(b) made redundant following the abolishment of NHS England under subsection (1) of this Act.”

This new clause would require the Secretary of State to publish the number of staff in the Department for Health and Social Care and the number of people made redundant following the abolishment of NHS England.

New clause 154—Medical training places—

“The Secretary of State must increase the number of medical school training places to 15,000 by the year 2031-32.”

This new clause would put a duty on the Secretary of State to double the number of medical school training places.

New clause 155—Self-care and health literacy in neighbourhood health plans—

“(1) Guidance issued by the Secretary of State under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act (neighbourhood health plan) must require that every neighbourhood health plan includes arrangements for—

(a) supporting self-care and self-management, including by enabling people to manage minor and long-term conditions, and conditions that are self-limiting, themselves where it is safe and appropriate to do so;

(b) improving health literacy and ensuring that people living or working in the area have access to trusted, quality-assured information, advice and digital tools to support them in managing their own health and wellbeing;

(c) facilitating access to community pharmacy services, including pharmacy services that support self-care, the management of minor ailments and medicines optimisation;

(d) supporting patients to access the most appropriate level of care for their needs, including through patient-facing digital services connected to any system established under section 250E of the National Health Service Act 2006 (single patient record); and

(e) reducing avoidable demand on NHS services through the promotion of self-care and prevention.

(2) In preparing guidance under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act, the Secretary of State must have regard to—

(a) improving health literacy,

(b) the role of community pharmacy as an accessible point of contact for self-care support and health advice, and

(c) the contribution of digital tools and patient-facing services to enabling self-care, self-management and appropriate care navigation.

(3) The Secretary of State must, within 12 months of the date on which this Act is passed, publish a self-care strategy for England (the "self-care strategy") which must set out—

(a) the national framework within which neighbourhood health plans will be required to embed self-care and self-management, including the management of self-limiting conditions, as a core component of local health and care services;

(b) the steps the Secretary of State will take to promote self-care and health literacy as part of the prevention and early intervention agenda across the NHS;

(c) the role of community pharmacy in delivering the self-care strategy, including the services and information that community pharmacy is expected to provide in support of self-care;

(d) the role of patient-facing digital services, including any system established under section 250E of the National Health Service Act 2006, in supporting self-care, self-management and navigation to appropriate care;

(e) the steps the Secretary of State will take to reduce avoidable demand on NHS services through the promotion of self-care; and

(f) the measurable outcomes against which progress in implementing the self-care strategy will be assessed, and the arrangements for reporting on progress.

(4) The Secretary of State must lay the self-care strategy before Parliament on the day on which it is published and must review and update it at least every three years.

(5) In this section—

“neighbourhood health plan” has the same meaning as in section 24 of this Act;

“self-care” means the actions taken by individuals to maintain their own health, manage minor or long-term conditions, including conditions that are self-limiting, and prevent ill health, including through the use of over-the-counter medicines, health information and digital tools.”

This new clause would require neighbourhood health plans to include arrangements for supporting self-care and self-management. It would require guidance to the responsible local authority and integrated care boards to reflect the guidance and require the Secretary of State to publish a national self-care strategy.

New clause 157—Report on delivery of transformative technology commitments—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish and lay before Parliament a report setting out the Government’s approach to delivering the transformative technology commitments in the document entitled “Fit for the Future: the 10 Year Health Plan for England” published in July 2025.

(2) The report under subsection (1) must cover the following areas—

(a) data quality, interoperability and the use of NHS data for research and innovation,

(b) artificial intelligence,

(c) genomics and predictive analytics,

(d) wearables and real-time monitoring, and

(e) robotics and precision technologies.

(3) The report must include—

(a) the principal milestones and intended outcomes for patients and the health service in each of the areas listed in subsection (2),

(b) the main risks to delivery and the steps being taken to mitigate them, and

(c) how progress will be measured.”

New clause 158—Progress reports on the women’s health strategy—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed and at least once every two years thereafter, publish and lay before Parliament a report on progress in delivering the renewed Women’s Health Strategy for England (published April 2026) or any successor strategy.

(2) A report under this section must include—

(a) a summary of delivery against the actions listed in the strategy’s action summary tables, including which actions are on track, delayed or revised and the reasons why that is the case;

(b) data from the women’s health data dashboard (or any successor data publication) on performance, access, outcomes and experience at national and neighbourhood level; and

(c) a summary of ongoing engagement with women, including through the women’s voices partnership and patient-reported experience and outcome measures, and how that engagement has informed delivery.

(3) The report may incorporate or cross-refer to existing published material (including the action summary tables and the women’s health data dashboard) where this meets the requirements of subsection (2).”

New clause 160—Annual report on specialised services—

“(1) Within 12 months of the passage of this Act, and every 12 months thereafter, the Secretary of State must publish a report on the commissioning and performance of specialised services commissioned by integrated care boards.

(2) A report under subsection (1) must include information relating to—

(a) patient outcomes;

(b) access to services;

(c) waiting times;

(d) workforce capacity;

(e) service sustainability;

(f) geographical variation in services;

(g) compliance with national service specifications; and

(h) arrangements for the coordination of specialist, community and neighbourhood care.

(3) A report under subsection (1) must be laid before both Houses of Parliament.”

This new clause would require the Secretary of State to publish an annual report on specialised services commissioned by integrated care boards.

New clause 162—Specialised services: annual report and published data—

“(1) The Secretary of State must, prepare a report on the performance of specialised services in England, measured against the relevant national standards for those services.

(2) The Secretary of State must lay a report under subsection (1) before each House of Parliament as soon as reasonably practicable after the end of the financial year to which it relates.

(3) The Secretary of State must make arrangements for the regular publication of data on the quality and outcomes of specialised services, including, but not limited to, data of the kind currently published as Specialised Services Quality Dashboards.

(4) In this section, "specialised services" has the same meaning as in section 3B of the National Health Service Act 2006 (as amended by this Act).”

This new clause would place a duty on the Secretary of State to report annually to Parliament on the performance of specialised services against national standards, and to maintain regular publication of data on their quality and outcomes, equivalent to the Specialised Services Quality Dashboards currently produced by NHS England.

Amendment 102, in clause 1, page 1, line 2, at end insert—

“(2) Before NHS England is abolished, the Secretary of State must publish a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document").

(3) The Secretary of State must publish a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the "workforce transition plan").

(4) The operating model document must include—

(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;

(b) the governance and accountability arrangements for the exercise of those functions;

(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and

(d) the proposed timetable for the transition.

(5) The workforce transition plan must include—

(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;

(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and

(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.”

This amendment would require the Secretary of State to publish an operating model for the merged DHSC/NHSE and associated plan to manage personnel before NHS England is abolished.

Amendment 19, in clause 4, page 3, line 29, at end insert—

“(c) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between coastal and inland areas, and

(d) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between rural and urban areas.”

This amendment would create a duty for the Secretary of State to reduce inequalities between coastal and inland areas and rural and urban areas.

Amendment 80, page 3, line 29, at end insert—

“(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.”

This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State's general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly.

Amendment 95, in clause 5, page 4, leave out lines 2 to 4 and insert—

“(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services.

(2) For the purposes of subsection (1), the Secretary of State must ensure that patients referred for a service to be provided outside a hospital setting (“out-of-hospital services”) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B.

(3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must—

(a) offer the patient a choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board;

(b) provide the patient with information about each available provider to support an informed choice, including—

(i) indicative waiting times,

(ii) the location at which the service would be provided,

(iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available, and

(iv) whether any costs may be incurred by the patient in travelling to or receiving the service with each provider;

(c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and

(d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe.

(4) For the purposes of this section, “out-of-hospital services” means services—

(a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department, and

(b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2).

(5) For the purposes of this subsection (4)(b), out of hospital services which the Secretary of State may specify by regulations may include—

(a) diagnostic services,

(b) audiology and hearing aid care,

(c) podiatry,

(d) dietetics and nutrition,

(e) physiotherapy,

(f) ambulatory cardiac monitoring, and

(g) such other services as the Secretary of State considers appropriate.

(6) In specifying services under subsection (4)(b), the Secretary of State must have regard to—

(a) the potential for the expansion of choice to reduce waiting times for the relevant service,

(b) the availability of sufficient independent and NHS providers to make genuine choice meaningful, and

(c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas.

(7) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out—

(a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply,

(b) the timetable for extending the choice obligation to further services, and

(c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section.

(8) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.”

This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.

Amendment 37, in clause 6, page 4, line 11, at end insert—

“(1A) For the purposes of subsection (1) the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England, including by reducing inequalities in clinical research funding and clinical research capacity between different regions of England.”

This amendment would ensure that in exercising their duty to promote innovation in the provision of health services, the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England.

Amendment 81, page 4, line 11, at end insert—

“(1A) The duty in subsection (1) includes, in particular, promoting innovation in the prevention, diagnosis and treatment of diabetes, including through the adoption of glucose monitoring and automated insulin delivery technologies.”

This amendment would ensure that the existing duty to promote innovation is understood to cover the specific diabetes technologies (flash/CGM and hybrid closed loop systems) currently being rolled out by NHS England ,so that momentum on adoption is not lost through the transfer of functions.

Amendment 97, page 6, line 12, leave out clause 10.

Amendment 38, in clause 11, page 6, line 28, leave out lines 28 and 29 and insert—

“(1) Where the geographic area covered by an integrated care board sits within a Mayoral Combined Authority, the relevant Mayor may give integrated care boards directions as to the exercise of their functions.

(1A) Where the geographic area covered by an integrated care board does not sit within a Mayoral Combined Authority, the Secretary of State may give integrated care boards directions as to the exercise of their functions.”

This amendment would give direction-making powers over integrated care boards to Combined Authority Mayors where boards sit within their authority. The Secretary of State would retain direction-making power where there is no relevant Combined Authority Mayor.

Amendment 39, page 7, line 4, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 40, page 7, line 11, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 103, in clause 12, page 9, leave out lines 33 to 39 and insert—

“(2) Before prescribing a service or facility under subsection (1)(b), the Secretary of State must publish an assessment of the likely impact of such a prescription on—

(a) patient safety;

(b) clinical outcomes;

(c) equality of access to services;

(d) workforce capacity and specialist expertise;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(2A) The Secretary of State must lay the assessment under subsection (2) before both Houses of Parliament.

(2B) In deciding whether it would be appropriate to prescribe a service or facility under subsection (1)(b), the Secretary of State must have regard to the assessment published under subsection (2).

(2C) Where regulations made under subsection (1)(b) prescribe a service or facility for commissioning other than by the Secretary of State, the Secretary of State must publish and maintain a national service framework for that service or facility.

(2D) A framework under subsection (2C) must include provision relating to—

(a) service standards;

(b) care pathways;

(c) workforce requirements;

(d) rehabilitation and long-term follow-up;

(e) collection and publication of outcome data;

(f) coordination between specialist, community and neighbourhood services; and

(g) coordination of care for persons receiving treatment through multiple clinical pathways.”.

This amendment would require the Secretary of State to publish an impact assessment before they make a decision to prescribe a service or facility under subsection (1)(b) of section 3B of the National Health Service Act 2006 and maintain a national service framework for any specialised service no longer commissioned directly by the Secretary of State.

Amendment 101, page 10, line 10, at end insert—

“(5) The Secretary of State must, within six months of this section coming into force, publish a specialised commissioning plan setting out—

(a) which services or facilities the Secretary of State intends to commission nationally under section 3B(1)(b), and

(b) the principles and criteria that will be used to decide whether a service or facility should be commissioned nationally or by integrated care boards.

(6) Before making regulations under section 3B(1)(b) that would make a significant change to the range of services or facilities commissioned nationally, the

Secretary of State must—

(a) publish a transition plan explaining the reasons for the change, the impact on patients, and the arrangements for continuity of care and clinical standards,

(b) consult such persons as the Secretary of State considers appropriate (including patients who use the affected services or their representatives, clinicians, and the bodies that would gain or lose commissioning responsibility), and

(c) publish a summary of the consultation responses and the Secretary of State’s response to them.

(7) The specialised commissioning plan under subsection (5) must be kept under review and revised as appropriate, and any revised plan must be published.”

Amendment 53, Clause 14, page 10, leave out lines 40 to 44 and insert—

“(a) confers functions on integrated care boards in relation to commissioning primary care services, including the provision of alternative general medical services for patients who—

(i) are unable to obtain appropriate care from the general practice responsible for their usual catchment area, or

(ii) no longer reasonably feel able or comfortable to receive care from that general practice,

(b) requires integrated care boards to make arrangements to support access to such alternative provision where it is necessary to meet the reasonable requirements of those patients,

(c) transfers related functions from NHS England to the Secretary of State, and

(d) contains other amendments relating to primary care services.”

This amendment would require integrated care boards to support and arrange alternative general practice provision for patients who cannot access appropriate care from their usual catchment GP practice, or who reasonably no longer feel able or comfortable receiving care from that practice.

Amendment 76, in clause 15, page 11, line 33, at end insert—

“(4A) The Secretary of State must take reasonable steps to ensure that arrangements under subsection (2) are accessible and inclusive, having particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.”

This amendment would require the Secretary of State to take reasonable steps to ensure that arrangements for public involvement in commissioning are accessible and inclusive, with particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.

Amendment 79, in clause 16, page 11, line 10, at end insert—

“(3) Regulations under this section must, in relation to children and young people referred to child and adolescent mental health services, require integrated care boards to make arrangements for appropriate interim support during any period between referral and the commencement of substantive treatment or assessment.

(4) The arrangements under subsection (3) may include—

(a) regular appointments or check-ups with a GP or other primary care professional;

(b) support from a family support worker;

(c) regular wellbeing checks or support provided through a school, including by a school nurse or other appropriate professional; and

(d) access to appropriate peer support, youth clubs or other community-based support.

(5) The purpose of arrangements under subsection (3) is to ensure that a child or young person does not remain without appropriate support solely because they are awaiting the commencement of substantive assessment or treatment.”

This amendment would require interim support for children and young people referred to CAMHS while they are waiting for substantive assessment or treatment.

Amendment 32, page 12, line 10, at end insert—

“(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

(4) For the purposes of subsection (3)—

“community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”

This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

Amendment 98, page 12, line 10, at end insert—

“(3) Regulations under subsection (1) must require the publication, at least monthly, of statistics on consultant-led referral-to-treatment pathways that include a breakdown of unreported removals, and the reasons for those removals, including distinguishing between—

(a) removals attributable to validation exercises (including administrative, technical or clinical validation), and

(b) other unreported removals.

(4) The statistics required by subsection (3) must be published—

(a) at national level,

(b) by integrated care board area, and

(c) by NHS trust and NHS foundation trust.

(5) In this section—

“unreported removals” means the residual figure calculated as the waiting list at the start of the period plus new RTT periods minus completed pathways minus waiting list at the end of the period;

“validation exercises” includes any systematic review of pathways for the purpose of removing those that should not remain on the waiting list.””

Amendment 99, page 12, line 10, at end insert—

“14Z45AA Prohibition on administrative minimum waiting times

An integrated care board must not adopt or apply any policy, contract term, activity planning assumption or other arrangement that has the effect of requiring or incentivising a minimum period of waiting before a patient may receive treatment, assessment, or a diagnostic test, where that minimum period is imposed for administrative, financial or capacity management reasons rather than clinical reasons.”

Amendment 34, page 12, line 16, at end insert—

“(1A) The regulations must impose a duty on integrated care boards to make provision for any person with a terminal illness diagnosis to be offered a conversation with a relevant healthcare professional about their needs for end-of-life care, including their—

(a) mental and physical health support needs, and

(b) financial support needs.

(1B) For the purposes of subsection (1A), if a person with a terminal illness diagnosis is unable to have the conversation, an integrated care board must ensure that the person’s next-of-kin are offered a conversation.

(1C) The regulations must make provision for any relevant authorities to have regard to the needs identified in a conversation under subsection (1A).”

This amendment would require the Secretary of State to make regulations which make provision for the any person with a terminal illness diagnosis to be offered a conversation with a relevant authority about their needs for end-of-life care.

Amendment 28, page 12, line 22, at end insert—

“14Z45BA Patient choice: community services substituting for consultant-led elective care

(1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.

(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—

(a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or

(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.

(3) Services to which this section applies include, but are not limited to—

(a) community audiology services;

(b) community glaucoma management and monitoring services; and

(c) minor eye conditions services.

(4) Regulations made by virtue of this section must ensure that—

(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service;

(b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and

(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.

(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”

Amendment 36, in clause 20, page 15, line 25, at end insert—

“(2A) Performance assessments must include details of how each integrated care board is meeting its duty to provide palliative care services or facilities to meet the reasonable requirements of the people for whom it has responsibility.

(2B) For the purposes of subsection (2A) the following guidance are considered reasonable requirements—

(a) NICE guideline [NG31] “Care of dying adults in the last days of life 2015”,

(b) NICE guideline [NG142] “End of life care for adults: service delivery 2019”,

(c) NICE quality standard [QS13] “End of life care for adults 2021”,

(d) NHS England “Palliative and End of Life Care” Statutory Guidance for Integrated Care Boards (September 2022).”

This amendment would require annual performance assessments to incorporate an assessment of whether each integrated care board is providing a reasonable standard of palliative and end of life care.

Amendment 104, in clause 20, page 15, line 28, at end insert—

“(4) In conducting a performance assessment under this section, the Secretary of State must assess the discharge by an integrated care board of any functions relating to specialised services.

(5) An assessment under subsection (4) must consider—

(a) patient outcomes;

(b) access to services;

(c) compliance with national service specifications;

(d) workforce capacity;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(6) The report published under subsection (3) must include a summary of the assessments undertaken under subsections (4) and (5).”

This amendment would require the Secretary of State to undertake and publish a national assessment of the performance of integrated care boards in relation to specialised services.

Amendment 45, page 15, line 29, leave out clause 21.

Amendment 91, in clause 21, page 15, leave out line 32 and insert—

“(a) for sub-paragraph (4), substitute—”

Government amendment 60.

Amendment 29, page 15, line 38, at end insert—

“(2A) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”

This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area.

Government amendment 61.

Amendment 30, page 16, line 3, leave out from “mayor” to “must” and insert

“or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A)”

This amendment is consequential on Amendment 29 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State.

Amendment 83, page 16, line 6, at end insert—

“(5) The constitution of an integrated care board must provide for the appointment of one or more members of the board with explicit responsibility for—

(a) people with learning disabilities;

(b) autistic people;

(c) people with Down syndrome; and

(d) children and young people with special educational needs and disabilities.

(6) The integrated care board must publish details of the member or members appointed under sub-paragraph (5).”

This amendment would require each Integrated Care Board to appoint one or more board members with responsibility for people with learning disabilities, autistic people, people with Down syndrome, and children and young people with special educational needs and disabilities (SEND), placing existing NHS England board-level leadership guidance on a statutory footing following the abolition of NHS England.

Amendment 92, page 16, line 6, omit subsection (b).

Amendment 96, page 16, line 7, leave out subsection (b) and insert—

“(b) for sub-paragraph (5) substitute—

“(5) The constitution must provide for the ordinary members of the integrated care board to include—

(a) at least one qualified, professionally registered, consultant in public health who provides wholly independent, transparent, leadership and advice to the board on preventing and reducing disease and improving the health of the population it serves,

(b) at least two clinicians with current experience of providing primary care services, at least one of whom is a general practitioner, and

(c) at least one medical practitioner with current experience of providing secondary care services.

(5A) A person appointed under sub-paragraph (5) must not be appointed to represent the interests of a provider organisation whose services are commissioned by the integrated care board.””

This amendment would require every Integrated Care Board to include an independent qualified and registered consultant in public health, at least two clinicians from primary care, and a clinical representative from secondary care.

Amendment 93, page 16, leave out line 8 and insert—

“after sub-paragraph (7) insert—”

Government amendment 62.

Amendment 31, page 16, line 9, at end insert—

““local authority” has the meaning given by section 2B;”

This amendment is consequential on Amendments 29 and 30 and defines the term “local authority”.

Amendment 94, page 17, line 12, leave out clause 23.

Amendment 77, in clause 24, page 17, line 35, at end insert.

“A neighbourhood health plan must include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions”

This amendment would require neighbourhood health plans to include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions.

Government amendment 63.

Amendment 84, in clause 29, page 21, leave out line 7.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Government amendment 64.

Amendment 55, in clause 42, page 30, line 29, at end insert—

“(5) After subsection (6) insert—

“(7) Where the Secretary of State is satisfied that a pharmacy provider has materially failed to comply with contractual, patient-safety or workforce obligations, the Secretary of State may by direction require the relevant integrated care board—

(a) to suspend or terminate arrangements with that provider, where appropriate,

(b) to make arrangements with another provider for the provision of pharmaceutical services,

(c) to secure continuity of the supply of medicines and other pharmaceutical services, and

(d) to take such other emergency measures as may be specified in the direction.

(8) A direction under subsection (7) may be given where the Secretary of State considers that there is a significant risk to patient safety, continuity of medicines supply or the provision of pharmaceutical services.

(9) The Secretary of State must ensure that arrangements made under subsection (7) are implemented as soon as reasonably practicable.

(10) A direction under subsection (7) must specify the period for which it has effect and must be published.””

This amendment would enable intervention where a pharmacy provider seriously fails to meet contractual, safety or workforce obligations, ensuring continuity of services and medicines supply.

Amendment 58, page 30, line 29, at end insert—

“(7) Where a situation or event has resulted, or is likely to result, in the closure, failure or disruption of a provider of pharmaceutical services, the Secretary of State and the relevant integrated care board must provide such assistance and support as is necessary to enable a new provider to establish or continue the provision of pharmaceutical services.

(8) Assistance or support under subsection (7) may include facilitating and establishing a relationship between a new provider and the manufacturers or suppliers of medicines and other pharmaceutical products.

(9) The assistance and support under subsection (7) must be available, in particular, where a new provider is—

(a) taking over premises previously operated by a provider of pharmaceutical services that has failed or closed,

(b) taking over premises where there has been evidence of serious misconduct, including malpractice or failure to pay staff, or

(c) an independent provider or a provider which is not part of a large company operating multiple pharmacy premises.

(10) The purpose of assistance and support under this section is to enable the new provider to secure supplies of medicines and other pharmaceutical products as quickly as reasonably practicable and to minimise any interruption in the provision of pharmaceutical services.”

This amendment would require the Government and integrated care boards to support new and independent pharmacy owners taking over failing, closed or disrupted pharmacies, including by helping them establish relationships with pharmaceutical manufacturers and suppliers so that they can secure medicines and other supplies quickly and maintain continuity of service.

Amendment 59, in clause 47, page 32, line 15, after subsection (4) insert—

“(4A) In determining the amount to be allotted to an integrated care board under subsection (1), the Secretary of State must have regard to the additional costs of providing health services in rural and coastal communities.

(4B) The matters to which the Secretary of State must have regard under subsection (4A) include—

(a) rurality,

(b) population age,

(c) transport and travel costs,

(d) seasonal changes in demand,

(e) recruitment and retention difficulties,

(f) the loss of economies of scale arising from sparsely populated communities, and

(g) unmet need for primary medical, dental and pharmaceutical services.

(4C) The Secretary of State must ensure that the methodology used in determining allotments does not rely predominantly on measures of deprivation where those measures fail adequately to reflect the costs or unmet need as set out in subsection (4B).

(4D) The Secretary of State must publish the methodology used in determining allotments under this section and must review that methodology at intervals of not more than five years.”

This amendment would require ICB funding allocations to reflect the additional costs and unmet health needs of rural and coastal communities.

Amendment 10, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.”

This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding.

Amendment 17, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services.

(2B) The increase in spending set out in subsection (2B) must be in line with the change in level of their total programme funding.”

This amendment would introduce the primary care Investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding.

Amendment 11, page 32, line 34, after “subsection (1)” insert “and (2A)”.

This amendment is consequential on Amendment 10 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding.

Amendment 18, in clause 47, page 32, line 34, after “subsection (1)” insert “and (2A) and (2B)”.

This amendment is consequential on Amendment 17 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding.

Amendment 26, in clause 51, page 35, line 38, after “available” insert

“for the purpose of delivering or improving patient health or social care”.

Amendment 42, page 36, line 1, leave out “health” and insert “direct patient”.

This amendment clarifies that the Secretary of State’s regulation-making powers in respect of the single patient record are limited to the provision of direct patient care and social care.

Amendment 105, page 36, line 8, at end insert—

“(ba) enabling a patient, following diagnosis of a health condition, to consent to the sharing of such information as is necessary for the purpose of enabling the organisation to offer or provide condition-specific support to the patient with an approved voluntary, community or charitable organisation providing condition-specific support services;

(bb) facilitating referral, where consent has been provided, to such an organisation under subsection (ba);”

This amendment would ensure that regulations establishing the Single Patient Record may include provision enabling patients, following diagnosis, to consent to referral and information sharing with approved voluntary, community and charitable organisations providing condition-specific support services.

Amendment 43, page 36, line 11, leave out “including” and insert “solely for the purposes of”

This amendment would ensure that regulations requiring or authorising the making available of patient information through the single patient record system can only make provision in respect of the circumstances set out in the Bill.

Amendment 15, page 36, line 13, after “behalf” insert “, including nominated carers”

This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.

Amendment 27, page 36, line 21, leave out lines 21 to 23.

Amendment 35, page 36, line 21, at end insert—

“The regulations must make provision for patient information to be readily available to providers of palliative and end-of-life care including voluntary sector providers.”

This amendment would ensure the single patient record is available to all palliative and end of life care providers.

Amendment 23, page 36, line 23, at end insert—

“(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.”

This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

Amendment 24, page 36, line 23, at end insert—

“(3A) The regulations must make provision for prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of making prior membership in the armed forces visible on the single patient record.

(3C) A report under subsection (3B) must consider—

(a) the ability of veterans to access the necessary NHS support, and

(b) the ability of medical staff to provide former members of the armed forces with appropriate care.”

This amendment would require prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record and require the Secretary of State to publish a report on making prior membership in the armed forces visible on the single patient record.

Amendment 88, page 36, line 26, at end insert—

“(4A) Regulations may not be made under this section unless the Secretary of State has first published and laid before both Houses of Parliament a Single Patient Record Outline Plan.

(4B) The Outline Plan under subsection (4A) must set out, as a minimum—

(a) the intended high-level design and scope of the single patient record, including the core data categories expected to be included and the principal care settings to be connected in the first phase;

(b) the proposed technical and architectural approach, including how existing source systems will be linked rather than replaced;

(c) the proposed timetable and phased rollout plan, including priority pathways;

(d) the intended access model for patients, clinicians and other relevant care professionals, including arrangements for proxy access and digital inclusion;

(e) the key safeguards for privacy, security, audit and prevention of inappropriate access; and

(f) the proposed approach to public engagement and awareness before the system becomes operational.

(4C) The Outline Plan must be published at least three months before any regulations under this section are laid.”

Amendment 22, page 36, line 32, at end insert—

“(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.

(6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups.

(6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for—

(a) those without access to a suitable electronic device,

(b) those without access to suitable broadband connectivity,

(c) those with physical and/or mental disabilities,

(d) those belonging to groups considered socially excluded, and

(e) those considered lacking digital skills.

(6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.”

This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of single patient record.

Amendment 87, page 36, line 32, after subsection (6) insert—

“(6A) Regulations under this section must make provision to ensure that the system—

(a) complies with the Accessible Information Standard, DAPB1605, or any standard which replaces it;

(b) uses and is interoperable with the Reasonable Adjustment Digital Flag, DAPB4019, or any system or standard which replaces it;

(c) enables patients’ communication, information and reasonable adjustment needs to be identified, recorded, flagged, shared, met and reviewed without avoidable repetition by the patient; and

(d) enables patients to receive and access information relating to their care in formats appropriate to their communication and accessibility needs.

(6B) In preparing regulations under this section, the Secretary of State must secure the participation of disabled people, including blind and partially sighted people, and organisations representing them, in the design, development, testing and review of the system.”

This amendment seeks to ensure that the Single Patient Record supports the communication, information and reasonable adjustment needs of blind and partially sighted people and other disabled patients by embedding existing NHS accessibility standards within the system. It also requires disabled people and their representative organisations to be involved in the design, development, testing and ongoing review of the Single Patient Record to ensure accessibility is embedded from the outset.

Amendment 52, in schedule 1, page 57, line 15, at end insert—

“83B Primary care estate investment programme

(1) The Secretary of State must establish and maintain a programme for providing capital funding for the improvement and modernisation of premises used for the provision of primary medical services.

(2) The programme must prioritise practices where premises—

(a) are no longer fit for purpose,

(b) require substantial repair, adaptation or modernisation, or

(c) otherwise materially restrict the provision of safe, accessible or effective primary medical services.

(3) The Secretary of State must ensure that the process for applying for and accessing capital funding under this section is proportionate and does not impose unnecessary administrative burdens.

(4) The arrangements must be designed to ensure that a viable provider of primary medical services is not prevented from carrying out essential improvements because of insufficient access to capital funding.

(5) In this section “premises” includes premises owned, leased or otherwise occupied for the provision of primary medical services.”

This amendment would establish a capital funding programme to improve and modernise primary care and General Practice premises.

Amendment 50, page 57, line 26, at end insert—

“5A after section 87 insert—

“87A Sustainable funding for general practice

(1) The Secretary of State must ensure that arrangements for payments under general medical services contracts provide for sustained investment in general practice.

(2) In exercising functions under this section, the Secretary of State must have regard to the role of general practice in—

(a) preventing illness,

(b) managing long-term conditions,

(c) providing care in the community, and

(d) reducing avoidable hospital admissions.

(3) Arrangements for funding general practice must have regard to the volume, complexity and value of care delivered through general practice.

(4) The Secretary of State must publish, for each financial year, a statement setting out how the arrangements for payments under general medical services contracts are intended to support the matters in subsections (1) to (3).””

This amendment would require sustained investment in general practice reflecting the volume, complexity and value of care provided.

Amendment 51, page 57, line 26, at end insert—

“5A After section 87 insert—

“87A Rural and coastal general practice funding

(1) Arrangements for payments under general medical services contracts must take account of the additional costs of delivering primary medical services in rural and coastal communities.

(2) The factors to which arrangements under subsection (1) must have regard include—

(a) rurality,

(b) the age profile of the population,

(c) transport and travel costs,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3) The Secretary of State must ensure that the funding arrangements under this section are reviewed periodically and amended where necessary to reflect changes in the costs of providing services in rural and coastal areas.””

This amendment would require GP funding to reflect the additional costs of providing services in rural and coastal areas.

Amendment 47, page 60, line 6, at end insert—

“99C Dental training hubs

(1) The Secretary of State must make arrangements for the establishment and support of dental training hubs in areas where there is an unmet need for NHS dental services.

(2) The arrangements under subsection (1) must include provision for dental training hubs in Dorset, including provision in west Dorset.

(3) In exercising the duty under subsection (1), the Secretary of State must work with—

(a) universities and other providers of approved dental education and training,

(b) local authorities, and

(c) integrated care boards and other NHS bodies.

(4) The purpose of dental training hubs is to—

(a) increase the capacity for dental education and training,

(b) increase the availability of NHS dental services in areas of unmet need,

(c) strengthen the recruitment and retention of the dental workforce, and

(d) support the development of the long-term dental workforce.

(5) Arrangements under this section must provide for students in the final year of an approved course of dental education to provide NHS dental treatment under appropriate supervision.

(6) Treatment provided by a student under subsection (5) must—

(a) be NHS treatment carried out on an NHS patient,

(b) be provided under the supervision of a suitably qualified dental professional, and

(c) be free at the point of use to the patient where the supervising provider is receiving, or is entitled to receive, the relevant NHS tariff or other NHS payment in respect of that treatment.

(7) A dental training hub must provide, or participate in, structured pathways into dental apprenticeships and other appropriate employment-based dental training.

(8) Arrangements under this section must include measures to support retention of dental professionals trained through the hubs to meet future workforce commitments.

(9) In this section “dental training hub” means a facility or network of facilities at which dental education, supervised clinical training and NHS dental service provision are integrated.”

This amendment would establish dental training hubs in areas of unmet need, including Dorset and west Dorset, to expand training, improve NHS dental access and strengthen the workforce.

Amendment 48, page 60, line 6, at end insert—

“99C Allocation of NHS dental funding according to unmet need

(1) The Secretary of State must make arrangements to ensure that NHS dental funding is allocated according to local unmet need.

(2) Where funding allocated for primary dental services in a financial year is not used for the purpose for which it was allocated, the Secretary of State must ensure that, so far as reasonably practicable, that funding is redirected to measures designed to increase access to NHS dental services.

(3) Measures under subsection (2) may include—

(a) additional NHS dental capacity,

(b) additional NHS dental appointments,

(c) measures to reduce waiting times,

(d) outreach dentistry,

(e) domiciliary dental services, and

(f) dental services provided in or in connection with schools.

(4) The arrangements must include mechanisms to ensure that funding allocated for the purpose of increasing access results, so far as is reasonably practicable, in additional NHS dental capacity, appointments or reduced waiting times.

(5) In making arrangements under this section, the Secretary of State must have particular regard to people who face barriers to travelling to dental services, including older people, people with disabilities, vulnerable people and schoolchildren.”

This amendment would require dental funding to reflect local unmet need and redirect unused funding towards improving access.

Amendment 49, page 60, line 22, after paragraph 18 insert—

“18A After section 103 insert—

“103A Rural and local-need factors in NHS dental funding

(1) Directions made under section 103 must provide for NHS dental funding arrangements to take account of local need.

(2) In making provision under subsection (1), the Secretary of State must have proper regard, in particular, to—

(a) the rurality of the area,

(b) the age profile of the population,

(c) the population who have disabilities,

(d) local transport and travel costs,

(e) seasonal changes in demand for services,

(f) difficulties in recruiting and retaining dental professionals, and

(g) the loss of economies of scale arising from sparsely populated communities.

(3) Provision made under section 103 must proportionately weight other measures alongside deprivation when determining the level of NHS dental funding required in an area.

(4) The Secretary of State must every three years review and by regulations amend the factors mentioned in subsection (2).””

This amendment would require dental funding to properly take account of rurality, local need, travel costs, workforce challenges and other factors alongside deprivation.

Amendment 56, page 64, line 34, at end insert—

“45A After section 133 insert—

“133A Emergency intervention in pharmaceutical services

(1) Where an integrated care board considers that a person providing pharmaceutical services is failing, or is likely to fail, materially to comply with—

(a) a contractual obligation,

(b) a patient-safety requirement, or

(c) a workforce obligation,

the board must consider whether emergency intervention is required to protect patients or continuity of pharmaceutical services.

(2) Where the board considers that emergency intervention is required, it may—

(a) require the provider to take specified remedial action,

(b) suspend specified arrangements,

(c) terminate arrangements with the provider,

(d) make arrangements with another provider for the provision of pharmaceutical services, or

(e) take any combination of the steps in paragraphs (a) to (d).

(3) The powers in subsection (2) must be exercised with regard to the need to maintain continuity of medicines supply and protect patients from avoidable disruption.

(4) An integrated care board must not continue arrangements with a provider where it is satisfied that the provider is demonstrably unfit to provide pharmaceutical services safely and effectively.

(5) Before exercising a power under subsection (2), the board must, except in an emergency, give the provider a reasonable opportunity to make representations.

(6) Nothing in this section prevents an integrated care board from taking immediate action where delay would materially risk patient safety or continuity of medicines supply.””

This amendment would give integrated care boards powers to intervene where a pharmacy provider is failing to provide their required services to protect patients and medicines supply.

Amendment 57, page 72, line 40, at end insert—

“(3D) Regulations made under subsection (1) must ensure that the remuneration arrangements for pharmaceutical services take account of the costs of providing those services in rural and sparsely populated areas.

(3E) In making provision under subsection (3D), the determining authority must have regard to—

(a) rurality,

(b) the age profile of the population,

(c) transport and distribution costs,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3F) The remuneration arrangements must be designed to support the financial sustainability of pharmacies providing essential NHS services in rural and sparsely populated areas.

(3G) The Secretary of State must review the operation of the remuneration arrangements periodically and make such changes as are necessary to ensure that the matters in subsections (3D) to (3F) continue to be reflected.”

This amendment would require pharmacy funding to reflect the additional costs of providing services in rural and sparsely populated areas.

Government amendments 70 and 71.

Amendment 85, in schedule 3, page 86, line 14, leave out paragraphs 5 to 8.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 86, page 86, line 30, leave out paragraph 14.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 16, page 88, line 19, at end insert—

“(1A) The function under sub-paragraph (1) must be exercised by a person employed in the civil service of the State, and a Minister of the Crown or a special adviser must not be involved in any decision relating to such an appointment, suspension or removal.”

This amendment would ensure that civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.

Amendment 54, in schedule 8, page 106, line 33, at end insert—

“5A After section 254 insert—

“254A Interoperability of health and social care information systems

(1) The Secretary of State must make regulations requiring providers of NHS health services to use interoperable digital information systems.

(2) Regulations under subsection (1) must apply, so far as appropriate, to—

(a) providers of primary medical services,

(b) providers of primary dental services,

(c) providers of pharmaceutical services,

(d) NHS trusts,

(e) NHS foundation trusts, and

(f) providers of community health services.

(3) The regulations must provide for the secure exchange of relevant patient information between providers using interoperable systems.

(4) The regulations must include provision for electronic prescribing across NHS care settings where prescribing is clinically appropriate.

(5) The Secretary of State must ensure that the arrangements under this section are designed to—

(a) reduce duplication,

(b) reduce unnecessary administrative work,

(c) improve continuity of care,

(d) reduce avoidable delays in diagnosis, treatment and referral, and

(e) enable clinicians to access relevant information securely when providing care.

(6) Regulations under this section must include appropriate requirements relating to information governance, cyber security, patient confidentiality and the lawful processing of personal data.

(7) Before making regulations under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including representatives of general practice, hospitals, community services and patients.””

This amendment would require interoperable NHS digital systems to improve information sharing, reduce duplication and support continuity of care.

Amendment 13, page 106, leave out lines 34 and 35 and insert—

“For section 255 (power to request NHS England to establish information systems), substitute—

“255 Powers to request the Secretary of State to establish information systems

(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.

(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.

(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.

(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—

(a) it is made by a principal body, and

(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.

(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—

(a) a mandatory request, or

(b) other request under subsection (1).

(6) In deciding whether to comply with the request, the Secretary of State—

(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and

(b) may take into account the extent to which the principal body or other person making the request has had regard to—

(i) the code of practice prepared and published by the Secretary of State under section 263, and

(ii) advice or guidance given by the Secretary of State under section 265.

(7) In this section “principal body” means—

(a) the Care Quality Commission,

(b) the National Institute for Health and Care Excellence, and

(c) such other persons as may be prescribed in regulations.

(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.””

This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.

Amendment 14, page 110, line 37, leave out paragraph 14.

This amendment is consequential on Amendment 13.

Amendment 41, page 112, leave out lines 1 and 2 and insert—

“23 For section 274A (Secretary of State’s guidance about NHS England data functions) substitute—

“274A Secretary of State’s guidance in respect of their data functions

(1) The Secretary of State must publish guidance about the exercise of—

(a) their relevant data functions, and

(b) their other functions in connection with their relevant data functions.

(2) Before publishing guidance under this section the Secretary of State must consult any other persons that the Secretary of State considers appropriate in relation to the guidance.

(3) The Secretary of State must have regard to the guidance published under this section.””

This amendment would transfer the existing statutory requirement for published guidance about data functions from NHS England to the Secretary of State.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

[Karin Smyth]

I wish at the start to take a moment to thank the Members on both sides of the House who served on the Public Bill Committee during what was a very hot end of June and July—if we can remember back that far. As part of that process, the Committee scrutinised every clause of the Bill and debated over 195 amendments, and we on the Government Benches are grateful for their diligence. The implementation of the Bill is better for all that hard work. I also welcome the spirit of collaboration that has greeted the main provisions of the Bill from both sides of the House, most notably on Second Reading but also in Committee, and I hope that we can continue in that spirit at this stage. For our part, we remain committed to working with MPs and peers across the House and other stakeholders to ensure that the end result is a Bill that strengthens the NHS.

I know that we have a large number of amendments on a variety of topics, so I will keep my remarks short. New clauses 96 and 97 relate to visiting rights. They strengthen the role of integrated care boards and local authorities in promoting visiting, supporting people to have someone with them and ensuring the involvement of family, friends and carers in decisions. They complement the existing legal requirements and the work already under way to drive a change in culture and practice by embedding visiting at the heart of the responsibilities of commissioners.

New clause 96 explicitly places duties on integrated care boards to promote opportunities for visiting and accompaniment, while new clause 97 builds on local authorities’ existing wellbeing duties by emphasising the importance of involving other people in decision making, receiving visitors and maintaining opportunities to take trips outside the care home. Maintaining meaningful contact and connection with family, friends and carers is critical to the health and wellbeing of so many people in our health and care settings. They provide invaluable practical help, emotional support and advocacy for their loved ones in accessing care and treatment, and commissioners should do what they can to support these relationships.

I turn to Government amendments 60 to 62. The question of who is required to sit on ICBs has raised comments from all across this House. I am grateful to all Members who have raised the importance of local government having a voice in ICBs, including my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) and the other members of the Health and Social Care Committee, who have continually advocated on this issue. We agree. It was never the intention to weaken the voice of local government in the NHS. We recognise that local authority board members are an important voice for commissioning on the ICB, and often provide helpful challenge and a very different perspective on commissioning decisions.

[Layla Moran (Oxford West and Abingdon) (LD)]

I thank the Minister for accepting our amendment on this issue. We pressed her and her colleagues over and over again—to the extent that we got a letter back that we honestly thought had been generated by AI, because the logic in it had no follow-through at all. I am delighted that she has listened. On what else does she intend to listen to us? In particular, there are amendments on the Health Services Safety Investigations Body, Healthwatch and health inequalities, which we will consider tomorrow, and, most importantly, the special needs amendment, which we are considering today. What else will she listen to us on?

[Karin Smyth]

I thank the Chair of the Select Committee —I can assure her that I am Karin, not Claude. She tempts me to go further on the rest of the Bill, but I genuinely thank her and the Committee; I hope she would agree that I spent a lot of time over the past months, before Report stage and Committee stage, meeting her, members of the Committee and many hon. Members from across the House. We have some provisions—we might call them simple provisions—in the Bill to democratise the NHS’s accountability, to reinforce the single patient record, and to improve the patient experience and patient safety landscape. We recognise that there is a lot of complexity within those simple propositions, and we will continue to listen to hon. Members. We want to ensure that the NHS is strengthened.

In relation to the ICBs and local authority voice, it was particularly significant over the summer to have heard from my right hon. Friend the Prime Minister about his commitment to rewiring the state and our ongoing reform to social care. With that in mind, I am pleased that amendments 60 to 62 will re-establish a requirement for ICBs to have at least one board member jointly nominated by local authorities in their area. That will sit alongside the existing duty to have a member nominated by the mayor of each mayoral strategic authority, as well as duties on ICBs and local government to work together, including on health and wellbeing boards. In Committee, we had a useful discussion about health and wellbeing boards, neighbourhoods and local accountability. I should also note that ICBs can appoint other people to their boards if they would benefit from their expertise. That is a decision to be taken locally.

Finally, let me briefly pre-empt the hon. Member for North Shropshire (Helen Morgan) by making a few comments about new clause 1. I thank her for the way she worked with me in Committee on the issue of a maternity commissioner—an issue that I think unites the House. As the hon. Member knows, we have accepted the recommendation from Baroness Amos’s national investigation into maternity and neonatal care. I can announce that, to deliver on this commitment, we will table an amendment to the Bill in the other place to establish a statutory maternity and neonatal commissioner. We are determined to get this right. For too long, too many women, babies and families have not received the care and support they deserve. The establishment of a commissioner represents a significant opportunity to strengthen accountability and champion their interests across the system. I hope that will give the hon. Member the reassurance she needs not to press her amendment.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Before I call the shadow Minister, I must tell hon. Members that this debate is heavily oversubscribed; Back Benchers will immediately be on a speaking limit and not everybody will get in. I call the shadow Minister.

--- Later in debate ---

[Andy McDonald (Middlesbrough and Thornaby East) (Lab)]

I rise as the chair of the all-party parliamentary group on spinal cord injury to speak to amendments 103 and 104, new clause 160 and amendment 105 in my name. I thank the Minister for meeting me during the passage of the Bill and for her subsequent letter. I also thank the Spinal Injuries Association for its support for the APPG and, crucially, for people living with spinal cord injury. These amendments are not about preventing reform; they are about ensuring that when responsibility for highly specialised services changes, patients continue to receive safe, equitable and nationally consistent care.

Spinal cord injury is a relatively low volume but complex lifelong condition requiring specialist expertise, rehabilitation and long-term follow-up. National commissioning exists to prevent fragmented services and postcode variation. If commissioning moves to integrated care boards, we need confidence that specialist workforce capacity, national standards and the sustainability of specialist centres will be protected. I therefore ask the Minister to clarify how those safeguards will work in practice, particularly around workforce, rehabilitation and geographical variation. I also seek clarity on whether spinal cord injury services will transfer to ICBs and what criteria will determine that decision.

Amendment 104 and new clause 160 would provide national assurance and parliamentary accountability for outcomes, access, workforce and geographical variation. Amendment 105 addresses the single patient record. Specialist charities provide vital practical and peer support after life-changing injury, even where they are not part of the clinical care. That is why this appeal is so resonant. If we can engage with those providers at that early stage, the outcomes will undoubtedly be improved. The amendment would allow referral, with patient consent, to approved condition-specific organisations sharing only necessary information.

I will not press these amendments to a vote today. I hope that the Minister will consider further safeguards and clarification during the Lords stages of the Bill. The care and access to support for patients dependent on specialist services should not depend on where those patients live.

[Karin Smyth]

I thank Members across the House for their contributions. As we would expect for a Bill of this size, it has been a wide-ranging debate, and I will not be able to address every single amendment, but I will try to cover them all in the time I have. If necessary, I will get back to people afterwards. As a Government, we know that what we have set out to do through this Bill is ambitious. We do not resile from that; we want to be ambitious. We are determined to make a real and positive change for people up and down the country who use the NHS, and throughout the Bill, we have remained focused on the key objectives. Those are to strengthen democratic accountability, strip back bureaucracy and empower patients.

--- Later in debate ---

[Several hon. Members rose—]

[Karin Smyth]

I am going to move on, because there is a lot to get through.

My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) made a powerful speech, based on his own experience and the terrible experiences of his constituents. I will write to him about what we want to do with ICBs to make that situation better.

I now turn to new clause 56, tabled by the hon. Member for Mid Sussex (Alison Bennett). I also thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for her ongoing work on, and interest in, carers throughout the passage of this Bill. I can assure the House that the Government fully recognise the importance of supporting carers’ health and wellbeing, including ensuring that they can take breaks from their caring responsibilities where needed. The Care Act 2014 already includes duties to assess and address carers’ current and future needs, and of course, we want to ensure that carers get the full benefit of the single patient record. To achieve this, we intend to use our regulation powers, which are already in the Bill.

The topic of inequalities has been highlighted a lot today. We are committed to ensuring that local areas are empowered to make decisions, tackle the specific health challenges they face and make real progress on health inequalities. I want to reassure the House that reducing health inequalities remains a priority for this Government. I know that the Chair of the Health and Social Care Select Committee, and the Committee as a whole, takes a great interest in this issue, and we are committed to working with them. I thank my hon. Friends the Members for Stoke-on-Trent South (Dr Gardner) and for Uxbridge and South Ruislip for their championing of this important issue and for our meeting last week.

I am not, however, convinced about new clause 91. Our focus is, and must remain, on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. We already have a wide range of duties from the 2006 Act, and we have a new duty on combined authorities. There was a duty on ICBs in the Health and Care Act 2022, and there is a duty on foundation trusts. We have the public sector equality duty, as well as our commitment in the 10-year health plan. Again, the issue is making it work and empowering local leaders to do just that.

I commend the work of my hon. Friend the Member for Lewisham East (Janet Daby) on the APPG on sickle cell and thalassaemia, and I will write to her specifically on the issues she raised. She talked about specialised commissioning, a topic that was also raised by my hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald). We know that this is an ongoing concern across many areas, and I commit to keeping in touch with them and with other Members.

Turning to women’s health—including mental health—and maternity services, again, I can assure the House that this is a priority for the Secretary of State. That is why we published the action-focused renewed women’s health strategy. It is why we are undertaking a single national action plan on maternal health, overseen by the national maternity and neonatal taskforce, to drive improvements where it matters to families, clinicians and other experts. I know that many Members of this House are committed to improving mental health, but I take this opportunity to thank my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for all her work in this area as the national maternity adviser.

Opposition Members mentioned the Hughes report, and I assure the House that the Government recognise the importance of providing a response. I do not have time to go into all the ongoing work at the moment, but I commit to doing so at the earliest opportunity. [Interruption.] The Conservatives had a long time. The hon. Member for Sleaford and North Hykeham (Dr Johnson) says that they were about to do it before the election, but that is not what we found when we came into power. The Conservatives left us a lot of work to do in this and many other areas, but we are committed to doing it.

Fertility services and reducing inequalities in maternity services has been raised by my hon. Friend the Member for Stockport (Navendu Mishra) and the right hon. Member for Stone, Great Wyrley and Penkridge (Sir Gavin Williamson), who has been a tireless advocate in this area, as have many others. I have recently written to him. NICE guidelines inform how ICBs should commission in this area, but I know that things are not uniformly implemented. We will continue to work with ICBs to evaluate the next steps.

There was a lot of discussion on primary care, and dental access across the country in particular. We are committed to rebuilding dentistry in England, but actions speak louder than words. We are making great strides in improving access, ensuring an urgent care safety net across the country, reforming the dental contract and developing a 10-year workforce plan. More broadly, we think it is right that under this Bill, primary medical services become the responsibility of ICBs. They have the right knowledge of their areas to make commissioning decisions, and that includes on eye care. They have responsibility for all primary medical services, but rightly they will be accountable to the Secretary of State for their performance.

The right hon. Member for Godalming and Ash (Sir Jeremy Hunt) is right that we will say that he could have dealt with the issues he raises while he was in power, but we do not always say that, and he is absolutely right about continuity of care. I have also visited the practice he talks about in Horfield in Bristol, and not just because I was on the primary care trust board when the 2004 changes happened. Broadly, Bristol does have different standards on some of these issues, and that highlights our point. We do not need to put some of these provisions in legislation. Exactly this sort of good practice can be shared in local systems through neighbourhood care plans, neighbourhood work and the work in primary care networks.

The single patient record is fundamental to the Government’s mission to create a modern, joined-up NHS that puts patients at the centre of their care. On amendments 26, 42 and 43, I assure Members that the overarching purpose of making regulations to create and operate the single patient record is limited to the direct care of patients, and clause 51 is already explicit about that. Crucially, the clause does not create any new data sharing gateways for secondary purposes such as planning and commissioning, so these amendments are not necessary. On data safeguards, the security and privacy of people’s health and social care data are paramount. As Members would expect, we will build the strongest safeguards into the record. On new clause 32, I can assure Members that the SPR will be designed to protect personal data by default, with the highest standards of cyber-security and information governance ensuring that only the right people can access the right information at the right time and only for the right reasons.

Finally, I have heard how important it is that the single patient record is accessible and inclusive. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for amendment 87 and the important work she is doing to publicise this hugely important area. I assure her and Members that we are confident that the Bill is drafted to enable information related to support needs and reasonable accommodations to be included in the SPR. The Department will have regard to the accessible information standard as the SPR is developed.

We are also committed to tackling digital exclusion. We have considered that as part of the single patient record equality impact assessment, and work is already under way to help address barriers around connectivity, skills and confidence. I heard what my hon. Friend the Member for Middlesbrough and Thornaby East said about the need to engage him and others about the single patient record as we go forward.

On the federated data platform, decisions about public contracts must be made through fair, open and non-discriminatory processes. That is governed by UK procurement law, which recognises certain international treaty obligations. NHS England is reviewing the federated data platform contract to determine whether it should continue with standard contract management processes. It will look at evidence of delivery and the impact of the platform, and that should be the basis on which a contract continuation is decided.

[Martin Wrigley]

Will the Minister give way?

[Karin Smyth]

I will not. We have heard a lot from the hon. Gentleman, and I want to make some clear points to the House this evening.

We have heard a great deal of discussion about commercial processes, and Members—including the hon. Member for Newton Abbot (Martin Wrigley)—have raised important points about data security, governance and ethical standards of contracts, and support for domestic suppliers and for voluntary, community and social enterprise organisations. Contracts involving NHS data and digital services must be subject to proper scrutiny. The Government’s approach is to assess risks on the basis of the nature of the data, service and supplier access. Crucially, we already have the tools that we need to carry out appropriate due diligence through legal powers and robust contractual provisions.

I agree with the spirit of new clause 108, tabled by my hon. Friend the Member for Liverpool West Derby (Ian Byrne). I fully recognise the importance of ensuring that the NHS does not inadvertently support exploitation or rights abuses. UK legislation already incorporates some international laws: for example, the Human Rights Act 1998 incorporates the European convention on human rights into UK law. Similarly, we can use existing legislation and guidance to exclude suppliers from NHS procurements. Both the Procurement Act 2023 and the provider selection regime allow us to exclude providers when there has been serious misconduct or illegality. For instance, we could exclude a supplier under the Procurement Act for breaches of modern slavery and/or human trafficking laws. We have very high standards and expect all suppliers —including whichever companies go on to provide the single patient record—to meet them.

On a related note, the Chancellor has already written to the Secretary of State to ask that the NHS procurement better support British industry. In the light of that, the Secretary of State has commissioned, within the health family, a review of strategic procurement pipelines to find opportunities for the new social value model to support more British jobs, skills and innovation. The First Secretary of State, my right hon. Friend the Member for Sheffield Heeley (Louise Haigh), who is leading work on procurement across Government, would be happy to meet my hon. Friend the Member for Liverpool West Derby as part of this important work as it progresses, and I can assure him that the actions that we take will be fully in line with the principle of international law.

[Steve Barclay]

Will the Minister give way?

[Karin Smyth]

I thank my hon. Friend the Member for Stroud (Dr Opher)—with his example of the sore throat—for his help in driving down demand for healthcare. Indeed, I thank Members in all parts of the House for their contributions to what has been an interesting and helpful discussion. Their expertise and their scrutiny will continue to strengthen the Bill.

[Steve Barclay]

Will the Minister give way?

[Rachael Maskell (York Central) (Lab/Co-op)]

Will my hon. Friend give way?

[Karin Smyth]

I will give way to my hon. Friend. [Interruption.]

[Rachael Maskell]

I have listened carefully to the debate. May I refer to my new clause 57? The challenge of the NHS is that so much significant, unaccountable power is being held that we, as Members of Parliament, cannot even deliver for our constituents. Will my hon. Friend look at her my new clause, and work with me to ensure that we get the Bill in the right place with regard to accountability before it goes to the Lords?

[Karin Smyth]

As my hon. Friend knows, I spoke from the Opposition Benches for many years about the lack of accountability of our local systems to local members of Parliament. I think that that was a great loss in the Lansley Bill. It was one of the things that drove me to become a member of Parliament, and in my role as the Minister of State I have endeavoured to make sure that local Members of Parliament have—

[Steve Barclay]

Will the Minister give way?

[Karin Smyth]

I will not. The right hon. Member was Secretary of State for Health twice, so he had his chance to put all the right things into legislation. [Interruption.] I am not helping my own sore throat.

As my hon. Friend mentioned, the Bill is about returning that democratic accountability directly to the Secretary of State. We have had a lot of pushback in different places, but that is what this Bill does. It returns accountability to the Secretary of State, it devolves that responsibility for delivering on the ground to NHS organisations, and, crucially, it empowers patients. Our new clause strengthens the Bill, and I commend it to the House.

Question put and agreed to.

New clause 96 accordingly read a Second time, and added to the Bill.

New Clause 97

Care and support: involvement of others and visitors

“In section 1 of the Care Act 2014 (promoting individual well-being), in subsection (3)—

(a) after paragraph (e) insert—

“(ea) the importance of the individual being able to involve other people in such decisions and of those people receiving the information and support necessary to facilitate that involvement;”;

(b) after paragraph (f) insert—

“(fa) the importance of the individual having appropriate opportunities to receive visitors;

(fb) in the case of a person who is provided with accommodation in a care home, the importance of them having appropriate opportunities to take trips outside of the care home;”.”—(Karin Smyth.)

Section 1(3) of the Care Act 2014 lists matters to which local authorities must have regard when exercising functions under Part 1 of that Act. The amendments refer to the importance of an individual being able to involve other people in decisions and to receive visitors etc.

Brought up, read the First and Second time, and added to the Bill.

NHS Pension Scheme

Karin Smyth Excerpts

Wednesday 2nd September 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Over the past year, I have made regular statements about the implementation of the McCloud remedy in the NHS pension scheme. This hugely complex undertaking across the public sector pension schemes is required to address age discriminatory policy legislated for by the coalition Government in 2013.

The NHS pension scheme is administered on behalf of the Department by the NHS Business Services Authority. In 2025, the NHSBSA failed to meet its McCloud delivery deadlines. In response, in July 2025, I commissioned Lisa Tennant in her capacity as chair of the NHS pensions board to carry out an independent review of the NHSBSA’s delivery of the McCloud remedy. The report from this review has been published today on www.gov.uk. Copies have been placed in the Library of the House.

The review was an extensive and forensic undertaking. It has identified and made recommendations across two broad categories of findings:

Strategic factors: including governance, leadership, organisational culture and systemic issues

Operational factors: including the operating model, operational readiness, digital and data, customer experience and change management.

Lisa Tennant’s final report makes clear that further action is required to put the NHS pension scheme on a secure footing and to prepare it for long-overdue modernisation.

Since July 2025, I have regularly met Lisa to hear her emerging findings and I have increased the Department’s oversight and support for the NHS pension scheme:

NHSBSA is now required to provide much more frequent and detailed reporting of scheme performance to the Department;

I have ensured that McCloud planning and delivery resources were increased;

I have visited the NHSBSA’s headquarters in Newcastle to see at first hand its work to strengthen delivery arrangements at the NHS pension scheme.

The NHSBSA has also acted. A dedicated new leadership team for the NHS pension scheme has been created. When the McCloud planning was largely complete, the NHSBSA team started to reassess in June how the pension scheme’s rules were being applied. They reported to the Department at the end of July that there were issues in the administration of a small proportion of members’ records, with the earliest dating back to 2008. Most of these issues built up between 2014 and today, and in a small number of cases, I regret to say that some are ongoing. As a result, while the vast majority of members are receiving the correct pension amount, some will have been entitled to more.

To establish with absolute certainty that all the affected members have been properly identified, I have this week appointed the Government Actuary’s Department to lead a comprehensive audit of the scheme’s administration. I will report back to the House on the audit’s progress and findings. A new departmental board has been established, with external and independent expertise, to oversee the NHSBSA’s implementation of the audit’s findings and its wider pensions operations. This board will meet regularly from next week, reporting to me.

Based on what we know today, around 95% of members will be unaffected. Many of those who are will already be retired and receiving a pension. The NHSBSA will continue to pay pensions promptly and reliably, and to process retirement applications.

Each member who is directly affected will be contacted personally by the NHSBSA, and I will make sure that this happens as quickly as possible. No action is needed by anyone who is a member of the NHS pension, whether working or retired. NHSBSA will ensure that information for members is available on its website and is updated regularly. Records will be corrected and, where appropriate, pension awards will be updated. Where payments or increases are due, interest will be payable.

There has rightly been much scrutiny of progress in delivering the McCloud remedy, which resulted from poor decision making by previous Governments. McCloud implementation introduced significant additional pressure on the administration of the NHS pension scheme, which was already strained, due to growth in scheme membership numbers, complexities in scheme design and an outdated technology infrastructure.

In the light of the new issues that have been uncovered, I have directed the NHSBSA to reassess the deliverability of its McCloud plans. I will continue to hold the authority to account for the delivery of the NHS pension scheme and to provide regular updates to the House, setting new statutory deadlines for McCloud when I can do so with confidence.

I am making this statement today because I want to be transparent about these concerning issues at the NHS pension scheme, and to confirm this Government’s commitment to addressing them in full. I will shortly visit the NHSBSA and will make it clear that if progress is not made at sufficient pace, I will consider what further action is required. I will keep the House updated on progress.

[HCWS307]

Health Bill (Seventeenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

Question again proposed.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. As the shadow Minister, the hon. Member for Sleaford and North Hykeham, said before the break, technology is a game changer. It is a key enabler of our 10-year health plan and a modern NHS. This new clause follows the plan’s five big bets, the transformative technologies key to NHS improvement: data to deliver impact; AI to drive patient power and productivity; genomics and predictive analytics for pre-emptive personalised care; wearables to make care real-time; and robotics to support precision. To require those diverse areas to be subject to a cohort of plans to be laid before Parliament, and to make them subject to perpetual monitoring by Parliament, would be to legislate for micromanagement. One of the priorities of tech delivery is that it needs to be agile. The new clause would inhibit that.

Parliament does not usually have a role in overseeing delivery plans for specific elements of NHS technology. Adding in new reporting structures is unnecessary bureaucracy that would slow down delivery of the technologies and their impact on patients. In some areas, we already have arrangements in place to underpin delivery, via legislation approved by Parliament. The Health and Care Act 2022, the Data (Use and Access) Act 2025 and related legislation have established a framework for mandatory information standards, which can set the technical and data requirements to ensure interoperability. Along with our 10-year plan, our ambition to be the most artificial intelligence-enabled healthcare system in the world by 2035 and our commitment to an AI road map, that means that the new clause is unnecessary. I therefore ask the hon. Member to withdraw the motion.

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

--- Later in debate ---

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

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

The new clause is a probing amendment. The aim is to press the Government to explain why the Bill does not include provisions to implement statutory regulation of NHS management, as they had said they would, and to commit to a timetable for bringing the regulations they promised into force.

I am an NHS consultant paediatrician and am regulated as such by the General Medical Council. The GMC regulates doctors, the Nursing and Midwifery Council regulates nurses and midwives, and different bodies represent other professionals in the health service—but not managers. The Government said that there would be such a register. I know that there are many excellent managers—the Minister was one—but as in every profession, bad apples need to be identified and managed appropriately.

The Times has reported that senior bosses at Leeds teaching hospital NHS trust asked consultants and nurses to work in ways that lie outside the national service recommendations. We have also heard from Donna Ockenden that of the 66 former senior staff members in Nottingham she approached, only 35 agreed to be interviewed. The former Secretary of State for Health and Social Care, the right hon. Member for Ilford North (Wes Streeting), has said that he finds it

“unconscionable that people who worked for the NHS would deny them”—

the families—

“an honest account of what went wrong”.

Establishing a register would be the first step in ensuring that bad apples can be held to account. Those who bully staff, cover up problems, endanger patients or misappropriate funds should not be allowed to fail upwards. The NHS benefits from having outside experience, including from the private sector and the armed forces, so I am looking not for full occupational licensing, but simply for a register of those who are not suitable to be appointed. We should not see managers going from one trust to another and another after they fail at the first. I should finish by declaring that I worked at Nottingham University hospitals NHS trust during late 2012 and early 2013.

[Karin Smyth]

May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.

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

Does the Minister agree that managers in the NHS sometimes get a very bad press from the medical profession? I believe that to be wholly unjustified.

[Karin Smyth]

I thank my hon. Friend and the shadow Minister for their comments about NHS managers. I agree that they often get a bad press, and often from politicians as well. We cannot run the health service without both clinically and non-clinically trained managers, so we need to ensure that they have the right support to do their difficult job. My experience is that when the partnership with clinicians works well, it is really powerful. I have certainly learned a lot from working with some fantastic clinicians in my career.

We are absolutely committed to introducing a statutory barring system. We will do that by introducing secondary legislation within this Parliament to enable the Health and Care Professions Council to operate that barring system. We intend to do so as part of the planned secondary legislation to modernise the framework that governs the Health and Care Professions Council.

Changes to this legislation are subject to a statutory three-month consultation period, in addition to which this legislation will be novel and complex. It will require extensive stakeholder engagement to ensure that we develop a barring system that is proportionate and operates efficiently alongside existing frameworks, codes of practice and other regulation governing the work of NHS senior leaders. For those reasons, a 12-month timeline to bring forward the section 60 order is unfeasible. The new clause also sets out prescriptive duties on the content of the section 60 order; we would not wish to pre-empt the outcome of detailed policy development and consultation.

I welcome the support of the hon. Member for Sleaford and North Hykeham for the broad programme of initiatives to professionalise and increase the accountability of managers and leaders in the NHS. Although we do not agree that it would be proportionate to set a requirement in primary legislation to lay before Parliament a timetable to which those measures will be delivered, officials in the Department of Health and Social Care and in NHS England are already working in partnership with organisations across the health sector and will set out more on the individual timelines in due course. For those reasons, I ask the hon. Member to withdraw her new clause.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 52

Access to dental provision: Dental deserts

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (‘the Scheme’).

(2) The purpose of the scheme is to end dental deserts.

(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.

(4) The scheme must make provision to support integrated care boards to—

(a) guarantee emergency access to an NHS dentist,

(b) provide free dental checks up for—

(i) children,

(ii) mothers within one year of having given birth,

(iii) pregnant women, and

(iv) low-income households, and

(c) guarantee dental appointments for persons commencing—

(i) surgery,

(ii) chemotherapy, or

(iii) transplant procedures.

(5) The Secretary of State must, before publishing the scheme, issue a reformed dental contract.

(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”—(Helen Morgan.)

This new clause would establish a scheme to support integrated care boards to end dental deserts.

Brought up, and read the First time.

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

--- Later in debate ---

[Dr Johnson]

I rise to discuss new clause 104, which stands in my name. The Labour Government’s general election manifesto made a bold pledge:

“Never again will women’s health be neglected.”

The Government have been in power for two years, and I am not convinced that they are doing all they can for women’s health. The latest NHS statistics show that waiting lists are rising under this Government. The trend is particularly acute for gynaecology services. More women are awaiting admission to hospital for gynaecology treatment or procedures than in July 2024. How does that square with the Government’s ambition to improve and prioritise women’s health?

We talked this morning about fracture liaison services, which is another treatment that would predominantly have benefited women if the Government had kept their promise and rolled it out as they said they would. The previous Conservative Government commissioned the Hughes report. The Labour Government have repeatedly pledged to address the issue at the earliest opportunity, but when will the Minister respond to the women who have been waiting so long? The Government published their renewed women’s health strategy in April, but where are the timelines, steps and milestones to deliver and implement improvements to women’s health? Where is the plan to reduce gynaecology waiting lists? Where is the timetable for delivering on long-acting reversible contraceptives, for example?

I have no doubt that the Minister has a desire to improve outcomes for women and improve their care, but I am concerned about the actual delivery, which has been a theme throughout the day. I tabled new clause 104 because this Labour Government have made promises to women that they need to keep, and that they need a plan for how they will keep them. My new clause would ensure that they have a plan to deliver, rather than just making promises in glossy brochures.

[Karin Smyth]

Hon. Members have brought to the Committee a really important discussion about women’s health. I am very happy to have that discussion, because the Government are committed to prioritising women’s health. That is why I am so proud that we published a renewed women’s health strategy earlier this year.

I say in response to the Liberal Democrat spokeswoman, the hon. Member for North Shropshire, that we renewed the strategy partly because—to be absolutely fair to the Conservative party—we agreed with much of what it put in place under its women’s health strategy. We did not see the need to start it from scratch, so to speak. There had not been a men’s health strategy, so they are very different propositions.

Much of the direction had been covered, but the implementation had not. On the point made by the hon. Member for Sleaford and North Hykeham, we wanted to go further and faster and acknowledge some things, as the former Secretary of State did, about medical misogyny, as well as the need to renew that strategy.

I fully agree with new clause 57 that women should get equal access to high-quality elective care. We are committed to tackling the long waits for services primarily affecting women; I am acutely aware that women can wait disproportionately longer for a wide range of treatments, although none solely impacts women more than gynaecology services. The Government recognise that injustice. That is why we have implemented measures to improve gynaecology services and women’s access to care, including piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding, increasing the relative funding available to incentivise providers to take on more gynaecology procedures, and using surgical hubs to help endometriosis patients to get quicker treatment. Those measures have helped to improve 18-week referral-to-treatment times for gynaecology by 5.1 percentage points over the past year.

We will go further over the course of this Parliament, including by launching NHS Online clinical services from 2027. That will initially prioritise nine conditions, including women’s health conditions such as severe menopause symptoms and menstrual problems that may be a sign of endometriosis or fibroids. Patients will have the choice of getting the specialist care they need from home, and we will provide additional appointments to reduce waiting times.

More broadly, we have committed to returning to the NHS constitutional standard by March 2029 so that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment across all patient groups and specialties. Delivering against this standard would also require the waiting times for a diagnostic test to improve significantly. We recognise that, which is why in the medium-term planning framework, the NHS target is to ensure that by March 2029 no more than 1% of patients are waiting more than six weeks for a diagnostic test.

On new clause 58, we acknowledge that women’s health has been neglected and that women deserve better. We acknowledge that there have been longstanding failings in women’s health outcomes, experiences and access to care. That is why we published the renewed women’s health strategy, making it clear that women’s voices and choices are central in healthcare. We will transform NHS performance in the services that matter most to women, support all women to live healthy, prosperous lives, and create an approach to research and development that works for and empowers women.

Reducing inequalities is hardwired throughout the strategy. Actions are targeted by deprivation, ethnicity and unmet need, with a focus on marginalised women, community-based services, neighbourhood health models, and transparent data. The renewed women’s health strategy marks a decisive shift from identifying problems to delivering change. By listening to women’s voices, improving performance where it matters most, and tackling the drivers of poor health and inequality, we will ensure that women and girls receive the care, respect and outcomes they deserve. As a result, we do not think that conducting an independent inquiry into women’s health provisions and outcomes in England at this time would add value. Instead, now is the time to deliver the change that we all know and agree is absolutely needed.

I recognise the intention behind new clause 104, but I do not believe that it is necessary to publish an implementation plan. The action summary tables in the renewed women’s health strategy clearly highlight the responsible delivery organisation and the planned timeframe for all 117 actions. Some actions are already under way or funded for this year; others will be delivered over the next two to five years, and more fundamental reforms will be phased in over the next decade, aligned with the 10-year health plan.

Progress in the renewed strategy will be judged against three overarching outcomes: reversing the decline in healthy life expectancy since the 2010s, raising healthy life expectancy in the poorest regions to at least 61 years, and reducing the time women spend in poor health, particularly where inequalities are greatest—something I see very starkly in my Bristol South constituency. We will also be transparent on progress through a new women’s health data dashboard, publishing neighbourhood-level data on performance, access, outcomes and experience.

This Government have already undertaken extensive engagement to inform the development of the strategy. We had nearly 100,000 responses to the 2022 women’s health strategy call for evidence, more than 400 submissions from individuals and organisations with expertise in women’s health, and analysis from the Change NHS engagement exercise, where roundtables brought together women with lived experience, clinicians, academics and expert organisations. I was part of some of those roundtables and it was very instructive. I thank them for the work they did to get us to this point. We will continue to engage and to listen to women through the new women’s voices partnership and through patient-reported experience and outcome measures, which will help to shape and improve services.

Creating a new statutory duty to publish an implementation plan risks diverting attention and resources away from delivering the actions in the renewed strategy, which should now be our priority. It is for those reasons that I ask hon. Members not to press their new clauses.

--- Later in debate ---

[Karin Smyth]

Usually, I say that I am grateful that a discussion has been brought before the Committee and that I am happy to have it, but it is unusual to have a discussion on a clinical trial in a political environment. I stand to be corrected, but I do not think that there has ever been a clinical trial subject to a parliamentary vote. There has been an Opposition day debate about this, in which many issues were rightly aired, so we will not spend much time discussing it this afternoon.

The safety and wellbeing of children and young people is paramount. Children’s healthcare must always be led by evidence and expert scientific and clinical advice. We all know that that was not the case in some of the instances at the Tavistock over time, in the late 2010s. We pay tribute, as we have done several times, to the then right hon. Member for Bromsgrove when he was Secretary of State for Health—in 2022, he finally took action on that particular service and what went on there, commissioning Dr Hilary Cass’s review, which we supported on a cross-party basis, for the health, safety and wellbeing of children. Hilary Cass’s interim review in 2022—which bears reading, for those who have not read it recently—found the evidence for the service model and the clinical base to be woefully lacking. In the 2010s, that was allowed to continue for a long time, but fortunately started to be stopped in 2022.

Ever since, we have had cross-party agreement in support of Dr Cass’s review. She found that the evidence on the use of puberty-supressing hormones for children and young people for treatment of gender incongruence is “remarkably weak”. Based on the available evidence, NHS England introduced a new clinical policy in March 2024 that means that puberty-suppressing hormones are no longer available routinely in the NHS for children and young people with gender incongruence. In December 2024, for non-NHS prescriptions, the Government introduced an indefinite ban on the sale and supply of puberty-suppressing hormones to children and young people for the purpose of gender dysphoria or incongruence. That followed independent advice from the Commission on Human Medicines.

Clinical practice should be based on evidence. When evidence is lacking, clinical research takes place to improve the evidence base. That is why, to properly understand the impact of puberty-suppressing hormones to treat gender incongruence, the Cass review recommended a clinical trial. In line with the Cass review’s recommendation, a trial has been developed and has now secured updated study approvals from the MHRA and the Health Research Authority.

This country has a well-deserved international reputation for academic and scientific excellence, with robust independent regulatory processes in place to properly scrutinise and assure the scientific rigour and ethics of publicly funded clinical trials. That helps to ensure that individuals receive evidence-based care, based on the highest quality research, regardless of their clinical diagnosis. I therefore disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, clinical trials for those types of medicines must be subject to the scrutiny and approval of both Houses.

[Dr Johnson]

A couple of points. Does the Minister recognise that the cancel culture associated with much of the work in this area, and in looking after those vulnerable groups of children, means that the tendency among those who get involved is to have a particular view? How has she worked to ensure no bias among those on the committee involved in producing the trial? Does she recognise that by choosing a cohort of children—226 of them—to do this experiment on, she is selecting a group of children of whom most will have a gender incongruence that will get better by itself? There are two effects of that. First, these children will have unnecessary treatment. Secondly, even if there were in theory a benefit to the small group of children who would have persisted in a trans identity, that would affect the reliability of the results; therefore, whatever the results, people would think them unreliable.

[Karin Smyth]

I think that was yet another addition to the hon. Lady’s speech. Initially, she asked whether I recognised the cancel culture in this area. I have already alluded to, absolutely, recognising that what occurred in the 2010s at the Tavistock and around was not acceptable. Under the stewardship of the Conservative party of the NHS and so on, it took until 2022 to start rectifying that situation in order to give good treatment to children and young people. She is herself a clinician, so I am somewhat surprised at her. Noting what I set out, I am surprised that she does not recognise that a clinical trial has never—I stand to be corrected—been subject to a vote in Parliament, whereby politicians who are not experts have a say; but we can come back to that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I am going to move on.

Noting what I have set out, having such a vote would set an uncomfortable precedent that would be likely to significantly compromise the value and reputation of UK research, as well as creating an inequity unique to individuals with gender incongruence or gender dysphoria. For those reasons, I ask the hon. Lady to withdraw the new clause.

[Dr Johnson]

I am not aware of any clinical trial that has provided potentially extremely harmful medication to children who have a self-limiting issue and who are physically healthy, to change their physically healthy bodies by changing puberty or anything else to a physiologically abnormal state from a physiologically normal one. These are children going through normal, physically healthy puberty. Their normal puberty is being stopped. I think the trial is badly designed, and I wish to press the new clause to a vote.

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

--- Later in debate ---

[Gregory Stafford]

Unlike that of the hon. Member for Guildford, my constituency covers both Surrey and East Hampshire, so I welcome the focus that new clause 72 places on our local area. Constituents regularly raise with me their concerns about seeing an NHS dentist. As I have announced a number of times in this Committee—although I have not checked today, so may not be true any more—there is not a single dentist in my constituency taking on adult or child NHS patients at the moment.

For many people, the challenge is not simply one of convenience; it is about being able to access timely care when they need it. Good oral health is an essential part of overall health, and we cannot allow dentistry to become an afterthought in our healthcare system. The ability see a dentist for routine check-ups, preventive care and urgent treatment helps to reduce pressure elsewhere in the NHS by dealing with problems before they become more serious.

The new clause rightly highlights the need both for urgent appointments and for improved access to routine NHS dental care. Prevention is at the heart of a sustainable healthcare system, and regular access to dental services plays an important role in achieving that. I welcome the accountability that the new clause seeks to introduce. In places where there are persistent challenges in accessing services—so-called dental deserts—local communities deserve transparency about what action is being taken and why improvements have not yet been delivered. As I have mentioned before, the spanking new dental surgery in Haslemere hospital has sat entirely unused since it was built, and, as far as I am aware, there are no plans to use it. That seems like a shocking waste of money and, more importantly, a shocking waste of a dental surgery that could be treating patients in Haslemere and the wider area.

The hon. Member for North Shropshire always wants to place the blame with the Conservatives, and does not seem to feel the need to challenge the Government, but I gently remind her that there was a Liberal Democrat Minister in the Department of Health and Social Care for five years, and apparently they did absolutely nothing to raise this issue.

Although this issue is particularly important for Surrey and East Hampshire, it reflects a wider challenge facing communities across the country. Residents should not have to struggle to find an NHS dentist, and ensuring that provision is adequate must remain a priority. I hope the Government take that on board.

[Karin Smyth]

Welcome to another rerun of the 2010s —happier times for the Opposition. Sometimes they do not remember what happened, and I have to remind them—and every now and then, they remind us. This is a really important issue, not only for the hon. Member for Guildford, who tabled new clause 72, and the hon. Member for North Shropshire, who moved it, but for all our constituencies. It has been a huge priority for this Government.

The Secretary of State will continue to have a duty to promote a comprehensive health service in England. In addition, clause 4 provides for an amended duty for the Secretary of State to reduce inequalities in access to services across England. However, we also recognise that practical action is needed to secure access to urgent and routine NHS dentistry care. As the Committee has discussed, that is why the Government have prioritised a number of improvements over the past two years.

Last year, ICBs commissioned additional urgent dental care appointments, and there is now an urgent care safety net across the country. In April 2026, we introduced a requirement for NHS dental practices across England to deliver a set proportion of their contract as urgent care. Supported by increased payments for dentists delivering that care, that made it easier for patients to get prompt support through the NHS. We are committed to reforming the NHS dental contract by the end of this Parliament—something that could have been done at any point in the past 14 years. As a first step, the package of reforms we introduced earlier this year will address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will help to prioritise those with the greatest need, supporting a shift away from clinically unnecessary check-ups.

The Government are already making progress on improving access to NHS dentistry across England, including in Surrey and East Hampshire. I hope that hon. Members can see how legislating for one area in particular conflicts with the Secretary of State’s duties to promote a comprehensive health service for England as a whole, and risks creating health inequalities in other regions. For that reason, I ask that the hon. Member for North Shropshire withdraw the new clause.

[Helen Morgan]

My hon. Friend the Member for Guildford has specifically requested that I press the new clause to a vote because she feels so strongly about the issues in her area.

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

--- Later in debate ---

[Helen Morgan]

It is really important not to blame people who have seen convincing information online or have been given convincing information by people who ought to know better—including at political party conferences. We need to battle the source of that information and ensure that accurate, factual information is available and communicated to everyone in an accessible way by people they trust. That is key to all this. As I have said before, ostracising or ridiculing people who have been given information in a very convincing way is not the way to resolve this problem. We need to tackle it in an understanding way by communicating the facts sympathetically and accessibly.

It is important to note that concerns about vaccinations are not exclusive to a single group of voters. There is significant vaccine hesitancy across some ethnic minority communities and in hard-to-reach places across the country. We must do more to support doctors, nurses and the NHS to fight fiction with facts, or the long-term health of the country will suffer. That is what new clause 77 seeks to do. There is some great local work being done, but there needs to be a joined-up strategy to combat all aspects of disinformation, because a nice social media video telling people to get their jab will not beat it.

Now that Reform UK has a greater presence in our local government, NHS leaders will have to handle more and more difficult conversations with anti-vax and conspiracy theorist councillors, and they deserve support to engage with those people effectively and constructively. The proposed strategy would provide just that. It would have to consider

“support for medical professionals to build trust and engage with persons who are anti-vaccine…investment in public messaging to combat medical disinformation, including engagement with trusted online influencers…outreach campaigns focused on communities that are sceptical about vaccinations…introducing criminal liability for those, including online influencers and politicians, who profit from medical disinformation, and…a new verification requirement for any social media account claiming to be a medical professional.”

We must do more systematically to protect the NHS and our nation’s health from the growing threats of medical misinformation. We urge the Government to give this issue the focus it needs, and we hope that they consider this new clause one way to do that.

[Karin Smyth]

The hon. Member has brought up an important topic. The Government absolutely recognise that inaccurate information can undermine confidence in vaccines, which are so important. We are already taking a multi-pronged approach to addressing that through national communications, support for healthcare professionals and the ongoing monitoring of emerging narratives.

The evidence is clear that, although it is a risk, misinformation is not a primary cause for people not to take up the offer of vaccinations. Rather, practical barriers such as access to services, socioeconomic factors and levels of awareness play a more significant role. We are already acting to reduce those barriers, with targeted action to improve access, strengthen communications and support frontline staff. A new statutory strategy focused solely on disinformation would risk narrowing our approach when a broader, evidence-led response is required.

For those reasons, we do not consider the new clause to be the right approach. I recognise much of what the hon. Member says about access to information, but we want to maintain a wider approach. On that basis, I respectfully ask her to withdraw the new clause.

--- Later in debate ---

[Gregory Stafford]

Hopefully, this is a pleasure postponed. I rise to support new clauses 81 and 82, tabled by my hon. Friend the Member for Sleaford and North Hykeham. As legislators, we have a moral duty to ensure that patients are protected during times of disruption in the NHS. Nobody disputes the fact that NHS staff work incredibly hard. They absolutely do. The dedication shown by doctors, nurses, paramedics, midwives and all those who keep our health service running deserves enormous respect. Having worked in healthcare for pretty much all my career, including for professional organisations such as the Royal College of Occupational Therapists, I know at first hand how hard they work.

Equally, we need to recognise that the NHS is not an ordinary service. Working for it is not like being a shop assistant, a bin collector or a tax inspector; in its importance to the health and safety of this nation, it is more akin to being a police officer or a member of our armed forces. It is an essential public service. When people are at their most vulnerable, whether that is because they are waiting for an operation, procedure or intervention or because they are in the process of having those interventions, they must have confidence that the care they rely on will still be there.

The right to strike has to come with responsibilities. In the NHS, the consequences of industrial action are real: cancelled operations, delayed treatments, missed appointments and increased pressure on emergency services. When I raised some of these issues with Sir Jim Mackey when he appeared before the Health and Social Care Committee, he could not tell me, hand on heart, that people have not died because of these strikes. I suspect that they probably have. For patients awaiting cancer treatment, for someone requiring urgent surgery or for families relying on maternity services, the impact can be deeply serious and potentially even deadly.

There is a moral obligation, both on NHS doctors and on us as legislators, to ensure that we have a universal, 24-hour, seven-day-a-week service that is free at the point of use that patients can and should expect to rely on. I therefore support new clause 81’s minimum service requirements and new clause 2’s the removal of clinicians’ ability to strike. We must ensure that our NHS staff are supported, protected, paid appropriately and given the resources they need to do their job, but the corollary is that they should remain on the job to serve our constituents.

[Karin Smyth]

There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it.

I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result.

I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—

[Dr Prinsley]

A fine vintage.

[Karin Smyth]

Indeed. They wanted to work with resident doctors to talk through a way to make progress without resorting to strike action, because that is a sign of failure in any system.

On new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. We want to create an industrial relations framework that is fit for a modern economy, and workplaces that work for everyone. That is why the Employment Rights Act 2025 repealed the Strikes (Minimum Service Level) Act 2023. The previous legislation created a hostile environment, which was not conducive to good partnership working with trade unions or to settling disputes.

On new clause 82, although strikes are hugely disruptive, a ban on a doctor’s right to strike is not the answer.

[Dave Robertson (Lichfield) (Lab)]

As I am sure the Minister knows, I have been a trade unionist since I started my teaching career some years ago. I have been involved in a number of industrial actions over that time, as a teacher and member of a trade union and as a trade union staffer. The driving force behind a significant majority of those industrial actions was not pay; it was often the safety of staff, the safety of sites, bullying managers or the inability to deliver an environment in which members felt they could deliver their best. Does the Minister agree that the ability to take industrial action is not always about money-grubbing or about pay? It is often about health and safety and about delivering the very best workplaces for our workers.

[Karin Smyth]

I thank my hon. Friend for bringing his experience to bear on this matter. I absolutely agree. New clause 82 stems from that resident doctors dispute. One of the first things that we did was to agree the 10-point plan with regard to the management in trusts. I have said before how truly shocking the working conditions are in many trusts not just for resident doctors, but for other doctors and professionals. There is no ability to take a break, have a rest or get away. Some of the equipment that they are dealing with is also shocking, as are the levels of the estate. Those are some of the many things that have driven and continue to drive poor industrial relations, along with the fact that there is no one to speak up for them.

[Dr Johnson]

The Minister says that if doctors want to go on strike, that is a failure of the system. The consultants have just balloted to go on strike. What failure in the system does she think has caused that?

[Karin Smyth]

I think I said that it is a failure of representatives on both the management side and the union side to agree a solution. That is what I meant by a failure of the system. Ultimately, strike action, as my hon. Friend the Member for Lichfield would attest, is a sign of the failure of good, conducive relationships and partnership working. That is why we never want to see it.

--- Later in debate ---

[Dr Johnson]

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

In their final months in office, the last Labour Government introduced the Equality Act 2010. That consolidated several pieces of anti-discrimination legislation, which was welcome, but it also introduced a new public sector equality duty, requiring public authorities to have “due regard” to preventing unlawful discrimination and fostering equality of opportunity between groups. The public sector equality duty also requires authorities

“to…encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionately low.”

Unfortunately, that has become a vehicle for social engineering. It was designed, I believe, to improve equality of opportunity, but it is being used to gerrymander equality of outcome instead. That can mean discrimination—against different groups of people, but discrimination nevertheless.

That is clinically objectionable, because it means that health and social care staff may be recruited for reasons other than their clinical abilities, which are what we need and are most important. We have parts of the health service spending their time working on cultural learning classes and pushing paper around, rather than on patient care.

We must get the health service back to basic healthcare, ensuring that it delivers the very best healthcare, free at the point of use, to all individuals based on their clinical need, not their ability to pay. We need to focus on clinical need and the best possible staff, not on trying to gerrymander some sort of social engineering.

[Karin Smyth]

With new clause 83, I think the hon. Member for Sleaford and North Hykeham would like to exempt organisations that receive public funding to provide health and social care services from the public sector equality duty. I do not agree with the intent of this measure.

The duty under the Equality Act 2010 was designed to ensure that public authorities

“have due regard to the need to…eliminate discrimination…advance equality of opportunity”

and

“foster good relations”

in the exercise of their functions. That includes when designing and delivering services. It is not an unnecessary addition but part of good service design and delivery.

The duty is not there to dictate a particular outcome or set of priorities for the decision maker; it is there to help decision makers understand and take account of the consequences of their choices. It ensures that issues of discrimination, equality of opportunity and good relations between different groups of people are not overlooked during complex decision making. That is why it is important for publicly funded providers of health and social care to have due regard to the duty.

The public sector equality duty should always be applied in a proportionate way. It should not create an administrative burden. If a provider of health and social care is taking a decision that has little or no consequence to equality outcomes, it needs only to note that. It is for that reason that I ask the hon. Member to withdraw her new clause.

--- Later in debate ---

[Karin Smyth]

I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee again today. The safety recommendations are an important mechanism for improving services and securing better outcomes for patients. We support the aim of bringing greater clarity to the recommendations landscape, and we are already taking forward work in this area.

The Dash review of patient safety across the health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost-benefit analysis, which is why the 10-year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the national quality board. In line with the Dash review, work is progressing on a recommendations hub that will sit within the Department.

The hub will include a repository to hold all national-level recommendations relevant to care quality, including safety, effectiveness and patient experience. It will provide an efficient system for co-ordinating, prioritising and overseeing recommendations made by the national quality board. The hub will record responsibility for implementing prioritised recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, which is something I think we all welcome. This new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes.

Where reviews or reports commissioned by the Secretary of State make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within the overall co-ordination retained by the Department. Our existing plans meet the intention behind new clause 85; in fact, they go further by prioritising national-level recommendations for the NHS in a proportionate way, without being bound to specific timescales. They will provide the greater clarity that the new clause seeks without the need for legislation.

On the specific question, I am sorry to disappoint the many campaigners on this issue and Opposition Members by saying that we will not be announcing anything in the next two hours, but the point has been well made. I responded to a Westminster Hall debate myself, and the Minister responsible for patient safety has previously responded to the commissioner and made public the work that the Government are doing. Due to the cross-Government nature of the work, we cannot give exact timelines.

We have heard the calls for clarity, speed and decisive action, and we have committed to setting this out at the earliest opportunity. I have not had a chance to speak directly with my right hon. Friend the Member for Makerfield about this issue, but I am sure many conversations on many subjects will be coming our way soon. As both my right hon. Friend and the Prime Minister made clear during Tuesday night’s debate on the Hillsborough law, redress and patient trust are important aspects of rebuilding the confidence of the public and those who have been wronged in all parts of the state. We are committed to getting this out as soon as is credibly possible. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

[Dr Johnson]

The new clauses ask the Government to respond to recommendations on patient safety, and to say within six months whether they will implement them. As I said, we have been waiting several years for the Hughes report response. All new clause 98 would require is that the Secretary of State must, within 30 days of the Bill’s passage, publish the Government’s response to the report. That, in itself, is not immediately soon; it is 30 days after the Bill is passed, and it is still yet to go through the Lords and return to the Commons. The new clause would effectively provide a backstop or legal end date—it is still too far away—after which the Government cannot go any further. I will be very disappointed if the Government are not prepared to do that, so I would like to press the new clause to a vote. These people have waited long enough.

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

--- Later in debate ---

[Dr Johnson]

If they are, they can use the advice and guidance service. The point is that when a general practitioner wants to refer his or her patient to a consultant on the basis of their clinical need, they should be able to. That is the purpose of the new clause.

[Karin Smyth]

As someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion while everybody else watches us for the next hour and a half, but I am not going to do that.

Some interesting points have been raised. To add my two pennies’ worth to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, the change in practice is partly due to increased specialism among consultants, which makes it harder to refer. When we set up a referral management service in Bristol, two issues were the pressure on general practice and the use of locums, who were perhaps working temporarily in the area and did not know the full range of available community services. That was some 12 years ago, so greater support on advice and guidance is long overdue as we roll this out.

At the end of the day, the aim is to support patients getting the right clinical care in the right place as fast as possible. We want patients to have timely assessment of their care needs and clear next steps in the right settings. GP referrals and support for GPs in making those referrals is crucial.

The advice and guidance model, which allows GPs to seek rapid specialist input into a patient’s care without an initial face-to-face appointment, and the single point of access model, which will be rolled out in October, support GPs and hospital specialists to work together and make the best treatment plans for patients while reducing unnecessary referrals and increasing waiting lists.

Trusts and integrated care boards must ensure that local GPs, GP leaders, local medical committees and interface groups are involved in the design and ongoing refinement of elective single point of access pathways. In my experience, that is important because we gain their expertise and there is more buy-in to making the pathways a routine part of their work. Advice and guidance is already a routine part of much GP practice. GPs continue to be able to make clinical decisions to refer for specialist care where that is in the patient’s best interests. Advice and guidance and the single point of access do not alter the clinical threshold for a referral, and a GP’s clinical decision to refer remains unchanged. All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight.

We are clear that GPs should continue to make a clinical decision to refer to specialist care where that is in the patient’s best interests. The model is intended to support decision making, not override it. To be clear to the hon. Member for Sleaford and North Hykeham, the intention was never to mandate. There is a difference, which I think was made clear in subsequent guidance on the system. The diversion rate, as she calls it, is an estimate of the potential of patients who are not referred to the right place in the first place. It is not compulsory. What the new clause proposes already exists and does not need to be set out in primary legislation. For those reasons, I ask her to withdraw it.

[Dr Johnson]

If the hon. Lady is correct, she will not be perturbed by the new clause, which simply says that general practitioners must be able to directly refer patients to consultants when clinical need requires it. I would like to press the new clause to a vote.

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

--- Later in debate ---

[Dr Johnson]

New clause 87 would amend the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. Prioritising British students in the selection process would have been the right thing for the Government to do, but way the Medical Training Act has been drafted places British students who studied at international branch campuses of British universities at a disadvantage.

On Second Reading of the Act, a Member spoke of a constituent who had been given

“a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus.”—[Official Report, 27 January 2026; Vol. 779, c. 801.]

Another Member said that he had

“representations from all quarters, both in the UK and in Malta, about the impact on Malta of this.”—[Official Report, 27 January 2026; Vol. 779, c. 802.]

My right hon. Friend the Member for South West Wiltshire (Dr Murrison) asked about

“British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service”. —[Official Report, 27 January 2026; Vol. 779, c. 803.]

The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke of a constituent who was schooled and grew up here and was

“given a guarantee by the university that she would face no disadvantage compared with students on the London campus.”—[Official Report, 27 January 2026; Vol. 779, c. 842.]

These concerns are shared across the House.

Young British people who have trained at a British or London-based university and gone to study in Malta, perhaps in an adventurous spirit—it is a beautiful place to go—and have graduated with a British degree have found themselves at the back of the queue, unable, round after round, to get jobs in the foundation programme in their home country. That will not just be the case for students who are due to start their degree; it is the case for students who have just completed their degree. They have done the five years of training, they have worked really hard and they have passed their exams, but suddenly they cannot get a job on the foundation scheme in their home country to complete their full registration with the General Medical Council.

Our new clause would ensure that British citizens who studied at international branch campuses of UK higher education institutions can be prioritised. I invite Members to do right by our constituents and the NHS and to vote for it.

[Karin Smyth]

I appreciate the intention behind new clause 87, but the Government cannot support it. The Medical Training (Prioritisation) Act is designed to support a sustainable medical workforce that can meet population health needs and deliver the best patient care while reducing the UK’s reliance on an unpredictable international labour market. By creating a clear pathway for medical school to speciality training, we also strengthen domestic talent and improve retention.

What matters is where a doctor is trained, not where they were born. Data shows that domestic graduates are more likely to stay in the country they trained in than those trained internationally. Doctors trained primarily in the UK are also likely to be better equipped to deliver healthcare that is tailored to the UK’s population, because they have a stronger understanding of UK-specific epidemiology and NHS practice.

In addition, the Government set UK medical school places based on future health system needs. Student intakes and graduate outputs of overseas campuses are not included in our domestic workforce planning. If we prioritised British citizens for foundation training regardless of where they studied, it would undermine our aim to build UK-trained capacity while ensuring that we do not provide more foundation programme places than we need.

I would like to emphasise—this is an important point—that prioritisation does not mean exclusion. Non-prioritised applicants can still apply for the foundation programme and will be offered places if vacancies remain after prioritised applicants have received offers—I understand that is already happening for the 2026 recruitment round. For individuals who do not secure a foundation post this year, there remain alternative routes to pursuing a medical career in the UK. Those include obtaining GMC registration through the established pathways, such as completing an approved internship in the country where they trained and entering the UK healthcare system through a locally employed doctor role or other non-training posts. I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clauses.

--- Later in debate ---

[Joe Robertson]

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

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

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

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

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

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

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

[Karin Smyth]

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

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

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

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

[Joe Robertson]

I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 97

Publication of annual dementia care report

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

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

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

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

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

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

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

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

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

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

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

(g) dementia research activity in the NHS.

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

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

Brought up, and read the First time.

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

--- Later in debate ---

[Dr Johnson]

It would amend the relevant part of the Medical Training (Prioritisation) Act 2026, so that when people are put forward for these jobs in the foundation programme, it should be done on the basis of merit. At the moment, as the hon. Member is aware, it is done on the basis of random allocation—preference-informed allocation—which I think is wrong. I would be interested to know the Minister’s thoughts on the subject.

[Karin Smyth]

This is an area of some discussion, some of which we have heard, but we do not think it is necessary, where we are now, to put such a measure in primary legislation. The Medical Training (Prioritisation) Act establishes a statutory process for prioritising certain groups for training posts; it is not intended to change eligibility for training or the high standards that applicants must meet. Embedding some of these provisions in primary legislation would leave them inflexible to future workforce needs or standards of education and training. If Parliament wishes to change how recruitment processes themselves operate, that is best done outside legislation through established routes.

The preference-informed allocation system was introduced in 2024 following stakeholder engagement, because the previous system was felt to be unfair and stressful for applicants, with a lack of standardisation across schools. Since its introduction, as I understand it, 82% of applicants have been allocated their first choice of foundation school this year, up from 71% in 2023. NHS England has committed to a review of the system, which will commence later this year. Prescribing the allocation method in legislation would pre-empt that review and limit our ability to make future changes to ensure that the system remains fit for purpose. On that basis, I ask the shadow Minister to withdraw the new clause.

[Dr Johnson]

The new clause deliberately says that applicants would be prioritised based on merit, and it gives examples of ways in which merit might be judged. I understand what the Minister says about some people getting the job of their choice, but the people who do not have no control over the process, and no ability to influence it through their own hard work and effort. That is fundamentally wrong in principle. Although I recognise that the current method was brought in as a result of consultation, I feel confident that the same consultation, done now, would reject it. We would like to vote on the new clause.

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

--- Later in debate ---

[Dr Johnson]

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

During a Westminster Hall debate in December, a Government Minister said:

“In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan”.—[Official Report, 4 December 2025; Vol. 776, c. 472WH.]

We are now in the second half of 2026. Members may be familiar with the charity Headway UK, which does phenomenal work to support people affected by brain injury, including people in my constituency. Headway has called for the Government to treat the plan as a priority, reiterating that every delay has real consequences and that survivors need support now. The all-party parliamentary group for acquired brain injury, which the hon. Member for Blaydon and Consett has done a great deal to support, has called for the Government to take action.

So why is action not forthcoming? Why have the Government failed to deliver another policy on time? It is part of a pattern. The Government spent a year writing a 10-year plan. They spent another year working on a workforce plan, which still has not been published. It is simultaneously “imminent” as of 30 days ago and non-existent today. They are behind on the Hughes report, the modern service frameworks, universal 24/7 mechanical thrombectomy, fracture liaison services and more.

The new clause would simply commit the Government to delivering on their promise to the 1 million people living with the effects of acquired brain injury. I struggle to see how the Assistant Whip can compel Members to vote against that.

[Karin Smyth]

I think all Committee members can recognise the importance of this issue. An acquired brain injury is a life-changing event for those affected, and for their families and loved ones. Its treatment involves co-ordination between primary, community, secondary and specialist care, and is personalised to the needs and life circumstances of the individual. Its effects are not limited to a person’s health: it can impact their journey through education, their employment prospects and so many other aspects of life. Because of that, they rightly expect coherent, joined-up support from across Government.

Therefore, as we have discussed, we are working in partnership with eight other Government Departments, ABI charities, patient representatives and the NHS to develop an ABI action plan. We also continue to work closely with the United Kingdom Acquired Brain Injury Forum, which is the umbrella organisation for brain injury charities, as the plan develops and moves towards publication.

[Liz Twist (Blaydon and Consett) (Lab)]

I am glad to hear that work is going on, but as the Minister may remember, work has been going on for a very long time—some Opposition Members may remember that past work. The issue is clearly important to people, so we need to see action—again, it is about how we get to that end. I would like to see some commitment from the Government. I recognise that the Minister is not in charge of the acquired brain injury strategy, but could she help us by referring the issue to the relevant Minister for an urgent discussion?

[Karin Smyth]

I thank my hon. Friend for her work on and commitment to this issue, as was highlighted by the shadow Minister. I thank her also for her work on the APPG and with organisations such as Headway, to which we pay tribute for its work supporting patients and the public, and for her work with Members of Parliament and the Government on getting this right, which is legion. My hon. Friend has made similar comments in the House. The Minister responsible is continuing to work on the action plan, which I will talk about as we continue our consideration.

The new clause raises the issues of prevention, identification, acute treatment, rehabilitation, long-term support, care planning, workforce capability, data and research, all of which are being considered in the work being done across the eight Departments. The Government agree that there should be a plan, and the relevant Minister, to whom I will of course pass my hon. Friend’s comments, will be working on that.

The question is whether the proposals in the new clause are best placed to ensure that any plan will be robust, sustainable and timely for the patients it is designed to serve. I say gently to the shadow Minister that I think they are not. First, setting an arbitrary 30-day timeline for publication risks causing either an unnecessary delay or a duplicate plan. Secondly, as I hope she will appreciate, we have engaged more widely than with just the three Departments named in the new clause. As I have said, as many as eight Departments are contributing, which reflects the wide range of areas that are impacted by brain injury.

Let me give the shadow Minister the assurance that I believe she is seeking, as are others: a plan will be published as soon as possible. That plan is being developed with the breadth, rigor and pace that the issue demands and is receiving input from across the health system, as well as from other Departments responsible for supporting people with acquired brain injuries and sector-specific stakeholders and organisations. I hope that she will work with us to support the plan once it is published, in the interests of our constituents, who desperately require a new approach to ABI prevention, care and support. I ask her to withdraw the new clause.

[Dr Johnson]

The Minister said that the plan is being developed with the pace that is needed, but it is not. It was due to have been published already, but it has not been. It was due to have been published, then a later promise was made, and now she is making another promise with an uncertain date. I just do not think it is good enough. A theme of our consideration this afternoon has been all the different things the Government have promised but have failed to deliver.

--- Later in debate ---

[Karin Smyth]

On new clause 105, I can assure the hon. Lady that the Government are committed to supporting self-care. Community pharmacies already play a vital role by offering accessible advice and, where appropriate, over-the-counter medicines for minor ailments. Through Pharmacy First, patients can walk into a pharmacy or be referred by NHS 111, a GP or A&E for expert support, including access to treatment under the seven clinical pathways. That helps people get the right care quickly while easing pressures on other parts of the NHS.

However, we do not think that it is necessary to specify health literacy and self-care in neighbourhood health plans. The neighbourhood health framework is clear that ICBs and local authorities should work together through health and wellbeing boards to develop locally led neighbourhood plans to improve local population health and reduce health inequalities. The framework sets out what should be included in those plans, and is clear that neighbourhood health plans should be informed by local joint strategic needs assessments.

If local areas think they would benefit from having a greater focus on self-care and health literacy, they are of course free to do so. However, that is for them to decide, based on their understanding of the local area’s needs. That permissive approach recognises that local leaders know their communities best and are therefore best placed to determine how to meet the population’s needs. We are not setting a ceiling on what local areas can deliver, and that approach will drive progress more than dictating an overly prescriptive national approach would. For those reasons, we do not think it is helpful or appropriate to define the contents of a neighbourhood health plan in legislation.

Moving to new clause 106, the Government recognise the important role that medicines reclassification can play in supporting self-care, improving access to treatment and helping patients manage their health more effectively, where it is safe for them to do so. There is already an established, evidence-based, proportionate framework for medicines reclassification in place, which is overseen by the Medicines and Healthcare products Regulatory Agency. The UK is already a world leader in medicines reclassification, and the MHRA has reclassified more than 140 medicines over the last 30 years across varied therapeutic areas, including pain and inflammation, and continues to approve new reclassifications each year.

The Government have taken proactive steps to support further reclassification. The MHRA has worked closely with industry partners in recent years to streamline and improve the reclassification application process to ensure that it is as efficient as possible for applicants, while maintaining high clinical standards. Creating an additional statutory reporting requirement would not improve the assessment of individual applications, and nor would it accelerate access to medicines for patients. Instead, it risks duplicating activity undertaken in recent years and diverting resources from the effective operation of the current system. For that reason, I hope the hon. Member for Sleaford and North Hykeham has the reassurance she needs and will not press her new clause to a vote.

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

--- Later in debate ---

[Dr Johnson]

New clause 109, tabled in my name, is very simple, requiring hospice funding to be provided in three-year blocks. Hospices are struggling under the weight of the national insurance rise in the Government’s first Budget, so they would benefit greatly from having a bit more certainty over how much their funding will be from year to year. I am interested to hear the Minister’s response to the new clause.

[Karin Smyth]

This is a really important subject, as everyone approaching the end of their life deserves dignified, compassionate and high-quality palliative and end-of-life care. Hospices provide extraordinary care, and hon. Members are right to highlight the issues the sector faces. That is why the Government are committed to developing a modern service framework for palliative care and end-of-life care. The final framework will be published in the autumn.

New clause 108 would require integrated care boards to collect and report data on people who died while waiting for end-of-life care. It would also require the Department of Health and Social Care to publish that information nationally. New clause 109 would impose a single statutory three-year funding period on hospice funding. Both new clauses are likely to be answered by work already under way or included in the modern service framework.

On funding, we recognise that the sector faces a serious challenge, and the Public Accounts Committee found in March that integrated care board funding ranges from 0% to 80% of an individual hospice’s income, and that commissioning relies on grants and block contracts. There are also wider funding issues, such as the reliance on historic grants.

The Government are acting on those issues, and we have provided around £80 million over three years for children and young people’s hospices, or at least £26 million a year to 2028-29, adjusted for inflation. We have also provided a separate £125 million capital boost for both adult and children and young people’s hospices. That is the largest investment in hospices for a generation.

The MSF will support commissioning away from grants and block contracts to sustainable contracts based on integrated assessment of population need. It will consider contracting arrangements more widely, including a move away from short-term grant funding as part of the more comprehensive reform that the sector agrees it needs.

We are also strengthening data and evidence. We commissioned the National Institute for Health and Care Research’s policy research unit to build the evidence base on palliative and end-of-life care, including on inequalities in access and the identification of need.

We also expect the MSF to give us better insight into the performance of the system. Its metrics and accountability framework are being co-developed with people with lived experience and partner organisations from across the sector. It will measure identification, access, quality, outcomes and inequalities.

In the context of that ongoing work, the new clauses are not necessary. The MSF will give the House and the public a far more comprehensive picture of access to care than a single count could. It will also do so as part of improving the entire patient journey for people who need palliative and end-of-life care. Because this is a non-statutory approach, there will be more flexibility to adapt and change over time, rather than the system being required to follow requirements set out in primary legislation. I hope that that gives hon. Members the reassurance they need not to press their new clauses to a vote.

[Helen Morgan]

I thank the Minister for her response, and I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

--- Later in debate ---

[Dr Johnson]

Under the previous Conservative Government, the NHS constitution was updated with a commitment to guarantee that

“those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside.”

The previous Government also introduced the veterans’ strategy action plan, committing NHS England to providing millions of pounds for specialised support services. Ministers also introduced a single point for veterans to access mental health services and support. The previous Conservative Government also created an armed forces covenant duty. Today, we need to see the principles the covenant brought to life at all levels of Government.

Only last week, I received an email from a constituent who has moved around because of her husband’s service in the armed forces and who was struggling to access specialist services for her child’s health as a result. That is why we need new clause 112, which would require the Health Secretary to report on how they are meeting the duties under the covenant. Members will know that I am cautious about mandating any more paperwork, but veterans are being let down. We need some accountability. That report would hopefully achieve that, so I commend the new clause to the Committee.

[Karin Smyth]

On new clause 110, the Government are proud of the courage and dedication of our armed forces. We must all play our part in upholding the armed forces covenant, including for our armed forces veterans. The original covenant was under a Labour Government; I was proud, as part of my commissioning duties in Bristol, to work with the Royal British Legion to implement that more than a decade ago, and the work continues. I am therefore sympathetic to the intention to promote the health and wellbeing of our armed forces veterans, but I can assure hon. Members that the new clause is not necessary.

The Government’s vision for veterans is clearly set out in the veterans strategy, which recognises veterans as one of the UK’s greatest strategic assets. Furthermore, the existing armed forces covenant duty already places a legal obligation on integrated care boards to give due regard to the unique obligations and sacrifices of the armed forces when carrying out their statutory duties.

[Helen Morgan]

In terms of ICBs and their responsibilities to veterans, there are specialist veterans’ services around the country. One exists in my constituency, at the orthopaedic hospital in Gobowen, which has an excellent veterans’ centre. Yet the commissioning and payment for those services between ICBs is complex, messy and unnecessarily difficult. Would the Minister consider using the measures at her disposal to ensure that those things can happen more smoothly in the future?

[Karin Smyth]

I thank the hon. Lady for referencing that service in her constituency. I am not aware of the complications in the funding, but I will commit to getting back to her to understand that better, and I will see what the responses are from the commissioning function—I suspect it is a specialised one that falls between many different people. I am sure it has a long history, but I am afraid I am not directly aware of it, but I commit to getting a satisfactory response to her.

The covenant duty is underpinned by two core principles: first, that disadvantages arising from membership of the armed forces community should, where possible, be removed; and secondly, that special provision may be appropriate for those who have given the most, such as the injured and bereaved. Beyond that, ICBs have a range of inequalities-related duties relevant to the circumstances of veterans. They include a duty to have regard to the need to reduce inequalities between persons in accessing health services and in outcomes achieved from those services; a duty to have regard to the wider effect of decisions, including inequalities relating to health and wellbeing and to the benefits obtained from the provision of health services; and the public sector equality duty, with which all public sector bodies must comply.

Therefore, there is already a range of legal duties on integrated care boards to promote the health and wellbeing of veterans as part of the community the ICB serves. It is precisely because those duties already apply that we do not consider it necessary to replicate them in relation to neighbourhood health plans.

On new clause 112, a requirement on the Secretary of State to publish an annual report on compliance with the armed forces covenant duty would be wholly unnecessary. Legislation already requires the Secretary of State to lay a covenant annual report before Parliament each year covering the effects of membership, or former membership, of the armed forces on service people in the fields of healthcare, education, housing and the operation of inquests. Under that legislation, the Ministry of Defence must obtain the views of relevant Government Departments, including the Department of Health and Social Care, when preparing the report. Any annual report on compliance with the armed forces covenant duty produced by the Secretary of State for Health and Social Care would cover precisely the same subject matter and would be a duplication of information already publicly available.

New clause 111 relates to providing service personnel with their medical records within one month of discharge. The Government agree entirely that it is important that a patient and their care providers have access to their medical records. Primary healthcare for serving members of the armed forces is the responsibility of the Ministry of Defence and is provided by the Defence Medical Command. As a result, such care would be outside the scope of the amendment. There are established processes to allow for the safe transfer of relevant medical information to the service leaver and their new GP when that person leaves the armed forces. Service personnel receive a medical care summary, and are advised to register with an NHS GP and share the summary with their new GP.

Existing data protection legislation also allows an individual to request their full record on discharge. We recognise that, in some instances, the process does not work as well as we would like, which is why the Defence Medical Command is already working towards greater interoperability with NHS systems and the electronic transfer of medical records from Defence Medical Command to NHS GPs.

As hon. Members know, the single patient record will, wherever possible, draw on and connect relevant information in source records, such as GP IT systems and hospital electronic patient records, and allow the patient to see their record in the NHS app. That innovation further renders the measure unnecessary. For those reasons, and because the objectives are already being delivered through existing duties and ongoing reforms, I ask that the new clause is not pressed to a Division.

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

--- Later in debate ---

[Gregory Stafford]

I heard the Liberal Democrat spokesperson say that she will not press the amendment, but I would be sorely tempted to vote for it if she did so. This important amendment sums up a number of our concerns about the Bill, and the commencement amendments to follow are also appropriate.

As the hon. Member will not press her amendment, however, I will not speak for long, save to say that I have enjoyed the past few weeks on this Committee. I hope that the Minister is still in place when we return in September. If she is not, I wish her very well and thank her for all her hard work, not just in this Committee, but in her role over the past two years.

[Karin Smyth]

I will respond to the hon. Gentleman in a moment, but first I will address clauses 68 to 72, as well as amendment 77, which was tabled by the hon. Member for North Shropshire.

Clause 68 will allow the Secretary of State, by regulations, to make provision that is consequential on this Bill. Amendment 77 would amend that provision. The Government recognise the importance of parliamentary scrutiny of the significant changes proposed in the Bill. While the Bill contains some new regulation-making powers, the majority are existing powers that have been amended in the light of the abolition of NHS England. They will therefore be uncontroversial and consequential, so we consider it proportionate for the same parliamentary scrutiny arrangements to continue to apply in respect of those powers.

However, where we are introducing new regulation-making powers, we have carefully considered what parliamentary scrutiny arrangements should apply. For example, any regulations that are made to facilitate the single patient record will be subject to the affirmative procedure, because we understand the importance of debating that issue in both Houses. Furthermore, any statutory instruments made under clause 68 that amend, repeal or revoke provisions made by primary legislation will be subject to the affirmative procedure and will need to be debated and passed by both Houses. I hope that the hon. Member for North Shropshire agrees that a blanket requirement for the affirmative procedure would be disproportionate. She said that she will not press amendment 77 to a vote, but I hope that what I have said provides her with the reassurance she was seeking.

Clause 69 is a standard clause that appears in Bills that provide for the expenditure of public money. It simply provides for any expenditure incurred by the Secretary of State as a result of changes made under the Act, once it has received Royal Assent, to be paid out of money provided by Parliament.

Clause 70 sets out the territorial extent of the Bill. While most of its provisions extend only to England and Wales, some are UK-wide. The clauses in the Bill largely apply to England only, and in previous sittings we debated the consequences for Wales, Scotland and Northern Ireland, and any issues relating to devolution, as and when they have arisen. Amendments to other legislation made by this Bill will have the same territorial extent as the legislation that will have been amended.

Clause 71 sets out when provisions in the Bill will come into force once it has received Royal Assent. As is usual, the clause provides the Secretary of State with the power to commence the majority of the Bill’s clauses on a date to be set out in regulations. It may also be appropriate to bring different provisions in the Bill into force at different times, and the powers in clause 71 will allow for that. The powers will also enable the Secretary of State to make saving or transitional provision in connection with the coming into force of any provision, which will enable the commencement of the Bill to operate smoothly and efficiently.

Under clause 63, as the Committee has heard, the Care Quality Commission will be able to take action to bring proceedings against a health and social care provider for a serious breach of regulations. However, that provision will apply only to new offences. To ensure that we can act to prevent cases falling through the gaps, we are committed to bringing in the measure as soon as possible after Royal Assent, while respecting the routine two-month window, as is set out in the Bill.

Clause 72 is self-explanatory and provides that, once passed, the Bill may be cited as the Health Act 2026. I commend the clauses to the Committee.

Before I conclude, I put on record my thanks to you, Ms Lewell, and to the right hon. Member for Herne Bay and Sandwich (Sir Roger Gale), my hon. Friend the Member for Ealing Central and Acton (Dr Huq) and the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), for guiding this Committee—[Hon. Members: “Hear, hear.”] I also thank the Clerks for everything that they have done behind the scenes. This is the first Bill that I have taken through a Public Bill Committee, and the work really is quite legion. The Clerks’ expertise is second to none and a delight to see closely.

Equally, I thank the officials in the Department of Health and Social Care and the lawyers, some of whom have worked on several Committees over the years. Again, I have learned so much from them and their expertise. It is a dedicated team, and their hard work and expertise on Bills over many years is good to see. I thank them for their support in making this Bill go forward.

I thank the hon. Members for Farnham and Bordon and for Sleaford and North Hykeham for their kind comments and good wishes. I also thank members on both sides of the Committee for their contributions over the past few weeks. Despite the heat, I, too, have enjoyed our discussions. I think that we have given the Bill a very good airing and there has been constructive engagement and scrutiny. They have given us lots of food for thought, which we have taken careful note of, regardless of whether we have taken up the amendments.

[Dr Johnson]

I echo the Minister’s thanks to the Clerks, House staff and others, as well as members of the Committee. Leaving aside the heat, I have also enjoyed our exchanges. I hope that the Minister has a good recess and that she does well in the upcoming reshuffle.

[Karin Smyth]

I thank the hon. Member for her kind comments. As the former Minister, the right hon. Member for Melton and Syston, recognised, I have been on the other side when considering a previous Bill. Opposition is hard work—the process is quite hard work on this side—and I commend Opposition Members for conducting that important scrutiny. I thank Members for their contributions and I think the Bill is stronger for those efforts.

[Helen Morgan]

May I associate myself with the Minister’s comments and thanks to everybody who has been involved in working on the Bill? I have also enjoyed my time on the Committee, despite the heat. I hope that the Minister remains in place when we come back on Report, because she is a hard-working and thoughtful Minister and it is a pleasure to stand opposite her in the House in my place as my party’s spokesman.

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 68 ordered to stand part of the Bill.

Clause 69 ordered to stand part of the Bill.

Clause 70

Extent

Amendment made: 80, in clause 70, page 48, line 18, at end insert—

“(2A) Section (Medical Devices Regulations 2002: mutual recognition agreements) extends to England and Wales and Scotland.”.—(Karin Smyth.)

This is consequential on NC92.

Clause 70, as amended, ordered to stand part of the Bill.

Clause 71

Commencement

Amendments made: 81, in clause 71, page 48, line 25, leave out “Section 63” and insert “The following”.

This paves the way for Amendment 82.

Amendment 82, in clause 71, page 48, line 26, at end insert “—

(a) section 63 (Care Quality Commission: time limit for bringing proceedings);

(b) sections (Regulations: reference to agreements and standards), (Medical Devices Regulations 2002: mutual recognition agreements), (Consultation about medicines and medical devices regulations), (Medicines and medical devices regulations: parliamentary procedure), (Medical devices: parliamentary procedure for certain fees regulations).”.—(Karin Smyth.)

This provides for the new clauses listed to come into force 2 months after royal assent.

Amendment proposed: 37, in clause 71, page 48, line 28, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the conditions in subsection (3B) are met.

(3B) The conditions are that—

(a) the Secretary of State has published a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document"); and

(b) the Secretary of State has published a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the “workforce transition plan”).

(3C) The operating model document must include—

(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;

(b) the governance and accountability arrangements for the exercise of those functions;

(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and

(d) the proposed timetable for the transition.

(3D) The workforce transition plan must include—

(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;

(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and

(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.

(3E) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3F) Before laying a draft instrument under subsection (3E), the Secretary of State must allow a period of at least 60 days beginning with the date of publication of the operating model document and the workforce transition plan (whichever is the later) before the draft instrument is laid.

(3G) A period during which Parliament is dissolved, prorogued or adjourned for more than four days are not to count towards the 60-day period in subsection (3F).”.—(Dr Caroline Johnson.)

This amendment would prevent the abolition of NHS England before the production of an operating model for the merged DHSC/NHSE and associated plan to manage personnel.

Question put, That the amendment be made.

Health Bill (Sixteenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 16th July 2026 Public Bill Committees

[The Chair]

As that was a speech and not an intervention, we will take the Minister before the hon. Member for Winchester responds.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Dr Huq. The hon. Member for Winchester raises an important point. Cardiac issues are serious, and people too often lose their lives as a result of unidentified cardiac conditions. As we know, ECGs are used significantly across the whole of healthcare, from accident and emergency to new community diagnostic centres and beyond. They are important for investigating palpitations or unexpected syncope and for evaluating pacemaker function, and are an extremely useful diagnostic tool. However, as my hon. Friend the Member for Bury St Edmunds and Stowmarket suggested, there is no clear evidence that non-symptomatic population screening using standard ECGs would yield any useful health data or improve population outcomes.

Clearly, the loss of life—particularly a young life, as in the case of the constituent the hon. Member for Winchester mentioned, although we have all seen or, sadly, experienced such cases—is an awful tragedy for those concerned, but we need to rely on evidence. The UK National Screening Committee, which is an independent scientific advisory body, advises all four nations and is considering the issue. The committee launched a three-month public consultation on 8 June to look at the evidence on screening for sudden cardiac death. Its draft recommendation is against screening, because ECGs, as well as other tests, are an unreliable tool for identifying significant cardiac issues in asymptomatic individuals. ECGs are useful tools in the diagnosis of symptomatic patients, and the UK National Screening Committee is in the process of reviewing ECG use for asymptomatic individuals. For those reasons, I ask the hon. Member to withdraw the new clause.

[Dr Chambers]

I thank the Minister for her comments. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 32

Review on deaths related to antimicrobial resistant infection

“Within six months of the passage of this Act, the Secretary of State must conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.”—(Dr Chambers.)

This new clause would require the Secretary of State to conduct and publish a review into the number of yearly deaths in the UK which are related to antimicrobial resistant infection.

Brought up, and read the First time.

[Dr Chambers]

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

The new clause would require the Secretary of State to conduct and publish a review into the yearly number of deaths in the UK related to antimicrobial-resistant infections. I declare an interest as the secretary of the all-party parliamentary group on antimicrobial resistance. AMR is a major threat to public health globally and domestically, and it is already contributing to an estimated 35,200 deaths every year in the UK.

AMR is a bit like a silent pandemic. It gets little media attention, but given the prediction that 39 million people worldwide will have died of AMR by 2040, it will eventually be pushed right up the political agenda. This is not simply a matter of people dying from infections that could not be treated; nearly all the advances in modern medicine over the last 50, 60 or 70 years would be null and void. It would be too risky for someone to have something like a hip replacement, because of the risk of getting an infection that could kill them; they would be better off living with a painful arthritic hip than taking the risk of dying from sepsis. It is the same with things like heart disease, while giving birth will once again become one of the most dangerous things a woman can do if we lose the impact and effectiveness of antibiotics.

The Government invested more than £560 million in AMR programmes between 2020 and 2024, so it is reasonable that Parliament should receive an annual assessment of AMR-related deaths to ensure that that significant public investment is delivering results, represents value for money and is targeted where it can have the greatest impact. We cannot effectively tackle what we do not measure, and an annual review of deaths linked to AMR would provide a clear, consistent picture of the scale of the problem and enable Parliament and the public to track whether policies are working.

Better data leads to better targeted interventions. We know that rapid diagnostic tests and different types of decontamination will be hugely important in tackling AMR, along with potential future technologies such as phage technology. Surveillance has already identified significant variations by age, deprivation and geography. Understanding where deaths are occurring, and in who, would help direct resources to the communities and services that are most affected.

AMR threatens the effectiveness of modern medicine, including surgery, cancer treatment and routine healthcare. An annual review of AMR-related deaths would ensure that this growing public health threat receives the attention and urgency it deserves. The reason I am determined to push it up the agenda is that the national cancer plan does not specifically mention AMR or infection, but it is the second biggest cause of death in cancer patients. At the moment, it is not pushed up the political agenda enough.

[Karin Smyth]

I commend the hon. Member for outlining this important issue before the Committee and for his work on the APPG.

AMR is recognised as a chronic risk in the Government’s national risk register. In 2022, it was estimated that 7,500 deaths per year can be directly attributed to AMR in the UK, with a further 35,000 deaths per year associated with AMR. It is a significant and growing issue that the Government take very seriously—I want to assure the hon. Member and the Committee of that. Through the delivery of the 2024 to 2029 UK AMR national action plan, the Government are already taking comprehensive action to tackle this threat and ultimately reduce the burden it places on individuals, families and the healthcare system. That is where that work is located.

I am not convinced that a review of the number of deaths at this point, while important, would add significantly to our understanding of the impact and burden of AMR or to the action being taken to address it, which we do take seriously. The Government will continue to work with APPGs and with information around this issue through the action plan. For that reason, I ask the hon. Member to withdraw the new clause.

--- Later in debate ---

[Karin Smyth]

I thank the hon. Member for North Shropshire, who raises issues of patient safety diligently on behalf of her constituents and the wider system. I will take the time to answer some of the points about where the Government are. Obviously, we support prioritising patient safety, which along with service quality and experience is of the utmost importance.

On new clause 36, trusts are already subject to regulatory and contractual requirements to report medical malpractice, which is why we do not think the new clause is necessary. For example, CQC regulations on safe care and treatment and on good governance are central to trust accountability for systemic malpractice. They require trusts to have effective systems to identify patterns of harm, manage risks and deliver system-wide improvements.

Trusts are required to identify and report incidents leading to significant harm through the Learn from Patient Safety Events service, ensuring that the CQC is informed and enabling NHS England to identify trends and support learning and improvement. This information can be shared with and accessed by HSSIB and could in the future be shared with and accessed by the investigations arm of the CQC.

The CQC regulation on duty of candour reinforces transparency through truthful accounts of what has happened when something goes wrong, including where harm reflects systemic issues. Under the patient safety incident response framework, trusts must undertake patient safety learning investigations into certain incidents to support learning and improvement.

In parallel, the NHS provider licence requires NHS trust boards to maintain clear accountability for quality of care and reporting of safety information through effective governance systems. Where failures of governance occur, NHS England has the powers to intervene. Those powers will transfer to the Secretary of State as part of the Bill.

The new clause would clearly duplicate current processes. Together, the existing mechanisms already help trusts to identify and address systemic issues locally, while enabling national aggregation to support system-wide learning.

New clause 37 seeks to require the creation of a standardised framework for coroners and medical examiners to report health system failings. I take the opportunity to reassure the hon. Member for North Shropshire that regulations already require medical examiners to report serious concerns identified in respect of clinical governance, patient safety or public health surveillance, in accordance with local reporting arrangements. Existing regulations also require coroners, in the context of an investigation, to issue a report to a person, organisation, local authority, or Government Department or agency where the coroner believes they may have power to take relevant action to prevent future deaths.

In September 2024, the Department of Health and Social Care introduced death certification reforms, putting in place regulations to provide greater safeguards for the public by ensuring independent scrutiny by medical examiners of all deaths not investigated by a coroner. These reforms, as set out in the Medical Certificate of Cause of Death Regulations 2024, which require an independent review to be carried out for all deaths in England, introduce a system whereby all deaths are subject to either a medical examiner’s independent scrutiny or a coroner’s investigation.

Should the medical examiner detect concerns about care, they will refer such cases to established clinical governance review processes and bodies and notify the coroner or, if necessary, the police. The Notification of Deaths Regulations 2019 require all doctors, including medical examiners, to refer a death to a coroner if they believe that deficiency of care while undergoing treatment contributed to the death, making the death unnatural. Under the Coroners and Justice Act 2009, a coroner has a statutory duty to report issues to the appropriate bodies where they believe that action can be taken to mitigate or prevent the risk of future deaths, and both the report and responses to it are published by the chief coroner.

When incidents and errors occur resulting in death or serious injury, it is important that we learn any lessons. The Government are committed to ensuring that the prevention of future deaths reports are taken seriously and lead to meaningful action. The Department is working across Government and with the chief coroner to identify ways to strengthen oversight and ensure that the right organisations are consistently notified of concerns, respond to them in a timely manner and drive appropriate action.

Under the Medical Act 1983, the General Medical Council ensures that all doctors, including medical examiners, report suspected health system failings by speaking up. That is a mandatory professional obligation linked to a doctor’s licence to practise, embedding this whistleblowing requirement into the GMC’s core regulatory and fitness to practise frameworks. The GMC also enforces a professional duty of candour requiring all doctors to be open and honest with patients and official bodies when things go wrong and actively report adverse incidents so that systematic lessons can be learned.

In summary, both new clauses duplicate requirements that already exist. Regulations, systems and processes are already in place to report suspected health system failings to the appropriate bodies. For that reason, I ask the hon. Member for North Shropshire to withdraw the new clause.

[Helen Morgan]

I thank the Minister for outlining the existing statutory framework. I agree that it ought to be sufficient, but there are high-profile instances where it has not been, so I look forward to hearing more from her on Report about how the cultural change will be implemented so that further legislation is not necessary. I beg to ask leave to withdraw the new clause.

Clause, by leave, withdrawn.

New Clause 38

Single sex facilities

“The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff

(b) toilets and washing facilities for NHS staff

(c) wards for NHS patients

(d) toilets and washing facilities for NHS patients.”—(Dr Caroline Johnson.)

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients.

Brought up, and read the First time.

[Dr Johnson]

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

This is a very straightforward new clause. The Secretary of State would be required to ensure that there are single-sex changing rooms, toilets and washing facilities for NHS staff and single-sex wards, toilets and washing facilities for NHS patients.

The UK Supreme Court unanimously ruled that a woman is defined by biological sex in 2025, and the Minister herself said:

“We are completely committed to single-sex spaces.”

However, it appears that the Minister for Women and Equalities did not get that memo. Despite having apparently been sat on her desk since September, the new draft code from the Equality and Human Rights Commission was not laid before Parliament until 21 May. One week before that guidance was published, a female NHS England employee in Leeds won her claims of indirect sex discrimination and harassment over a policy allowing transgender colleagues to use toilets and changing rooms that correspond to their gender identity rather than their biological sex. On 28 June, after the draft code was laid, it was reported that West London NHS trust had told patients that they could use single-sex facilities based on gender identity.

It has taken the current Health Secretary some time, but I understand that he has changed his mind on the issue and come to the same conclusion as others: that a woman is, in fact, a woman and that toilets and changing facilities must be protected. Will the Minister follow his lead and protect single-sex spaces in NHS trusts? The Supreme Court has ruled that a woman is defined by her biological sex. My party knows that. The Minister claims her party knows that too. It is time for her to show it by pulling the levers that only she can to ensure that patients and staff are protected right across our health service.

[Karin Smyth]

I am grateful to the hon. Member for bringing this discussion before the Committee. She is right that, following the For Women Scotland case at the Supreme Court in April 2025 and the recent laying of the Equality and Human Rights Commission’s updated code of practice on 21 May, ensuring the provision of single-sex facilities for patients and staff is a prominent issue. The Government welcomed the clarity provided by the Supreme Court judgment. The EHRC code of practice sets out how service providers may lawfully apply sex-based distinctions following the Supreme Court judgment. That guidance is applicable to services, public functions and associations and includes, but is not limited to, the services provided in the NHS.

Following that, NHS England drafted the revised guidance, “Privacy, dignity and safety in hospital accommodation”, which will align with the legal position and the EHRC code of practice and replace existing guidance. I know that many colleagues are impatient to see the existing guidance replaced following the Supreme Court ruling. It was important to wait for the EHRC code of practice to be published so that it could be considered in any guidance. The code of practice was published on 21 May. Following the publication, NHS England reviewed the guidance to ensure that it was in line with the code. The code was subject to a 40-day laying period before Parliament, which ended on 9 July. The Government expect the code to come into force in early August. Guidance for the NHS will be published shortly afterwards.

NHS England is also developing guidance on staff facilities, including changing rooms, toilets and washing facilities that should be used by trusts and ICBs. The provision of physical single-sex facilities for NHS staff is for NHS organisations to individually manage in line with their legal obligations. There is already legislation covering this issue, particularly the Workplace (Health, Safety and Welfare) Regulations 1992. Organisations should already be conducting assessments of their own estates and the needs of their workforce to decide what changes they need to make to comply with all legislative requirements.

On mixed-sex accommodation and breaches, there is a long-standing policy of same-sex accommodation. Individuals should not have to share sleeping accommodation with patients of the opposite sex unless appropriate. In practice, the proposed amendment does not allow scope for mixed-sex accommodation where clinically appropriate—for example, intensive care unit facilities or where it is necessary for patient safety. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.

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

--- Later in debate ---

[Karin Smyth]

Well, what was a disaster was the Tories’ management of the capital estate pre-1997 and post-2010, if the hon. Member for Sleaford and North Hykeham wants to talk about disasters on capital planning. I could talk about this for a very long time, but I know the Committee is keen to move forward, and I addressed some of these issues in debate on a previous amendment. I am very proud of, for example, Southmead hospital in Bristol, which is one of the finest examples of a hospital in the country and was built under a PFI scheme. I received treatment there a couple of years ago, in facilities that are good for staff to work and patients to be treated in. It replaced a hospital that was falling down and in shocking condition, despite the best efforts of staff. We can see similar examples across the country.

Under the Tories’ management, and for some of the early PFI schemes under the last Labour Government, contracts were poorly negotiated. They had issues with, for example, management of inflation. We have learned lessons from that. The hon. Member for Sleaford and North Hykeham talked about some contracts, including one where, I think, her whiteboard was not working. We know what the lessons are to be learned from that, and we are doing exactly what a good Government do when they take charge—change it.

In the 14 years that the Conservatives were in power, they could have started negotiating these contracts differently at any point, but they chose not to. They chose to let the estate atrophy and fall down. That is bad for patients and the public. That is why I was proud last week to launch the Government’s capital plan, building for the future, looking forward and giving nine years of certainty for estates across all our constituencies.

[Dr Prinsley]

I agree with everything that the Minister has to say—what a surprise—but particularly the fact that when the new Government came in, they did something about these 40 “new” hospitals that were not full hospitals. The people of Bury St Edmunds were delighted to learn that their RAAC-affected hospital, which is tumbling down, will be one of the first to be reconstructed. We look forward to that and are grateful for the decisions made by the Government.

[Karin Smyth]

I thank my hon. Friend for that. Across the east of England, where we now have so many Labour MPs, everyone has been trying to rectify the mismanagement that local people have seen, particularly of the capital estate. I will not detain the Committee on the capital estate—one of my favourite subjects—for very long.

The hon. Member for Sleaford and North Hykeham is aware that the decision on neighbourhood health centres was announced in the autumn. The decision-making process was supported by a business case to examine the feasibility of developing a new model, learning the lessons of the past on public-private partnerships specifically to build neighbourhood health centres as part of our 10-year plan. That informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with the Treasury’s five case model. We are now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn.

I recognise the interest in making the business case available to both Houses, but that must be balanced with the need to develop an effective policy. Publication while policy development is ongoing would limit full, candid and proper deliberation. Civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications. Their candour in doing so would be affected by their assessment of whether the content of such discussions would be disclosed.

We are committed to building neighbourhood health centres across the country. That is what patients and the public deserve. We will obviously be mindful of public money and subject to the usual processes of the House, including the Public Accounts Committee. We will learn those lessons. We are in full discussion with NISTA. For those reasons, we are committed to developing good estate across our country. That is what our constituents deserve. I therefore ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

[Dr Johnson]

For the record, I am a member of the Royal College of Paediatrics and Child Health and work as a consultant paediatrician at North West Anglia NHS foundation trust, which will have a new hospital. I would like to press the new clause to a vote.

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

--- Later in debate ---

[Dr Johnson]

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

This new clause asks the Government to use private providers to help get waiting lists down. We are told that waiting lists are falling, but the Government’s own figures show that waiting lists are higher than they were last month, and if we look at the group of people who are waiting for admission for a procedure or operation, they are higher than they were last month, last year or indeed at the general election in 2024. There were 76,250 women waiting for gynaecological treatment at the end of July ’24, when this Labour Government took office; that rose by more than 6,000 patients to 82,623 as of May 2026. Private providers have capacity that may be able to help with that.

The deployment of private providers is about using all the resources and capacity on offer across the country to get waiting lists down. The NHS uses private providers to perform some surgeries and scans, mental health support, GPs and dentistry, but it is a sensible measure to ensure that all hands are on deck when it comes to treating patients. I look forward to hearing how the Minister can use private providers to get more patients seen more quickly as opposed to wiping them from waiting lists at record rates.

[Karin Smyth]

Again, I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. This new clause would require the Secretary of State to make regulations about how the NHS uses private provision to support access to treatment and reduce lists. I understand the point that she is making, but I assure her that this is an unnecessary new clause.

ICBs already can and do use private healthcare providers to offer patients treatment in their area and boost capacity to reduce lists. Our approach is pragmatic, not ideological: in the 10-year health plan, the Government committed to continuing to use private sector capacity where it is available; that is not because we favour the private sector but because we are committed to using capacity wherever it is available. Our priority is treating patients in a timely manner, not favouring one form of provider over another. Under existing legislation, patients must be offered a choice of provider for their first outpatient appointment, where the duty of choice applies. If a person’s needs are not met by local services or waiting times are high, they can use that choice to see an appropriately qualified provider.

However, we must resist the temptation to apply a one-size-fits-all approach here. ICBs are responsible for the financial sustainability, planning and strategic commissioning of services for their local populations, so they are best placed to decide how private premises should be used to meet a population’s needs. For example, high waiting times, which we obviously inherited from the Conservatives, for a particular specialty may result not from a lack of capacity but from increased demand from GP referrals. The ICB must have the flexibility to improve how advice and guidance—referral support, for instance—is working for GPs, rather than being required to wastefully spend NHS funds on increasing capacity with the private sector.

[Sojan Joseph (Ashford) (Lab)]

If this is put on the statute book, will it not mean that the private sector can have more and more hospitals, when we should be using them only if the NHS does not have the capacity? The private sector should be the last resort rather than a first choice.

[Karin Smyth]

I am slightly confused, as I suspect other Committee members are, by the Opposition’s approach to the private sector, having had a discussion in relation to the previous new clause about not using the private sector and boosting work and employment opportunities in our country. They do have a slightly odd view with regard to this. As I said, our view is very pragmatic: it is to support the treatment of patients to get waiting lists down. That is what our constituents deserve. Where capacity can be used, we want to make sure that that choice is available.

[Dr Prinsley]

I am confused by the Opposition referring in their new clause to a requirement to “make regulations” in this respect, as the private sector is already widely used to reduce waiting lists where appropriate. However, we must also be aware of the problem we have with overuse of private facilities. That can have an effect on the provision of NHS services, because the number of available staff is limited. I think particularly of ophthalmology services, as we have created a situation in which the overprovision of private services has disabled the provision of ophthalmology services.

[Karin Smyth]

That is why I was clear in outlining that ICBs have a duty to make sure that they are financially sustainable and that their planning and strategic commissioning meets the needs of their local population. They need to balance those requirements.

Under the new clause, there is a risk that the Secretary of State, by setting blanket requirements, would contravene the level playing field provisions in clause 10 of the Bill. For those reasons, I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clause.

[Dr Johnson]

The previous use of private providers was to remove debt from the Government’s balance sheet. That is not the same as providing guidance and regulations on how to increase capacity and use the spare capacity of private providers to reduce waiting lists, which are currently rising. In response to the point made by the hon. Member for Bury St Edmunds and Stowmarket, the workforce plan is important. Despite that plan being “imminent” for several weeks now, it has not been published. I will press the new clause to a vote.

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

--- Later in debate ---

[Dr Johnson]

New clause 46 would require the Secretary of State to publish the number of staff in the Department of Health and Social Care and the number of people made redundant following the abolition of NHS England. New clause 75 would require the Secretary of State to prepare and lay before Parliament a formal transition strategy. Amendment 37 would prevent the abolition of NHS England before the production of an operating model. Amendment 38 would require the Secretary of State to publish and submit to independent scrutiny an impact assessment on the abolition of NHS England containing quantified cost and benefit figures before making regulations to abolish it.

Amendment 39 would require the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using the powers in the Bill for abolition. The plan must address joint commissioning, funding flows, delayed hospital discharges and the workforce. The problem is essentially that Ministers marched off into a battle without a plan and continue to fight without one.

In this Committee, we have heard consistently about the number of times that things have not been thoroughly planned out and properly considered, particularly in relation to social care. I know that Members on all sides of the House are concerned about how social care will interact with the health service under the proposed new regime. In March 2025, Ministers and officials were going to work to determine what was needed, and in March 2026, they were still progressing to develop the design—12 months later, there was a change in tense but still no proper plan.

When putting the Bill before the House, the Government published an impact assessment, but where there should be numbers quantifying how much this is all going to cost us, there is simply “N/A”. How is that any way to conduct a reorganisation? That is why I tabled amendments 37, 38 and 39. They would apply the brakes until the operating model had been established by requiring the full publication of a proper impact assessment, a detailed plan of how the health service will work alongside social care, and the publication of redundancy figures. They would ensure that the Government have worked out what they are going to do before they get on and start doing it.

[Karin Smyth]

The Government of course recognise the importance of clarity and assurance as we undertake this significant transformation, including on how functions, governance and the workforce will operate in the future. That is essential for ensuring that our staff and other stakeholders understand the new role of the Department.

On new clause 46, we recognise the importance of transparency around departmental workforce numbers and the impact of abolishing NHS England. The Government remain committed to significantly reducing headcount across NHS England and the Department of Health and Social Care, but I put on record my thanks to all the staff and talented professionals working in both organisations; this is a difficult time for them. However, this new clause is not necessary. Workforce information is already published both monthly and through the Department’s annual report and accounts, alongside wider Government transparency publications. Placing a further reporting requirement in legislation would risk duplicating existing transparency data, so it is unnecessary to include it in the Bill.

On amendment 37, I reassure the Committee that we will consult on the proposed structure for the new Department of Health and Social Care, and that is also required under existing employment law. The structure will clearly explain what every part of the new Department will do and set out every post we think we need. The target operating model is an internal document that sets out the proposed purpose, role, governance and organisational structure of the future Department. It will be shared internally, following engagement with staff and stakeholders, including trade unions. The chair of NHS England, Dr Penny Dash, has committed to sharing it with the Health and Social Care Committee once it is finalised.

The target operating model will be used to guide detailed organisational design and will iterate over time. The proposed design of the new organisation will be subject to consultation. The target operating model does not implement changes that remain subject to parliamentary approval through this Bill.

On workforce transition, we will follow TUPE-like principles whether TUPE or any other transfer mechanism applies, in line with the Cabinet Office statement of practice on staff transfers in the public sector. That means that recognised trade unions will be formally consulted and engaged with on measures related to the transfer. No changes to contractual terms and conditions will be made without proper consultation and engagement.

We are committed to maintaining an ongoing dialogue with trade unions and staff throughout this period of change, and we are updating them as often as possible. Where appropriate, we are also committed to working with staff networks on the changes, particularly on how we can best support staff. Given those commitments, I hope that the hon. Member for Sleaford and North Hykeham agrees that placing further requirements in the Bill would be disproportionate.

On amendment 38, we agree that it is important to be transparent about the costs and benefits of this programme. The Department has been open about the initial estimate of around £1 billion of savings per year, and we published an impact assessment alongside the Bill. The detailed timing and scale of costs and savings from the programme depend on factors such as the take-up of voluntary exit and redundancy schemes, which are under way. We will continue to refine our assessment of costs and savings as the programme progresses and as we move towards the abolition of NHS England. We will continue to be open about those figures.

The savings will support continued investment in frontline services. The timescales set out in the amendment would risk delaying the abolition of NHS England and, as a result, would delay the transfer of savings to frontline services and the stability and certainty we need for our staff.

On amendment 39, the Government are committed to supporting the integration of health and social care so that people experience more joined-up, person-centred care. Key planning frameworks, including for the better care fund and for neighbourhood health, already stress the critical importance of strong join-up and integration. We expect those frameworks to continue to guide the health and care system following the abolition of NHS England. Most importantly of all, we are committed to developing neighbourhood health approaches as an essential part of reforming the health and care system. That approach will deliver more integrated services across health, local government and wider partners, including the voluntary and community sector.

The Bill simplifies existing complex legal frameworks to make collaboration easier and emphasises the role of health and wellbeing boards as a focal point for that collaboration. However, partnership and collaboration take many forms depending on local circumstances, and they cannot simply be prescribed through a centrally developed plan. Instead, we should encourage areas to develop effective, productive relationships in the interests of the people they serve. We have discussed that in this Committee, and hon. Members from all parties have a key role to play there.

Turning to new clause 75, we absolutely recognise the need to ensure that critical functions, expertise and organisational capability are identified, retained and effectively transferred during this period of change. That is essential to maintaining continuity of services and supporting the delivery of key health programmes, including vital services such as cancer care.

I reassure the Committee that that work is already well under way. We are carefully mapping all areas of current activity across NHS England, assessing what capabilities we need to deliver them in future and putting processes in place to support the retention and transfer of expertise. This includes the phased approach we are taking to workforce changes, alongside a robust and consistently applied process for voluntary redundancies and voluntary exits, to minimise disruption and protect critical skills. We are also committed to ongoing monitoring and oversight through the transition, and as part of our programme of governance, there is ongoing consideration of skill retention, knowledge transfer and organisational capability, and we will take action where gaps are identified.

As drafted, the new clause would introduce a new statutory requirement to produce and lay before Parliament a formal transition strategy before the abolition of NHS England and the implementation of transfer schemes, alongside new ongoing reporting obligations. While well-intentioned, it would add another unnecessary step into what is already a complex and carefully sequenced programme. It would reduce the flexibility needed to adapt workforce organisational decisions as the transformation progresses. For those reasons, the Government believe that the objectives of the new clause are already being delivered through existing programme arrangements, without the need to place further requirements in the Bill.

[Dr Johnson]

I listened carefully to what the Minister said, but I do not know where the Government have transparently published all these numbers and calculations. A lot of parliamentary questions have been asked on the detail of this transition, so I think it is important that the detail is published so we can see it, and that the detail is planned, before the abolition process takes place. I therefore want to press the new clause to a vote.

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

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Dr Huq. I welcome the Minister back from her son’s graduation —I hope it went well.

I rise to state my support for new clause 47, which would require the Secretary of State to publish a clear roll-out plan for fracture liaison services across England and report annually to Parliament on progress towards universal coverage by 2030. It is not about creating a new target, because the target already exists: both this Government and the previous Government committed to achieving 100% fracture liaison service coverage by 2030. The question before us, as proposed by the shadow Minister, is simple: how will that promise be delivered, and how will Parliament know whether meaningful progress is being made?

Fracture liaison services are one of the most evidence-based interventions in osteoporosis care. They systematically identify people aged over 50 who suffer a fragility fracture; assess their bone health; initiate treatment where appropriate; and monitor patients to reduce the risk of subsequent fractures. Given that around half of patients who sustain a hip fracture have previously broken another bone, those services represent a vital opportunity to intervene before a life-changing injury occurs. The human cost is considerable. Osteoporosis affects millions of people, particularly older women, and fragility fractures can result in a loss of independence, reduced mobility, social isolation and significant pressure on health and social care services. The National Institute for Health and Care Excellence estimates that around 180,000 fractures each year in England and Wales are attributable to osteoporosis.

There is also a compelling economic case: the Royal Osteoporosis Society estimates that investing around £30 million in fracture liaison services could prevent approximately 74,000 fractures over five years, including 31,000 hip fractures, saving the NHS around £665 million and freeing up some 750,000 bed days. Few preventive interventions offer that combination of better patient outcomes and substantial savings for the NHS.

The Government frequently point to their commitment to universal coverage by 2030, but as the shadow Minister pointed out, progress has been achingly slow. When the Secretary of State appeared before the Health and Social Care Committee last week, I questioned him on that issue directly. While he confirmed that the Department remains committed to meeting that 2030 target, which was first established by the previous Conservative Government, no plan—or indication of when a plan would come—was given. A commitment alone is not a delivery plan.

There are also growing concerns that the Government have overstated the progress that has already been made. The Royal Osteoporosis Society has confirmed that more than 97% of the fracture liaison services counted by the current Government were already in place before the change of Government. So, rather than that representing any significant expansion in national coverage, this Government have gone slow. I think it is therefore very reasonable—to answer the question from the hon. Member for Bury St Edmunds and Stowmarket—for Parliament to be entitled to ask what additional progress has actually been made since the commitment was reaffirmed.

New clause 47 would also require the Secretary of State to publish an assessment of access in every integrated care board area. It would also require annual milestones, because, at present, there is no publicly available timetable showing where the services will be established, or which areas will be prioritised or progressed between now and 2030.

Crucially, the new clause would require the Government to set out how integrated care boards will actually be supported. Ministers rightly point out that fracture liaison services are commissioned locally by integrated care boards, but if the responsibility for delivery rests locally while responsibility for national targets rests with central Government, there clearly needs to be a well-thought-through national framework explaining how those boards will be supported through funding, guidance, workforce planning and accountability.

This is, therefore, a straightforward request for transparency, accountability and, most importantly, delivery. If Ministers are committed to achieving this by 2030, they should have absolutely no objection to publishing a plan that shows how they intend to get there. For those reasons, I support the new clause.

[Karin Smyth]

I will partly agree with the Opposition to start off with: they are absolutely right that osteoporosis is a really important issue, particularly for older women. The hon. Member for Farnham and Bordon outlined some of the economic case, but crucially, it is a strong health issue. I worked and campaigned on this issue in opposition myself, because it predominantly affects older women. It also very much fits into our 10-year health plan regarding prevention. That is why we have also, for example, increased access to DEXA—dual-energy X-ray absorptiometry—scanners.

It is rather disappointing, though, for a subject on which there is obviously so much agreement to be used as a political back-and-forth here today. Let me be clear. I think some of the comments show why some of this has got a bit confused, including for people who genuinely care about this rather than just wanting to make it a political issue. Again, it is entirely the Opposition’s job to oppose the Government, and I do not have any problem with that, but there is a serious issue here about how this is monitored.

We are absolutely committed to having coverage across the country by 2030, as the Secretary of State has recently said. That is why we are rolling out more DEXA scanners and so on, but with the clustering of ICBs, 92% of the country is now covered across those clusters.

[Dr Johnson]

rose—

[Karin Smyth]

That is why it is important that we look at what is actually happening on the ground and how we are moving forward. We are committed to supporting this cohort, and particularly those patients for whom this condition is largely preventable. Care closer to home, based around our 10-year plan, is absolutely the right way to go about that.

[Dr Johnson]

Will the Minister give way?

[Karin Smyth]

I was going to outline the points, but I am happy to give way if the hon. Lady wants.

[Dr Johnson]

Can the Minister be clear on the point about ICBs? There is a concern that, where there are perhaps three ICBs, one of which has a service and two of which do not, and they merge together, the Government then say, “Aha! This ICB area now has coverage,” but that is for part of it, not all of it. What is important for a universal service is that it is available to all.

[Karin Smyth]

Again, the hon. Lady has intervened, but that is exactly my point. There is a danger here of the Conservative party focusing on a target or number and totally missing the point, which is to have good, locally available services accessible to this predominantly female and predominantly older population through our 10-year health plan. If one counts the new clustered ICBs in that target, 92% of areas are covered.

We want to get to the heart of this issue. Integrated care boards are the commissioners of local health services and remain best placed to make decisions according to local need. Commissioning these services at a local rather than national level—which is the entire thrust of our 10-year health plan, and indeed this Bill—means that ICBs are best placed to commission holistic, integrated care that wraps around the patient’s need, where the patient is.

We have been very clear in our 10-year health plan, and indeed in this Bill, that we are not expecting patients to fit in with models of care that have been devised over a period of time and in hospitals that are largely located far from their homes. We are looking at a close-to-home service and building models of care around peoples’ needs. A legislative requirement for a national implementation plan would cut across that responsibility, undermining local ability to tailor services to patient needs and causing confusion for delivery. That is why we do not think the new clause is necessary.

The renewed women’s health strategy sets an expectation that ICBs prioritise community-based models when commissioning new fracture prevention services. The Department will continue to work closely with NHS England and ICBs to explore a range of options that provide better quality, and better access to, important preventive services. I therefore ask the shadow Minister to withdraw the motion.

[Dr Johnson]

I am afraid I am not reassured at all. The Minister seems to be saying that the ICBs will do it—the same ICBs where she is cutting their budgets, making them change the board and making them merge with each other all at the same time. The target is behind schedule and it is important that we hold the Government to account on it. Therefore, I will press new clause 47 to a vote.

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

--- Later in debate ---

The 10-year cancer plan, which we absolutely welcome, included a commitment for 28 new radiotherapy machines. That is far from enough, particularly for a cost-effective and successful treatment. We would like to see the Government go further, particularly in those areas that have significant radiotherapy deserts.

[Karin Smyth]

This is an important debate, as many of them are today. I understand that waiting for a cancer diagnosis, as I have had to do myself, is very stressful. The national cancer plan sets out how the Government will change that experience for patients and their families. Crucially, the plan is driven by evidence and shaped by the voices of more than 11,000 patients, charities and professionals who responded to our call for evidence.

The plan covers the entirety of the pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention and research and innovation, and tackles the key issues raised in the new clauses. Delivery of the plan will be monitored by the national cancer board, with an independent co-chair reporting to the Department.

On new clauses 48 and 65, let me be clear that improving access to high-quality radiotherapy services is a priority for the Government, and one that we are already delivering. In May last year we announced the roll-out of new linear accelerator machines, we have committed to meeting all cancer waiting time targets by the end of this Parliament, and timely access to radiotherapy is central to the 31-day and 62-day treatment standards. We will go further by reviewing the targets, once they have been met, to consider whether they should be strengthened. That will include considering what data is needed to support improved performance. A separate statutory framework would duplicate the established performance regime.

We are well aware that radiotherapy performance is below that of other treatment types, as the hon. Member for North Shropshire outlined. We are also aware of the serious variation between different parts of the country. We have at our disposal the Getting It Right First Time programme and national interventions to address those issues at a local level. The national cancer plan also tackles unwarranted variation through robust national data and oversight from the national cancer board, while ensuring that service configuration remains clinically led.

We have committed to improving the productivity of radiotherapy services, including by using artificial intelligence to streamline treatment. We will make a £70 million investment in state-of-the-art radiotherapy machines by 2027 through a managed national replacement programme. Imposing fixed legislative limits on the age profile of equipment would reduce the flexibility required to manage that programme effectively. Additionally, the NHS is already under a clear statutory duty to fund NICE-recommended interventions, supported by national commissioning guidance. Additional minimum standards would duplicate those safeguards without improving outcomes.

New clause 48 also suggests metrics to track radiotherapy performance. I assure the hon. Member for North Shropshire that high-quality and detailed data already helps us to understand emerging issues and to monitor performance. The National Disease Registration Service in NHS England collects diagnosis, treatment and outcome data on cancer patients in England. It routinely reports incidence, prevalence, survival, routes to diagnosis and treatment data on all cancers. NHS England also publishes monthly radiotherapy performance data.

On workforce capacity, we are already seeing increases in key roles, including clinical oncology doctors and radiologists, and the Getting It Right First Time review of radiotherapy services will report later this year. The new clauses risk duplicating efforts already in train to improve the oversight of radiotherapy services, workforce, data quality and coverage, and would create additional bureaucracy and divert resources away from patient care.

I turn to new clause 53. Improving performance against cancer waiting standards is a priority for this Government. We have made year-on-year progress with cancer waiting times, but we know that there is some way to go. Cancer incidence is about 15% higher than when the 62-day standard was last met, in late 2015. There are more than 200 distinct cancer types, and each is complex. The cancer waiting time targets, including the 62-day referral-to-treatment target, are not set at 100% for several reasons, including patient choice, clinical guidelines and the complexity of diagnosis and treatment planning. That means that not every patient can or should be treated within the waiting time standard. We therefore do not think the new clause is appropriate.

Change, including improvements to the cancer pathway and to tackle variation in performance, cannot be delivered overnight. The national cancer plan sets out the concrete actions that we are taking to get there. We have already demonstrated our commitment to transforming diagnostic services by investing £2.3 billion in diagnostic capacity. That will support us in achieving the 62-day standard through faster diagnosis. We recognise that the provision of cancer services, including treatment, varies across the country. The national cancer plan addresses how to tackle that variation.

To accelerate breakthroughs in cancer treatments, we will explore innovative procurement methods. That will aim to stimulate the development of new diagnostic tests, targeted therapies and more effective treatment for rare cancers, ensuring that the NHS remains at the forefront of medical innovation.

We believe that new clause 54, in the name of the hon. Member for North Shropshire, is unnecessary because the Department already has the National Institute for Health and Care Research and the national cancer plan underpinning its cancer research strategy. The Department invests about £1.8 billion each year on research through the NIHR. Cancer is a major area of its spending, at £141.6 million in 2024-25, reflecting the fact that it is a high priority. The NIHR does not usually ringfence funds for research in specific conditions; it welcomes funding applications for research into any aspect of human health and care, including cancer. Research is funded through open and fair competition and peer review to ensure that the highest-quality proposals most likely to deliver real impact for patients are funded without imposing financial targets or limits.

The national cancer plan is the first plan to have a dedicated chapter on rare cancers, which is important to many hon. Members across the House, including my hon. Friend the Member for Blaydon and Consett, who has done great work. The plan includes a commitment to make progress on rare cancers as one of six key research priorities to tackle stubbornly low survival rates. Our aim is to be in the top quartile across 28 countries for survival of 14 rare and less common cancers. Through the NIHR, the Department is the largest funder of clinical academic training. The NIHR plays a key role in attracting training and supporting the best clinical academic researchers, providing comprehensive research career pathways for clinicians across all career stages, from undergraduate level through to professional appointments.

New clause 100 would require the Department to publish a report on the feasibility of using data in patient records to flag symptoms. I understand the concerns behind it. We fully support using the single patient record and other data to improve cancer care and diagnosis, but we have largely covered the issues raised by the new clause in the cancer plan. We understand that there are concerns in some areas. The Government have introduced Jess’s rule, which instructs GPs to rethink a diagnosis if a patient presents with the same symptoms. That followed a campaign on behalf of the family of Jessica Brady, who tragically died after symptoms of her cancer were not recognised. The single patient record will give clinicians timely access to a single trusted record, which is why it is such an important part of the Bill. We envisage that the Bill, together with the cancer plan, will enable more personalised insight into cancer risk, for example, through the NHS app. For those reasons, we do not think the new clause is necessary.

[Dr Johnson]

If I heard the Minister correctly, she said that the ICBs would provide NICE-approved treatment, which they have to do within 90 days at the moment. At an earlier sitting, we debated an amendment tabled by the Minister that would enable the Secretary of State to delay the provision of NICE-approved treatment, which was agreed to. I am not quite sure how that is congruous, but in either case we would like to press new clause 48 to a vote.

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

--- Later in debate ---

[Karin Smyth]

I am grateful to the hon. Member for bringing another important disease to the attention of the Committee. I agree that modern service frameworks are important tools for improving patient care. They sit at the heart of our 10-year health plan, enabling a step change in both service quality and delivery. That is why we are prioritising making rapid progress on them. The first two MSFs, on sepsis and cardiovascular disease, will be published shortly, and a further four are in development. Given the momentum, it is clear that primary legislation is not needed to drive the development of MSFs; instead, we have established a robust, expert-led process.

[Liz Twist (Blaydon and Consett) (Lab)]

I should declare that I am an officer of the all-party parliamentary group for respiratory health. Clearly, a modern service framework is important, certainly for a constituency such as mine in the north-east that has a lot of respiratory health problems, but as the Minister said, we need action rather than legislative change.

[Karin Smyth]

Like my hon. Friend’s constituency, my constituency of Bristol South has a large tobacco industry legacy, and it is crucial to address respiratory disease in a way that looks at the whole person.

[Dr Prinsley]

Does the Minister agree that the single most effective thing that we have done for public health since we were elected is to get the Tobacco and Vapes Act 2026 passed? The gradual abolition of cigarette smoking will save more lives than anything else we could conceivably do in politics.

[Karin Smyth]

My hon. Friend tempts me to go down the path that we went down in another Committee. I recognise that the Tobacco and Vapes Bill took a long time to come through Parliament, despite having been started by the Conservatives under the right hon. Member for Richmond and Northallerton (Rishi Sunak). It faced a lot of opposition, but we are absolutely clear that that is the single most beneficial piece of work. The hon. Member for Sleaford and North Hykeham asked me about the future, in terms of vape shops and so on, and I have corresponded back to her on that issue.

Instead of what is proposed in new clause 49, we have established a robust, expert-led process. The national quality board will assess all proposals for new MSFs against a clear set of criteria, ensuring that we prioritise those areas where an MSF will deliver the greatest impact for patients. Alongside developing the first wave of MSFs, we are further strengthening the process, including by setting out a clear and consistent approach for assessing future proposals. Embedding an MSF in respiratory health in primary legislation would risk limiting that flexibility, rather than strengthening our ability to improve care, as my hon. Friends the Members for Blaydon and Consett and for Bury St Edmunds and Stowmarket have outlined, by taking the action that is so necessary to help and support people with respiratory disease.

[Dr Johnson]

The Minister talks about momentum, but as I understand it, there is a severe mental illness MSF, for which timelines are to be published in due course; a sepsis MSF that was expected in the spring but is now anticipated in the summer; a frailty and dementia MSF expected sometime this year; a palliative care MSF that was published in June as an interim update, but will not be complete until the autumn; and a cardiovascular MSF. I do not see very much momentum there, given that the Government have been in office for two years.

[Karin Smyth]

It is a lot faster than the 14 years in which it was not done under the Conservatives.

[Dr Johnson]

Actually, there were plans, changes and improvements in respiratory care. One of the more obvious ones for lung cancer was the start of the lung cancer screening programme. I do not think the Government have the momentum and vigour that is required. Of course, they have also paused the long-term conditions strategy, which was already written and would have delivered. This is important, and we will press new clause 49 to a vote.

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

NHS Pension Scheme: McCloud Remedy

Karin Smyth Excerpts

Monday 13th July 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

On 21 May 2026 I issued a written statement to update the House on progress on delivering the McCloud remedy for affected members of the NHS pension scheme. The delivery of the remedy in the NHS pension scheme is a hugely complex undertaking across the public sector to address the age discrimination that the previous Government admitted in 2018.

In the NHS, over 1.1 million pension scheme members are affected by the McCloud ruling, around 450,000 of whom have already retired. The Department has asked the NHS Business Services Authority, as the scheme’s administrator, to prioritise, where possible, delivery of the McCloud remedy to around 49,000 retired members who are likely to receive higher benefits following their McCloud choice. By 24 June, statements to enable McCloud choices had been sent to 13,982 of these members. Work to calculate and send statements to the remaining members facing detriment is progressing, with a current forecast completion date of December 2027, as set out in my statement on 21 May 2026. Members who have not yet retired will all receive a personalised statement and choice, either when they retire or retrospectively.

I also confirmed in May that the NHSBSA had developed detailed delivery plans for providing remedy choices to all members, including those higher earning members whose pension tax position is affected by McCloud. The NHSBSA has already issued remedial pension saving statements—RPSSs—to 122,036 members and is continuing work to complete the particularly complex statements for 19,694 members whose RPSS remain outstanding. The current forecast for completion of this work is March 2027.

I noted in May that these forecasts and the plan overall were subject to several critical dependencies highlighted by the independent review of NHSBSA’s McCloud functions. These dependencies include procuring external suppliers to supplement the NHSBSA’s capacity to manually calculate remediable service statements, and the release of software to automate statement production wherever possible. In my previous statement I expressed expectations that those dependencies would have advanced sufficiently so that I could issue new statutory deadlines for the issuance of remediable service statements—RSSs —with confidence before summer recess.

The NHSBSA has made progress in maturing those dependencies, including launching an invitation to tender to bolster calculation capacity for RSS and progressing testing on new IT systems that are being developed to automate some elements of statement production. I am pleased to report a positive market response to the invitations to tender. The NHSBSA is consequently taking the time needed to fully scrutinise bids and engage with constructive feedback in relation to the design of the second contract. The automating software has now entered its testing phase and its timetable for delivery will be dependent on the outcome of this testing. I have therefore concluded that further time is required to reduce the uncertainty in the plan timings to a level at which I am comfortable in setting new statutory deadlines. When the current work is sufficiently progressed I will set new RSS deadlines that are realistic and achievable and that protect delivery of normal pension service operations, which continue to run in parallel to remedy activity. I will also publish the independent review’s report and place a copy in the Libraries of both Houses.

Irrespective of when new deadlines are set, delivering the McCloud remedy remains a priority, particularly for those members who are likely to be facing financial detriment. The NHSBSA continues to issue remediable service statements and remedial pension saving statements to scheme members affected by McCloud, in line with the delivery schedule I set out in May. Data is now published monthly by the NHSBSA on the number of remediable service statements issued and remedy choices enacted. This is available at: https://opendata.nhsbsa.net/dataset/public-service-pensions-remedy-mccloud-remedy-remediable-service-statements-rss-delivery

[HCWS228]

Health Bill (Fifteenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing the following:

New clause 56—Accident and Emergency: waiting times—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.

(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.

(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (‘the Scheme’) to support NHS hospital trusts to achieve the requirement set out in subsection (2).

(4) The Scheme must consider—

(a) creating safety-net social care beds,

(b) increasing step-down care,

(c) publishing a dedicated accident and emergency care workforce plan, and

(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.

(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.”

This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this.

New clause 84—Publication of data on avoidable deaths—

“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.

(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.”

This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning.

We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.

[Sojan Joseph (Ashford) (Lab)]

I was pleased to take part in the debate in the Chamber yesterday. I raised some examples from my local hospital, which is expanding its same-day emergency care because of the funding that we received from the Labour Government. We also have a safe haven for mental health patients who do not need to go into accident and emergency. Lots of work is happening in my local hospital area, which will make a big improvement to corridor care and wider emergency care pressures. Does the Minister agree that that is what we need to do, and that the Labour Government are doing it?

[Karin Smyth]

My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement.

In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see.

Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that.

On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards.

The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published.

Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them.

In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent.

New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so.

To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided.

We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most.

I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital.

Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.

[Helen Morgan (North Shropshire) (LD)]

I will speak briefly to new clauses 12 and 56, about which we had quite a long debate this morning. Let me respond to a couple of questions. The shadow Minister asked about the role of Healthwatch in selecting the panel that would interrogate the Secretary of State, as we envisage in new clause 12, given that Healthwatch will be abolished by the Bill. She also asked about new clause 56, which would require the Secretary of State to have due regard to Baroness Casey’s final report. The shadow Minister said that those things are essentially inconsistent, but, considered as a suite of amendments, the provisions we have tabled are consistent. We oppose the abolition of Healthwatch; had that been successful, Healthwatch would still be there. We have also tabled new clause 60, which we will get to later and which would require Baroness Casey’s commission to report much more quickly. That is why that apparent inconsistency exists; I hope I have sorted that out for the shadow Minister.

The right hon. Member for Melton and Syston, a former Minister, talked about capacity in the system as a whole and its impact on corridor care. His concern was that if we focus on corridor care, we will end up with more people being treated in ambulances, have longer ambulance handover times and very long ambulance wait times. He will know, having been the responding Minister to my first Adjournment debate, that ambulance wait times have been a significant problem where I live. I am pleased to say that they are becoming less of a problem, because the new management of the hospital have focused relentlessly on the A&E department and on ensuring that ambulance patients can be taken into it very quickly, or certainly much more quickly than they used to be. I recognise his concern, but I think it is a manageable one.

--- Later in debate ---

[Karin Smyth]

I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so.

As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs.

In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it.

I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.

[Liz Twist]

I would point to examples such as in the north-east of England, where the work on smoking has been incredibly effective and still continues, and makes that real shift and change. Does my hon. Friend agree that it is those practical examples that we need to see, and to support along the way?

[Karin Smyth]

I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health.

My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel.

In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking.

The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages.

Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.

[Dr Johnson]

The Minister is very, very aware of my views and opinions on the Tobacco and Vapes Act, particularly on vaping and stopping vaping among children. That Act, a bit like this Bill, left lots of opportunities for the Government to provide for regulations. Anyone who has been in a shop in the past few days will have seen vapes still behind the counter, still very visible, very colourful and in lots of different flavours and suchlike. Can the Minister update the Committee, and therefore the House, on when she expects the regulations provided for by the Tobacco and Vapes Act to come into force, so that we can actually apply the law, as opposed to just having it sat on the statute book?

[Karin Smyth]

Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.

[Dr Prinsley]

I sit on the Home Affairs Committee, and we have lately been discussing the matter of serious organised crime, and vape shops in particular. It turns out that many of the vape shops are in fact not really shops; they are places for laundering money. Specifically, they launder money in relation to drug businesses and the drug trade, which is another huge public health matter that I am sure the Minister will agree needs to be dealt with. We were informed that about 10% of this country’s adult population are using illicit drugs, and that for the most part those are being delivered via the post office. Does the Minister agree that that is a massive public health issue that will also need to be urgently addressed?

[Karin Smyth]

I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it.

Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery.

What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there.

On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances.

Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause.

As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed.

On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities.

Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted.

Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister.

The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.

[Dr Johnson]

I understood that one of the Government’s greatest priorities was to reduce waiting lists, but one of the things that people are waiting for the most is musculoskeletal or orthopaedic treatment. Why is it not a priority for the Government?

[Karin Smyth]

There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken.

She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.

[Dr Johnson]

I am not opposed to the principle of GPs seeking advice or guidance; the issue is the compulsory nature of that and GPs not being able to refer.

[Karin Smyth]

The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that.

The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.

[Dr Chambers]

I thank all Members for their contributions to the discussion. The hon. Member for Lichfield made the good point that a committee of 70 people may not be that efficient. He should come to the Lib Dem parliamentary party meetings, which are incredibly efficient. We have incredibly insightful discussions, which is what makes us such an effective force, so I would not knock a committee of 70 people.

I appreciate the Minister’s acknowledgment of the important of cross-party work for public health. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 15

Impact of trade deals on the NHS

“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”—(Dr Chambers.)

This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

Brought up, and read the First time.

--- Later in debate ---

[Karin Smyth]

I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses.

Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [Interruption.] You started it.

On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.

[Helen Morgan]

The disquiet about the deal comes from the fact that the sums involved are huge—possibly £9 billion a year, or even more towards the back of the 10-year period—according to big companies in the sector. The Association of the British Pharmaceutical Industry was not involved in the negotiation of the deal; it was negotiated with the US. We fully support of the life sciences sector in this country, and there is a complex debate to be had about access to novel medicines for people with unusual and rare diseases, and about balancing that with everybody else’s access to volume services on the frontline, but that important discussion should be had by Parliament and the British people, not between a trade negotiator and Donald Trump’s White House. That is where our disquiet comes from, and it is why we tabled these new clauses.

--- Later in debate ---

[Karin Smyth]

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

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

[Joe Robertson]

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

[Karin Smyth]

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

[Dave Robertson]

To quote the Precision Health Technologies Accelerator at the University of Birmingham, very close to my Lichfield constituency, its leadership has been supportive of the removal of tariffs from pharmaceuticals, saying that the introduction of the tariffs could lead to

“supply chains collapsing and patients suffering.”

That is an enormous growth opportunity for the West Midlands combined authority, for Birmingham and for the wider region. There have been a lot of discussions, but I wanted to make sure that the views of organisations that will benefit are on the record, because this will be so beneficial for my region.

[Karin Smyth]

My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents.

New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.

[Liz Twist]

I want to emphasise a point that has already been made, which is the positive impact of the agreement for people with rare and undiagnosed conditions. As the Minister will know, I have worked with a number of those organisations, and this is certainly an opportunity for innovative treatments to be funded, as they might not have been before. I thank the Minister for that.

[Karin Smyth]

Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry.

We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.

[Dr Chambers]

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

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

--- Later in debate ---

[Karin Smyth]

Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House.

The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do.

I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important.

I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.

[Dr Johnson]

I thank the Minister for her good wishes. The council has not just proposed closing Swallow Lodge; it has also recently closed the memory support service. I listened to what my hon. Friend the Member for Isle of Wight East said about services for people with dementia, and this is another area where people will suffer because of the closure of vital services.

[Karin Smyth]

When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents.

We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers.

Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.

[Liz Twist]

As the Minister says, many people in this room have had experience of being a carer for a family member. She said that there is already a legal framework, but carers are clearly saying that they need a bit more. How will the Government ensure that we provide not just words and legal documents, but help on the ground?

[Karin Smyth]

I was just moving on to talk about some of the work beyond the legislative framework.

Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.

[Dr Prinsley]

Will the Minister acknowledge that the uplift in the carer’s earnings allowance is a very significant measure that this Government did introduce?

[Karin Smyth]

I thank my hon. Friend. That is indeed one of the ways in which, working through the DWP and across Government, we have sought to bring in, as my hon. Friend the Member for Blaydon and Consett said, practical measures to make carers visible and to support them. That is exactly the sort of thing we wanted to do and have done, and it does start to recognise the work that people do.

Let me turn to new clause 17 and new clause 89, which my hon. Friend the Member for Blaydon and Consett talked about and which was tabled by my hon. Friend the Member for Shipley, whose expertise and commitment in this area are well known across the House. The new clauses look at the identification of, and provision of information to, unpaid carers. I agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice so that they can be better supported and involved in care decisions.

However, we do not believe that explicit requirements to identify and record particular patient and carer groups are appropriate for legislation. We have made clear commitments in the NHS 10-year health plan and are taking practical steps to improve identification, support carers and involve them in care planning. If we need to mandate compliance, that is best done by including requirements in national NHS contracts or in statutory guidance or directions, where we can provide more detail and directly address barriers.

Information about unpaid carers will be captured systematically to ensure that their responsibilities are recognised and supported, and developments such as the single patient record, which we have discussed in Committee, will make that easier in the future. That is a really important step forward.

We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England recently published guidance to support that, and work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.

We are also working to improve the quality of local authority data on unpaid carers. The Partners in Care and Health programme, launched with the Local Government Association, is working with local authorities to improve their data and address barriers to data sharing between local systems.

[Dr Prinsley]

Since I have been an MP, I have visited a number of schools in my constituency, and I have always been struck by the number of children who are carers. [Hon. Members: “Hear, hear.”] I think that is a very under-recognised group of people, whose lives are completely dominated by the fact that they are carers for their parents.

[Karin Smyth]

I thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy.

I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that.

More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it.

I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning.

New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer.

Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services.

The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities.

For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.

[Dr Chambers]

I thank Committee members for their contributions. The hon. Member for Isle of Wight East spoke particularly well and emotively—I know that he worked for Dementia UK before entering Parliament. My mother was a carer for my father, who had dementia, and my sister and I gave her respite care, although probably not enough of it. I know that many Committee members will have been in a similar situation, as it is a common disease, and it is becoming increasingly common. I also thank the Minister for her comments and reassurance.

The hon. Member for Bury St Edmunds and Stowmarket made a point about children being carers. I sat on the Mental Health Bill Committee last year, and to give an example of how impactful such Committees can be, it is now a requirement, as a result of the Committee’s consideration, to identify whether mental health patients have children who are carers. That was not the case before, and we appreciated the Government engaging with us on that issue. It is often teenagers who care for adults with severe mental health issues, but they were not even identified before, so they could not be given the support they required. That has changed now, and it is fantastic to see that, through Committee scrutiny, we can make a tangible difference to people’s lives.

I will not press new clauses 16 and 17 to votes, but the Liberal Democrats do think that it would be sensible and impactful to establish a national respite care scheme, so I will press new clause 18 to a Division. On new clause 16, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 18

National Respite Care Scheme

“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.

(2) The scheme under subsection (1) must make provision for—

(a) a local authority carrying out a carer’s assessment under section 10 of the Care Act 2014 to be required to consider whether a carer is able to take sufficient breaks from their caring responsibilities.

(b) unpaid carers to receive support to take breaks from their caring responsibilities to—

(i) maintain their physical and mental health and emotional wellbeing,

(ii) participate in work, education, training or recreation, and

(iii) participate in family and community life.

(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.

(3) Under subsection (2), ‘support’ may include—

(a) replacement care for the cared-for person;

(b) respite services;

(c) any other steps a local authority considers appropriate as support.

(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.

(5) For the purposes of this section ‘unpaid carer’ has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.”—(Dr Chambers.)

This new clause would require the Secretary of State to establish a National Respite Care Scheme.

Brought up, and read the First time.

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

--- Later in debate ---

[Dr Johnson]

The hon. Member for Dewsbury and Batley (Iqbal Mohamed), who tabled new clause 25, asked me to speak to it, which I shall do briefly. This is a very serious issue. Critically ill children are infants, children and adolescents with life-threatening illness or injury, often requiring intensive, continuous care to survive conditions from leukaemia to meningococcal disease, traumatic brain injuries and major surgery such as spinal surgery. I should say that I am a consultant paediatrician, but I have worked in paediatric intensive care as a junior—now called a resident—doctor.

The new clause as drafted does not, I think, do what the hon. Member was aiming for. When I read it through, I think he is looking at cases such as the tragic one of little Charlie Gard, whom we all remember died of encephalomyopathic mitochondrial DNA depletion syndrome, known as MDDS. It is incredibly rare. That tragic case highlighted the potential for disputes between parents and doctors, which, thankfully, are unusual.

The new clause is headed, “Parents of critically ill children: communication and involvement in decision-making”. Of course parents should be involved in decision making about their children, but it is worth noting that the median time that children spend in ICU is two days and that, thankfully, most of them get better—very few do not. The new clause talks about teachers being involved, which in most cases is unnecessary and impractical; in many cases, a child may be admitted on a Friday and discharged from the ICU by the Monday. In the majority of cases, there is no practical reason for teachers to be involved.

I understand the desire for parents to be part of every meeting, but sometimes clinicians need to be able to talk frankly about cases. Sometimes they will have multidisciplinary meetings where they talk about a plethora of different cases, or they may compare one case with another in terms of what they have seen, the findings of scans and the like, so it is not possible to have parents in every single meeting, although it is of course desirable for them to be aware of the discussions.

Other parts of the new clause, including provision for parents to know about everything and to set out how communication and language needs may be met, seem reasonable. It mentions independent mediation where there is disagreement, which is a beneficial way to go about things, but we must not legislate so as to get in the way of urgent care, because most critically ill children in intensive care have urgent care needs that need dealing with now, not in a week’s time. Forming ethics committees to make decisions takes a long time, and that would get in the way of urgent care.

I think the hon. Member for Dewsbury and Batley is aiming for legislation that relates to chronically mechanically ventilated children with significant medical conditions, rather than children with an acute critical illness, but I said I would move the new clause and I have. I think he is trying to provide better care for some of the sickest children. That is a desirable aim and I know he cares deeply about it, but the new clause as drafted would not do what I think he aims for, and it could get in the way of paediatricians and others managing some of the sickest children in the country, so I will not press it to a vote.

[Karin Smyth]

I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee.

I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible.

New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time.

Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child.

To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.

[Dr Johnson]

The Minister is setting out the important guidance that can be provided to clinicians managing the care of children who are seriously unwell. I want to add for the record that I am a member of the Royal College of Paediatrics and Child Health, which is producing that guidance; I am grateful to her for setting out its importance. End-of-life-care decisions are very difficult. They need to be taken in conjunction with families but—the Minister is absolutely right—they must be made in the best interests of the child in all cases.

[Karin Smyth]

I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system.

There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 28

Appeals against health and social care provision in EHC plans

“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).

(2) After regulation 42, insert—

‘42A Other matters relating to EHC plans against which appeals may be brought

(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).

The matters are—

(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;

(b) where an EHC plan is maintained for the child or young person—

(i) the child’s or young person’s health care or social care needs as specified in the plan;

(ii) the health care provision or social care provision specified in the plan.’

(3) In regulation 43 (appeals), after paragraph (2) insert—

‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);

(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).

(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;

(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;

(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and

(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.

(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);

(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).

(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;

(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;

(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and

(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.

(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.

(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.

(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—

(a) the child's parent or the young person, and

(b) the local authority that maintains the EHC plan.

(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.

(11) A response under paragraph (9) must—

(a) be in writing,

(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and

(c) give reasons for any decision not to follow the order, or any part of it.

(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.

(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.

(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.

(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’

(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.

(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—

(a) regulation 10(3)(e);

(b) regulation 14(2)(e);

(c) regulation 201(11)(e);

(d) regulation 21(10)(e);

(e) regulation 22(5)(e);

(f) regulation 25(2)(e); and

(g) regulation 31(3)(e).”—(Dr Chambers.)

This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.

Brought up, and read the First time.

--- Later in debate ---

There is a lot of merit in the new clause and, as my hon. Friend the Member for Sleaford and North Hykeham said, it will be interesting to hear the Minister’s thoughts on it. Obviously, this needs to be done in collaboration with the Department for Education, and it is right—the Select Committee acknowledged this—that other changes would also be needed to support it, including workforce increases and changes to commissioning, but that should not prevent us from seriously considering the new clause. I pay tribute to all the parents and carers in my constituency who are struggling with the EHCP process and doing their best for their children under really difficult circumstances.

[Karin Smyth]

May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.

[Dr Prinsley]

My wife is an educational psychologist, so I have lived this, in a vicarious fashion, for the last 30 years or more. I understand how the system for special educational needs has evolved, particularly the role of the psychological services and how children are supported. As a result of a series of reforms, in particular during the years of austerity, the services provided by local authorities to schools—particularly the schools’ psychological services—became much more focused on psychologists providing reports to inform the distribution of resources, and much less focused on educational psychologists actually being in schools supporting children. I would like to see a change, such that educational psychologists and their expertise are back in schools, in classrooms, supporting teachers. Time and again when I visit schools, they say, “Let’s get educational psychology support back into schools.” I think that is something my wife would support.

[Karin Smyth]

I thank my hon. Friend for that. I put on record my thanks—our thanks—to his wife for her work in this area and for making him so aware of the issues, because he is absolutely right. This is a long-in-gestation issue that some of us have watched sadly get worse in our constituencies over recent years. Children only get one chance to come through this system, which is why people feel so passionately about it.

[Sojan Joseph]

I pay tribute to all the parents and schoolteachers who engaged with me last summer, following the White Paper and the SEND consultation. It has been a huge problem in Kent. Kent county council has been under Conservative administration for the last 25 years. In recent years, it was in special measures because of its SEND provision. Parents really struggled. My inbox is filled with these issues. We know that 98% of SEND provision tribunals rule in the parents’ favour. There has been a long wait. Does the Minister agree that, whether we accept the new clause or not, we need to look into how the NHS and local authorities can work together to make it easier for children, families and schools to get proper provision in place?

[Karin Smyth]

I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals.

The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.

[Liz Twist]

I recently held consultation meetings on the proposed SEND reforms in Blaydon and Consett. The message from parents was clear in both places: they wanted greater integration of health into EHCPs. I welcome the Government’s commitment to asking ICBs to work more closely with local authorities to develop SEND reform plans and tackle this issue. Does the Minister agree that it is important for ICBs to take that on board?

[Karin Smyth]

I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country.

That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms.

Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why.

There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, I ask the hon. Member for Winchester to withdraw the new clause.

[Dr Chambers]

I thank everyone for their comments. I thank the Minister for her reassurances on the seriousness of this issue. Given that we are waiting for the response to the report, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Ordered, That further consideration be now adjourned.—(Emma Foody.)

Health Bill (Fourteenth sitting)

Karin Smyth Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Dr Johnson]

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

[The Minister for Secondary Care (Karin Smyth)]

It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.

There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.

The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.

Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.

--- Later in debate ---

[Gregory Stafford]

It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.

It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.

I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.

That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.

Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?

[Karin Smyth]

Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.

On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.

NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.

As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.

On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.

At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.

There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.

The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.

[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 12

Corridor Care Accountability

“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.

(2) A report under subsection (1) must include—

(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,

(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,

(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and

(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.

(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—

(a) patients,

(b) bereaved or affected families, and

(c) frontline NHS staff who have been impacted by corridor care.

(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.”

This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff.—(Helen Morgan.)

Brought up, and read the First time.

--- Later in debate ---

[Gregory Stafford]

I will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do. 

On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.

[Karin Smyth]

As the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.

[The Chair]

Order. I think we are moving a little out of scope here. Could we bring it back to the contents of the Bill?

--- Later in debate ---

[Dr Johnson]

I am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.

[Karin Smyth]

To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.

[Dr Johnson]

I think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.

Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.

Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.

Health and Social Care 10-year Capital Plan

Karin Smyth Excerpts

Wednesday 8th July 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today the Government are publishing the 10-year capital plan for health and social care. Long-term capital under-investment has left the healthcare system starved of resources to function at its fullest, with large parts of the NHS and wider healthcare estate operating in outdated, inefficient and occasionally unsafe infrastructure. This was made clear in Lord Darzi’s report, which estimated a £37 billion shortfall of investment since 2010 compared with international peers.

The 10-year health plan set out the long-term vision for healthcare provision with the three shifts of hospital to community, analogue to digital and sickness to prevention as the core components of a new care model based on the NHS’s founding principles. This capital plan will bring together our commitments into a single coherent framework that is aligned with the 10-year health plan, and ensure infrastructure is the enabler for transforming the NHS over the decade ahead.

The Government are fully embracing this challenge and have already taken steps to address the root causes affecting healthcare delivery. At spending review 2025, the Chancellor provided the largest ever health capital budget, as well as multi-year allocations to 2030 for capital funding streams overall and extended certainty on NHS maintenance budgets to 2035. The priority is now to get on and deliver our priorities within this—making the most of both the budget and the certainty that enables the most strategic investment choices.

We will enable the first shift from hospital to community by reconfiguring the estate so that patients see the appropriate staff in the right place, and we have already invested £102 million in the primary care utilisation and modernisation fund, with a further £200 million over four years to 2030. In addition, we will support the development of neighbourhood health centres, as well as ensuring the secondary care estate can deliver the highest-quality healthcare for the most complex and specialist cases. Maintenance of the estate will extend beyond the current spending review via an investment of £6.75 billion over nine years to target the most critical building repairs through the estates safety fund.

The second shift from analogue to digital will be enabled through over £4.4 billion of capital investment over this spending review period, alongside over £6 billion of revenue funding into technological and digital programmes. This will enable seamless navigation between primary and secondary care such as through the NHS app and single patient record as part of an ambition to make the most digitally accessible healthcare system in the world.

The third shift from sickness to prevention will be achieved through continued investment into research and development as part of DHSC’s non-NHS capital allocation over the course of spending review 2025. This will enable earlier identification of illnesses, allowing for earlier intervention and strengthening system resilience to future threats. This is backed by notable investments including a new state-of-the-art health security campus in Harlow, Essex, that will create 1,600 extra jobs, and up to £1 billion for pandemic preparedness to replenish and expand stockpiles, in line with lessons learned from covid-19. We are also continuing our investment into genomics, pledging more than £650 million over the next five years.

This plan also supports the Government’s wider missions set out in the plan for change of driving economic growth and productivity, supporting the housing agenda, creating new healthy spaces to live and progressing towards net zero and clean energy. We will continue to commit to the NHS’s existing net zero targets and increase its climate resilience through continued setting of standards, showing climate leadership, and working across the system to break down barriers to financing and delivering net zero investments.

The increases in funding will be supported by our capital reforms, to reduce the layers of approval and reduce the time from initial proposal to get spades in the ground. We have already set the additional freedoms and flexibilities through devolving more control over capital budgets to the NHS frontline. Through this plan, we are also placing much greater focus on the outcomes of spend, and on taking steps to continually strengthen our approach to evidence, evaluation and benefits realisation.

The 10-year capital plan provides the clarity needed to do things differently and allow capital to become a true enabler of healthcare reform.

[HCWS202]