Health Bill (Second sitting)

Debate between Liz Twist and Helen Morgan

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Helen Morgan]

Q My second question is similar. In reality and in practice, how do you envisage ICBs will be locally accountable once these legislative changes have taken place?

Sir Ciarán Devane: According to the ICBs we are talking to, which is all of them, they are saying that they believe in local authority engagement. We will be saying, “You may not be told you have to, but we would encourage you to do it.” I am sure that should be coming from the Department as well.

The witness to my right is an example of that; we know that when the NHS has really good local connections, you can get things done in the interests of your patients much more easily. The belief is there, but we need to make sure that the legislation is not seen as a signal that this is unimportant. That is a risk. As a representative organisation, we have to say to people, “We hear you saying that you really believe in this. Therefore, you need to demonstrate, not least to the Secretary of State, that you are following it through.”

I have a small additional point about mayors in unitary authorities being able to appoint somebody who is both the chair of the ICB and the local health commissioner. That should help. Those individuals will have to work out how to serve two masters, but that is okay—other people learn how to do that, too.

James Blythe: I would focus on a slightly different part of the Bill in terms of how this needs to work. There are 25 ICBs; that is quite a large footprint. From my experience of delivering meaningful collaboration and joint working between health and local government, I think it tends to happen at a more local level than that. The neighbourhood health plan in the Bill becomes extremely important. As a system, we should be very ambitious for those neighbourhood health plans. They should go a lot further than just describing what should happen in terms of improving health outcomes at a local level.

We should set an aspiration as a system that there should be a responsibility on health bodies and local government bodies to describe how changes will be made. The role of ICBs is to enable groups of providers and other organisations in local areas—most ICBs will have several places—to come together and not just work out what a local population needs, but actually do it. That will mainly be about relationships on the ground between an acute hospital team, a community services team, a mental health team and a social work team.

The role of ICBs is very much to give the contractual tools and mechanisms to local NHS organisations to work effectively with their local authorities so that there are really good neighbourhood health plans. Most importantly, they should not just write them but actually see them through.

[Liz Twist (Blaydon and Consett) (Lab)]

Q Sir Ciarán, the 10-year health plan, which is behind a lot of this, demands that we are really ambitious in involving patients and communities in shaping the services that they need. How can we best support ICBs, local authorities and other organisations to drive that change?

Sir Ciarán Devane: I go back to our having to convince people. Many people are convinced—that is probably the first thing to say. But we have to convince people of the benefit of doing this. Delivering the ambitious neighbourhood health plans that James describes will happen only if everybody is in the room and doing it.

I do not necessarily think that the legislation can mandate that belief or the way to do that. However, it can set an expectation for the ICB that, in developing its plans, it should be able to demonstrate that it has engaged with the local authorities, patient organisations and the public local to it. The legislation can set an expectation that the ICB is using population evidence to make the right commissioning choices and that, if reconfigurations, which may well be locally contentious, are to happen, engagement happens beforehand. As elected Members, the Committee will know that those conversations should start early and that local populations should not just be bounced into something.

It will be incumbent on the new department to set those expectations with the ICBs about the new way of working. That is the only way we are going to create an NHS that will be able to cope with the number of frail, elderly people with multiple morbidities. Those people are a consequence of the success of the NHS over decades. People are living longer with cancer; the prevalence of cancer—the number of people alive with cancer—has doubled in 20 years. But that means that there are four million people who are not necessarily well. The only way to cope with that is to make a significant and radical change to the neighbourhood health plans and bring the public with us. That will happen only with proper patient and public engagement.

--- Later in debate ---

[Liz Twist]

Q Minister, we have talked a lot today about ICBs, the local government Healthwatch and the single patient record, and we have heard some interesting comments. Can you summarise why you believe it is important that we look at this legislation now?

Karin Smyth: I will come to the single patient record because I think it is a gamechanger. We have heard today from some fantastic experts about the work they are doing to identify how it might work and how we might bring patients and the public with us. Again— I do not think we should just bank this—we have not heard anybody object to it.

We did have some evidence highlighting how things have gone wrong in the past. I worked at a primary care trust and clinical commissioning group at the time when care.data was brought forward. We can all point to where it has gone wrong, but nobody has said that this is not the right thing to do. That is good, but there is still a lot of detail to go through.

We need to keep highlighting the benefits. We heard from Peter Prinsley about whether patients have more control—we do think this is about empowering patients. That was what we said in the 10-year plan. The 10-year plan is about empowering patients in this very large system, for which they are now paying £200 billion of their taxes.

We heard from the excellent clinical panel. I defer to clinicians about what they need, both if they are dealing with chronic long-term conditions—we heard that it can sometimes take two and a half hours for an assessment—or if they are working in a busy emergency department. The fact that this is needed will be controversial. There will be a lot of questions about it and a lot of concern about privacy, data, cyber and so on. We need to hold on to those benefits, which are huge in clinical terms and for patients.

Another point we heard, which is also true, is that people think this already happens. People do not understand why, when they turn up at an A&E in Whitby, as we heard, or somewhere else, and then go back to central London, the systems cannot talk to each other. For me, that is about people’s trust and belief in what is a public service. It is a really important part of that.

On abolishing NHS England, I do not think anyone has come to one of my constituency surgeries and said, “Please do this,” or talked about it in great detail, but people do understand. My experience in opposition and so far in government is that MPs are perplexed when they try to intervene on behalf of patients, or to get an answer locally as to why on earth chief executives of ICBs or trusts sometimes do not respond even to a Member of Parliament’s requests for meetings. I find that shocking, but it does happen. How on earth is a patient or somebody struggling through the system expected to get a response? Getting it right is not black and white, and it is not easy to get the balance right between the Secretary of State’s democratic oversight and autonomy at a local level, but the Bill starts the process of doing that, and it is fundamentally important.

Regarding the other provisions, I accept that great work has been done by many people in Healthwatch and its predecessor organisations, and by people working in the patient safety landscape, but again it is not working. I think that those bodies have been allowed to abdicate responsibility for the core role of patient experience and patient voice. That is not their homework; it is their actual job. It is not something that should be outside, and that is why I think this Bill is really important.

[Helen Morgan]

Q I think I would agree with you, Minister, that no one thinks that abolishing NHS England is, in itself, a bad idea, given the duplication and cost. People do not think that a single patient record is a bad idea; I think that they assume that it already exists, and it could be transformative. There are therefore some really good points of agreement on the Bill.

It would, however, be helpful to reflect on where there is not agreement: on abolishing Healthwatch and HSSIB. You make the very good point that they have not been successful in their current incarnation, but it is important to consider whether that is because they do not have teeth, or because the organisations that they are trying to change are defensive.

We heard earlier about the culture of fear, and I think that we have probably all had people in our surgeries who can describe being frightened to speak up about their own personal care because they feel that they might be victimised for it. I know of clinicians who are frightened to speak up about their own experience in the organisation in which they work, because they feel that they will be punished for it.

In the light of that defensive culture that we know exists in the NHS, and has been highlighted time and again—Mid Staffs; the Shrewsbury and Telford maternity scandal—is the answer not to put the patient voice in the organisations that have a culture problem, but to give those other organisations the teeth they need, or confer a duty on the ICBs or providers to act on recommendations that are given to them, because I think that might be a more helpful way of dealing with this problem?

Karin Smyth: I think that gets to the crux of some of this. We will discuss it a lot in Committee, and I am obviously very open to keep discussing it.

Thank you for your support on the main provisions. I do not take that for granted because, again, they are still controversial. However, as I think I said earlier, you are right, although it is not true everywhere. I am not blaming individuals, because I think that people have been trying to do a difficult job, particularly in getting us through the pandemic and beyond. But they are defensive. That is why Members of Parliament and others do not get responses to their phone calls or their emails. That is a culture that we have to change, and we need to support people to change.

One of the things that we will do is to bring in regulations—that is a manifesto commitment from the Government—but another commitment that we have made outwith the Bill is to develop a leadership college to support in particular clinical and non-clinical managers, who have a very difficult job, in having the right skills for the new world, which patients and the public rightly expect to be more open and more transparent. We have to change this defensive culture.

However, even since Francis, the adding of bodies and the adding of recommendations, and with the bad experience that you have done so much around, something different has to happen. Again, what we heard from Jeremy Hunt was that we needed to put more prescription into the system and yet more requirements to do something without actually making that someone’s central function and job.

Now, it is a source of disagreement. As I have said, I think that there is a philosophical disagreement about the best way forward. It is not an antagonistic disagreement; there are fundamentally different views about what to do. We will continue to have discussions, because I think that ultimately we all want the same thing: a more open, transparent and supportive culture. By the way, nobody wants to work in a defensive culture, so I think people want that outcome.

It is up to us as politicians to support difficult conversations and trade-offs that happen locally. My view has always been that politicians will support difficult conversations and trade-offs—we heard a little bit about reconfigurations earlier—if the system provides good clinical rationale, good data and good evidence, but those bits of it do not always line up.

That is what I would like to get to. I absolutely understand and hear what you say—we will hear more about it and discuss it more, and I have read all the amendments about the best way forward. I think that we all want to get to the same place, but what is the best way to do that, given that we all know that this is really not working and cannot continue?

Service Family Accommodation: Maintenance

Debate between Liz Twist and Helen Morgan

Monday 19th June 2023 Commons Chamber

[Helen Morgan]

I agree with my hon. Friend wholeheartedly.

My understanding is that the current maintenance contract allows just two weeks after a family leaves a house to carry out any required upgrade work, including any repairs but also big-ticket works such as retrofitting insulation and replacing kitchens and bathrooms. Clearly, two weeks is not long enough if a significant amount of work is required. That leads to incomplete or poor-quality work, which costs more to fix in the future and causes disruption to the family living there.

The overall feedback from my constituents—there has been a lot of it—is that the response to requests for repair and the management of empty houses have deteriorated since the contract was restructured last April, and that while the coming of spring and summer has improved living conditions in the short term, there remain significant concerns about the operation of the process. There appear to be too many hand-offs between, in the case of my constituents, the contractors Pinnacle and Amey. I note that in response to an urgent question in December last year, the former Minister acknowledged that there were IT issues. That rings true with the experiences that have been related to me, in which requests have either not been logged in the first place or have gone missing in the hand-off between the two companies.

Anyone who works in a business knows that IT issues in a contract restructuring of this scale are inevitable, but the Minister suggested that they were unresolved in December 2022, a full nine months after the restructured contracts went live. Has there been any further improvement to date? I have a constituent still reporting little progress on a leaking roof and radiators. The roof was fixed in five days, but the scaffolding remained up for five weeks at goodness knows what unnecessary cost to the taxpayer and the radiators still leak. There is damp and mould, and they have not been given the results of a damp survey that was apparently carried out in December last year.

I hope I have illustrated the chaotic and broken process of reporting an issue and getting it fixed under the newly restructured contract, the shocking state of dilapidation of some empty homes that could otherwise be used for housing our service families, the impact on the service family community, and the unacceptable waste of taxpayers’ money. This is the price of a failing process. We have spent much time in this Chamber rightly debating, and indeed agreeing on, the need for social housing to be of a decent standard, and for tenants to have the right to demand a decent standard, both in the context of the Social Housing (Regulation) Bill as it passed through Parliament and in demanding an end to the system that led to the shocking death of Awaab Ishak.

[Liz Twist (Blaydon) (Lab)]

I congratulate the hon. Lady on setting out the issues in her excellent speech. Labour launched our “Homes Fit for Heroes” campaign a few months ago to focus attention on this scandal and my Front-Bench colleagues have said that, if elected, we will make addressing it a priority. As she said, we cannot carry on with leaky roofs, broken boilers and damp; we must make this a priority. Does she agree that the Government could have done a lot of work already to improve things for the services?

[Helen Morgan]

I thank the hon. Lady for her intervention. I broadly agree with her.

We need to accept that our service families have the same right to decent housing as everyone else in this country. When they report a problem, they should expect a response. I do not need to remind anyone that, as my hon. Friend the Member for Bath (Wera Hobhouse) pointed out, servicemen and women are prepared to make the ultimate sacrifice for us. We should at least ensure that they can have a hot shower and a mould-free home in a supportive community. I am sure the Minister will agree with that point, so I would like to conclude by asking him to respond to some questions about the functioning of the contract as it currently stands.

Will the Minister update the House on the current situation regarding outstanding calls and issues raised? How confident is he that all the data on those calls has been captured, given the issues I have recounted of problems not being recorded or being lost in the hand-off between the two companies? What is the long-term plan to deal with the issue of empty properties falling into disrepair and out of use altogether? Does the Minister believe that the current contract structure is commercially viable in the long term, given the unanticipated additional resource that the contractors have had to commit to resolving backlogs and dealing with the additional hand-offs within the process? Is there a deadline by which he expects these contracts to be operating on an acceptable “business as usual” basis? Has he considered restructuring and renegotiating the contracts, given the obvious operational difficulties that have been experienced? Finally, is he able to quantify the additional cost to taxpayers of dealing with the problems that have occurred over the last year?

I am grateful to the Minister for his time at this late hour on a Monday, and to Mr Speaker for granting a debate on an issue that I know is of the utmost concern both to the service families currently based in North Shropshire and to those elsewhere in the UK. I look forward to the Minister’s response.