Underperforming NHS Trusts: Government Oversight

Debate between Marie Goldman and Caroline Johnson

Wednesday 14th October 2026 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Chelmsford (Marie Goldman) on securing this debate on a subject important not only to her constituents but to all of us right across the country. The performance of the NHS is key to the health of the nation. It gives us all the best chance of good health and recovery, which is important for our social wellbeing and brings economic benefits.

The first question is this: how do we know which trusts are performing well and which are not? First, we need to decide what good performance looks like. We can look at that in a couple of ways, in particular in relation to outcome and experience, both of which are important. The outcome, for example, may be a death. That will come to us all eventually, but the experience might be one of comfort, in line with the wishes of the individual—as good as can be delivered. Conversely, one could on the face of it have a good surgical outcome from a trust but a poor experience of care during that experience.

Experience is measured in a number of different ways: individual staff, such as consultants, have patient feedback as part of their appraisal and revalidation; the friends and family test enables people to give anonymous feedback; the number of complaints or compliments can be measured; and trusts do their own surveys—but those are all to some extent internal processes.

[Marie Goldman]

I would love to hear more of what the hon. Lady is saying, but none of us can hear her well. My plea to the hon. Lady is to speak up a bit.

[Dr Johnson]

Sorry, the microphone went off, but it has just come back on again.

The processes are mostly internal. Healthwatch is an independent patient voice, which looks at people’s experience across the health service in a way that is independent of Government. As part of the Health Bill, however, the Government plan to abolish Healthwatch and to bring it inside the Department. Will the Minister comment on whether they still plan to do that?

When he was Mayor of Greater Manchester and in charge of its integrated care board, the Prime Minister wrote to the Government to suggest that they might be on the wrong path. As Prime Minister, does he still think so? What instructions has the Minister had in relation to that? People are sometimes frightened to provide feedback to trusts, but they will be more willing to do so when they have confidence in being heard independently.

Other ways in which the Government measure experience relate to waiting times—how long it takes to be seen in clinic, how long it takes to be seen in A&E, how long it takes from the decision to admit a patient to actually admitting them, or how long it takes for a procedure or an operation. The Government produce lots and lots of figures but many of them, I am afraid, go in the wrong direction.

The Government have a dashboard for the referral to treatment statistics, and the waiting lists are rising. The number reached a low point in March 2026, just after the reports of exceptional numbers of removals, but it has now risen by 222,000 in the past four months. I am afraid that the numbers waiting for a procedure or operation are higher now than at the general election. This year, many more people than in 2024 waited more than 12 hours in A&E after a decision to admit them. Staff sickness rates, mentioned earlier in the debate, are also consistently higher than they were before the general election. Statistics across the NHS are not going in the right direction.

The Government also measure outcomes through the financial management of a trust, leadership and Government metrics, the number of procedures performed, the number of “never” events, and CQC inspections. Again, the Government are planning to fold HSSIB into the CQC, which many commentators have warned against; the Liberal Democrats and we the Opposition have spoken against the abolition of HSSIB. When the Government take the Health Bill through the Lords in Committee in the next week or two, I hope that they will think again. The Government also plan to roll a number of other things into the CQC at the same time, including events management; I wonder whether they are asking an organisation that they acknowledge has been struggling to take on too much.

If poor performance is identified, who is responsible? Is it the consultant or the matron? Is it the directors’ suite—the chief executive or the chair? Ultimately, if a trust is underperforming at the moment, governors are supposed to hold the board to account. The Health Bill abolishes those. The ICBs—the commissioners—can hold the trust to account but their budgets have been halved, so will they have the capacity to do so? Many of them have merged, and some of those mergers have been paused by the Government. This is all a distraction. NHS England has a role, but it is being abolished too. Apparently, the overall headcount in the DHSC and NHS England is to be halved. How will they have the bandwidth to provide the scrutiny that the Government say they will have?

Having identified the management of poor performance, the Government chose five trusts—North Cumbria, Mid and South Essex, Hull University Teaching Hospitals, Northern Lincolnshire and Goole, and East Kent—to have a special intensive recovery programme in March 2026. However, it is not clear what has been instituted in those trusts, what outcomes that programme is developing, how long it will last or what the Government will do for those trusts that fall just outside that group of five.

How will the Government improve the variability between trusts that do not fall into the bottom cohort? How did they choose the five trusts that were chosen? As we heard earlier, there are several metrics by which some trusts could be considered in the bottom five, but they were not chosen, and some metrics by which those that were chosen may not be in the bottom five. How has the Minister chosen those trusts and how does she intend to improve those that do not fall into her chosen few?

The Government have promised a workforce plan, but the workforce is the most important thing. Right hon. and hon. Members have spoken in this debate about the really good staff in their trusts working extremely hard in very difficult conditions. The previous Conservative Government developed a long-term workforce plan. This Government decided that they wanted their own workforce plan—they won the election so they are very much entitled to make one. But they have still not written it. They promised it by the end of 2025; we are rapidly approaching the end of 2026 and it is still not with us. Can the Minister—[Interruption.]

“For Women Scotland” Court Ruling: First Anniversary

Debate between Marie Goldman and Caroline Johnson

Tuesday 14th April 2026 Westminster Hall

[Marie Goldman]

That is exactly why we need the Government to come forward with proper guidance—so that organisations can work through this properly and understand when they are working within the rules, and so that they do not have to reinvent everything for themselves. We do not have that guidance, and it is desperately needed.

[Dr Caroline Johnson]

Could the hon. Lady say what her ideal situation would be? Would it be that if a gentleman walked into the ladies’ changing rooms, perhaps at a swimming pool, it would be illegal to stop them or even ask them? Would the solution be that any man could go into any women’s changing room if he wished?

[Marie Goldman]

I struggle with the idea that a trans person would go into the opposite sex’s changing rooms, which they are supposedly not allowed into, for the purpose of causing harm. That is surely what we are worrying about: harm being caused, particularly to women. I struggle with the idea that, at the moment, it is the sign on the door that is preventing someone from causing harm to women. Do they go, “Oh, I wanted to harm a woman, but I’m not going to do it because the sign on the door says I shouldn’t”? I struggle with that argument in general.

It should not need to be spelled out in Britain in 2026, but requiring women and girls to prove that we are female enough—because we have to do the same thing—is not only a deeply regressive step and an impractical requirement to put on businesses and other organisations, but deeply discriminatory, judgmental and, speaking as a woman, outrageous and unworkable.