Thirlwall Inquiry: Final Report and Recommendations

Nusrat Ghani Excerpts

Tuesday 15th September 2026 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Because the ministerial statement ran over, the shadow Secretary of State has six minutes.

--- Later in debate ---

[Yvette Cooper]

I thank the right hon. Member for his response and questions and for the compassion he shows for the families who have been so badly affected by these terrible events—by the failures in the NHS and the crimes that have taken place.

Our intention is to publish the full response within six months and to ensure that we have done so thoroughly. I will discuss this further with Lady Justice Thirlwall later this week. The issue about whistleblowers, which the right hon. Member raised, is incredibly important. The report states:

“The way the grievance and its consequences were handled was deplorable”

and the way in which the trust responded to these concerns was completely wrong. It also went against the guidance and rules that it was supposed to follow. That is why part of this is about ensuring that the right systems are in place; part of it is also about leadership, responsibility and culture, and ensuring that we are holding all those to account at every level in supporting this, particularly in relation to safeguarding. The safeguarding of babies should have been taken the most seriously of all.

The right hon. Member specifically raised the issues with HSSIB. The inquiry is clear about the important role of HSSIB. The intention of our reforms is for that role to continue. As part of the Health Bill, it involves transferring HSSIB into the Care Quality Commission. However, that independent role and investigations will continue. I plan to review the detail of this to ensure that we are meeting the spirit of the inquiry’s recommendation, because it is immensely important that we have those arrangements in place.

The right hon. Member also referred to the issues around the systems, interoperability and having the data assessments. Of course, we now have new systems in place, including the maternity outcomes signal system. That, when applied to the data that emerged from the Countess of Chester, does make it clear that real-time safety alerts would have been flagged, but of course, in the hospital, the clinicians already knew that a significant increase had taken place, but also they had unexplained deaths and a series of issues that were raised within the hospital. There was a failure of the board to review this, a failure of oversight, a failure of governance and a failure to take proper action.

The right hon. Member raised the recommendation that we need to look at a series of reports. In this case, we know that a series of recommendations have been made, particularly about patient safety and often including whistleblowing. We need to ensure that these recommendations are actually implemented. We must not keep going around in the same circles.

I am conscious that, shockingly, these events took place in 2015 and 2016, very soon after the Lampard review into the NHS, which had made clear the importance of safeguarding. Safeguarding should have been on everybody’s minds at the time, even if the circumstances were very different from what happened here. The issues around safeguarding and patient safety should have been taken incredibly seriously, and they were not. The right hon. Member is right that we need to ensure that systems are in place, but again, even immediately after reports were published, we still had a failure in this case to implement them and to adopt their spirit.

On the recommendations about the NAO, the right hon. Member will know that it is a cross-Government issue. However, I have made it clear that the Department of Health and Social Care will establish a hub for health inquiry recommendations, so that alongside the cross-Government discussion we can ensure that the NHS is doing what it needs to do.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Samantha Dixon. I appreciate that this is particularly sensitive for you, so please take your time.

[Samantha Dixon (Chester North and Neston) (Lab)]

Thank you, Madam Deputy Speaker; I really appreciate that.

This is another very dark day for the families affected by events at the Countess of Chester hospital—those who grieve, who suffer and who continue to live with the terrible fallout. It is crucial for them, as well as every one of my constituents, and those of my right hon. Friend the Member for Alyn and Deeside (Sir Mark Tami) and others, to have absolute confidence that our local hospital—my local hospital—is a safe place.

Lady Justice Thirlwall’s inquiry needs the firmest response possible from Government. She shines a light on a truly appalling state of affairs. Too many times in this place, in response to catastrophic events, we say, “Never again.” I have served previously as Minister for Building Safety, my work guided by the recommendations of the Grenfell tower inquiry. My right hon. Friend the Member for Streatham and Croydon North (Steve Reed) and I argued consistently inside Government for the establishment of a national oversight mechanism to capture the recommendations from important public inquiries, such as this one, to ensure that they are carried forward and are never forgotten or overlooked. Given Lady Justice Thirlwall’s evidence that inquiry recommendations are so often overlooked, will my right hon. Friend the Secretary of State support the calls to broaden her essential recommendation beyond the NHS to all inquiries and set up a national oversight mechanism so that when we say, “Never again,” we mean it?

[Yvette Cooper]

I thank my hon. Friend for raising this and for consistently speaking out for her constituents who have endured the unimaginable and been through the most horrendous experiences within their families—the loss of a baby, or a collapse—and to then have to go through everything that has happened since and still to have shown, as Lady Justice Thirlwall says, such huge dignity in responding to this inquiry. As the inquiry makes clear, those parents and families have given evidence exactly in the hope that this does not happen again to other families in other hospitals, as well as in Chester, and I pay huge tribute to them.

I will take forward the point that my hon. Friend raised about the cross-Government issues, in discussion with the Cabinet Office—she is right to raise that—and I will undertake to draw together the recommendations from NHS inquiries. I also highlight, because I know it will be important for her constituency, that Lady Justice Thirlwall says:

“in 2025, a large modern women and children’s unit opened, providing integrated family care for babies and their families. This welcome change represents a huge improvement in neonatal care at the Countess.”

That will be hugely important to families in her constituency, but it does not take away from the devastating conclusions of this report and the action that needs to be taken.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I send my heartfelt sympathies and those of my party to all the families who have been so cruelly harmed. I thank Lady Justice Thirlwall for her inquiry and the Secretary of State for early sight of the report.

Lady Justice Thirlwall’s final report is a dispiriting and, at times, shocking account of repeated mistakes and failures by organisations and individuals. The conviction of Lucy Letby for these murders and attempted murders sets this investigation apart from others, but while the situation is incredibly distressing, it is also distressingly familiar—a failure to investigate abnormal levels of death or harm; a failure to act on concerns raised and whistleblowing; a failure to follow established protocols for investigating deaths; and a management instinct to cover up failure, and to put the reputation of the hospital above the safety of the babies in it.

The importance of stronger whistleblowing mechanisms could not be clearer. There should be a duty of candour for management, as well as medical staff. Will the Government accept my amendments to the Health Bill, requiring boards to call in investigators when they receive reports of malpractice, and giving coroners and medical examiners stronger powers to whistleblow? The review makes it explicit that there must be an external body, such as HSSIB, to investigate trusts. Will the Government now drop the measures in the Health Bill that risk patient safety? Surely the Secretary of State will accept the amendments that we and others have put forward to prevent the abolition of HSSIB, protect Healthwatch and put patient safety first, including through the restoration of the National Guardian’s Office.

I am beyond angry that once again we are discussing the recommendations for action following an NHS scandal. It is like groundhog day—we are stuck in an endless cycle of expressing horror and doing nothing, with the reports and recommendations from multiple scandals gathering dust on a shelf in the Department of Health and Social Care. The Thirlwall inquiry cites a “lack of political will” as one of the causes of this cycle. We have a new Secretary of State. Will she promise us that she will be the one to find the will to end this? The families who have suffered such unimaginable loss deserve nothing less.

Health Bill

Nusrat Ghani 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.

--- Later in debate ---

[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.

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

I will try to keep my remarks brief. I thank my right hon. Friend the Member for Daventry (Stuart Andrew) for all the hard work he has done over the past year in holding the Government to account on health and social care, the whole Conservative health team for their support, and every member of the Committee that, as the Minister said, scrutinised the Bill in detail in such a hot and sticky room before the summer. I also thank my parliamentary team for their support. Finally, I congratulate the Minister on her reappointment and thank her for the time that she has taken to engage with the Opposition on the Bill. I must also declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health.

This is not a small Bill. It runs to more than 200 pages, and there are almost as many pages of amendments, with around 180 different MPs signing or supporting different amendments. I do not agree with every one, but I welcome thoughts and ideas from right across the House—well, from most of the way across the House; we did not see much from Reform. The Bill has scale, but does it have direction and clarity of purpose? Leadership sets direction—a destination—and from that follows a path, as smooth as possible, from A to B, with appropriate milestones. However, the Bill, like so many of this Labour Government’s, came as an announcement without enough thought.

Let us go back. The Government started with the Darzi report. I will not restate the arguments about why it was done or the weakness of the claims that it is independent, but suffice to say it is their report, published by a Labour peer and former Labour Minister for a Labour Government. It says a few things about reorganisation. Lord Darzi wrote that

“a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”,

yet the Government decided to abolish NHS England, restructure the ICBs and halve the ICBs’ budgets all at once, without properly planning for what would come next. That is clause 1—abolishing NHS England.

One of the main arguments provided related to the unnecessary bureaucracy and duplication of staff. As a Conservative, I accept that there is a strong case for efficiency: the Government must use taxpayers’ money wisely. In a letter that the permanent secretary sent to the Public Accounts Committee, officials estimated savings of £1 billion a year by abolishing NHS England and redundancy cost payments of approximately £1 billion to £1.3 billion, but we have not seen the calculations behind that. It was announced in March 2025 that the restructure would be completed in two years, yet we are now 18 months in and Ministers do not seem to be on track. From March 2025 to July 2026—a year, and three quarters of the time they have given themselves—total headcount across NHS England and the Minister’s Department decreased by 12.9%, which is nowhere near what the Government need to deliver their promised savings. We have therefore tabled amendment 102, which would require the Government to publish a full workforce transition plan, and new clause 153, which would require the Government to publish precisely how many people they make redundant.

I would like to raise a contradiction: the Government talk a lot about devolution and local decision making, but the Bill does the opposite. It will remove councils of governors from foundation trusts, give Ministers the power to hire and fire health leaders, and put an end to local Healthwatch. It will give the Secretary of State the power to set and adjust annual funding allocations for ICBs, and direct them to ringfence funding for service integration. It takes away local decision making.

The Bill is also inconsistent with what the Prime Minister said the other day. In response to a question about the Bill, he said:

“I do not like the idea of a postcode lottery in the national health service.”—[Official Report, 1 September 2026; Vol. 790, c. 61-62.]

But if decisions are taken locally, they will be different in different areas, which will lead to a postcode lottery. Will Ministers shed some light on what they actually believe? Do this Government want decisions made locally and accept that those will be different, or do they want decisions made centrally?

Lord Darzi said something else in his report:

“Constant reorganisations are costly and distracting. They stop the NHS structures from focusing on their primary responsibility to raise the quality and efficiency of care in providers.”

Indeed. In fact, that is not too dissimilar from what the Minister for Secondary Care herself previously concluded, when in opposition. She said:

“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2020; Vol. 680, c. 809.]

How is the NHS performing? Let us take a look. The total number waiting for appointment has gone down a bit, as the Government have said, but in trauma and orthopaedics, ophthalmology, cardiothoracic surgery, elderly medicine and gynaecology, it has gone up, and in some cases is higher than it was before the election. For those waiting for an admission who need a procedure or an operation, it is not only going up month on month and year on year; it is higher than it was at the time of the general election. What about accident and emergency? The number of people waiting for more than 12 hours after a decision to admit was 29% higher in July 2026 than in July 2024, and that is despite the fact that there were fewer such admissions in July 2026 than in July 2024.

How have the Government performed in other health areas? Childhood vaccination rates are in decline. The workforce plan has not been published, despite the Minister saying it was “imminent” months ago. Fracture liaison clinics have not been delivered, despite allegedly being one of this Government’s planned “first acts”. I could go on, but we do not have much time, and I think I have demonstrated the point: NHS reorganisation is distracting from delivery.

One of the things I want to talk about that the Government are not delivering is the response to the Hughes report. I thank Dr Henrietta Hughes, the Patient Safety Commissioner, for her hard work on the report. When the trauma and suffering that some people, particularly women, have experienced from mesh repairs, and the harm that children have suffered because of exposure to valproate in the womb, became apparent, we were all horrified. The previous Government changed the way that valproate was prescribed and commissioned regional surgical centres of excellence to provide care for women who suffer from the effects of a mesh repair. The Conservative Government also commissioned the Hughes report, published in February 2024, that investigated compensation schemes for those affected, but the general election was called just three months later, so delivering compensation and on the report became the Labour Government’s job.

Sadly, Ministers have dithered and delayed for more than two years now. We have had written question after written question, several debates and a lot of warm words, but still no response to the report. It is simply not good enough. Those suffering should not have to wait any longer, and that is why we have tabled new clause 145, which would provide a legal backstop, ensuring that the Government publish their response to the Hughes report within 30 days of the Bill becoming law at the latest. That is still not soon enough for those affected, but it is the only way of putting in an effective backstop so the Government can stop fobbing off victims and start delivering justice.

Let me turn to other amendments. The Government announced out of the blue that ICB running costs will be halved. Why 50%? I have no idea, but ICBs scrambled to respond. We know from those inside the health service that it has been a major distraction, with a massive opportunity cost for patient care. When the Bill came, Ministers chose to change the composition of ICBs, too, removing the voice of hospitals and primary care from boards as well as the voice of local authorities, severing that link with social care.

Integrated care partnerships will also be abolished. There will instead be a focus on mayoral representation, even for mayors where there is little role, if any, in delivering social care. In Lincolnshire, for example, instead of a local authority and an ICB on the same geographical footprint working together over the same area to cover health and social care, we now have the Government conspiring to give us an ICB covering three counties, with no voice for the local authorities, which are unsure after today’s announcement whether they will be split up. We discussed at some length in Committee the importance of health and social care working together, so I welcome the Government’s U-turn on day one of this term to reinstate local authority representation, but I urge the Minister to consider, as the Opposition parties have proposed, reinstating primary care and secondary care representatives, too.

Given the time, I will speak briefly to the three amendments on workforce. First, new clause 154 would require the Secretary of State to increase the number of medical school training places to 15,000 by 2031-32. Why? Put simply, because they promised they would and they have not. Secondly, new clause 152 is on merit-based applications. Doctors used to be allocated their first jobs through a system based on performance—that was the case when I was a junior doctor. Now it is done by computer algorithm prioritising choice. This is unfair, demoralising and destroys the incentive to study hard. We believe in meritocracy, and I urge the Government to accept the new clause.

Thirdly, I urge the Government to support new clause 144, which would address the plight of a small but significant group of people: a group of medical students subject to a great injustice. These are British citizens studying at a British university, predominantly Queen Mary University in London, who were told four and a half years into their degree that they would not be able to have places on the foundation programme but would be at the back of the queue. The Medical Training (Prioritisation) Act 2026 has meant that non-prioritised doctors got only 1.8% of the jobs—the last 1.8% left. That was the point of the Bill, but the Government should put this particular group of British citizens into the priority group.

We will no doubt talk about our other amendments in the Lords. New clause 155 on self-care would give people more autonomy over their own care. New clause 101 is on the national commissioning of low-volume, high-complexity services, and would ensure that the Government cannot just move them into ICBs without a proper consultation and plan. Amendment 95 on the patient choice duty would ensure that patients have choice over the care they receive in neighbourhood services as well as hospital services.

Amendment 88 is on the single patient record. The single has the potential to be truly transformative, bringing the NHS in line with other modern healthcare systems. It can prevent people from having to repeat themselves. But there are lots of questions for the Government that have not been answered. This is another example of making an announcement without thinking it through. How will existing health records be linked? How will patients, carers and clinicians have access? Who will control the data? How will it be kept safe? Amendment 88 would require the Secretary of State to publish a full plan before making changes.

There are some parts of the Bill that the Opposition can support, but in the Government’s hurry to make announcements, they often do not seem to think things through properly. That is the story of local government reform that we heard in the House earlier today; it is the story of the much-delayed workforce plan; and it risks becoming the story of this NHS reorganisation. In health, there are life and death situations, so we cannot afford for the Government to get it wrong. The Opposition have made a series of sensible amendments and will be grateful for the Minister’s support.

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Back-Bench speeches are on a five-minute speaking limit.

[Clive Efford (Eltham and Chislehurst) (Lab)]

I rise to speak to amendment 97 in my name, which would remove clause 10 from the Bill. Clause 10 gives powers to the Secretary of State to vary the proportion of public and private provision of health services if they consider that to do so is in the interests of the health service. In evidence to the Health and Social Care Committee, the chief executive of the Nuffield Trust said that clause 10

“seems to make it more possible for the Secretary of State to explicitly set out to increase private or public provision.”

Why does the Secretary of State need this power?

Introducing an extra level of nuance now, as clause 10 will do, has the potential to raise fears within the NHS that it could be abused in future. The clause has the potential to create unintended consequences. The explanatory notes for the Bill say that this new flexibility is necessary

“where there may otherwise be a breakdown in provision of a health service.”

Can we imagine a situation where the Secretary of State has concerns about a health service and that an approach to assist a local provider would be rebuffed? It is hardly likely to happen. The explanatory notes suggest that, in such circumstances, the Secretary of State needs the power to direct local decisions, rather than to work with local health service providers to resolve any difficulties. How does the power to influence the proportion of public and private provision help in resolving a breakdown in service?

Labour’s 2024 plan to make work pay set out a welcome desire to bring more essential services back into public control—something that is welcomed by health workers across the country, because so far the

“biggest wave of insourcing in a generation”,

as was promised, has felt more like a trickle when it comes to the NHS.

The new Prime Minister and new Secretary of State have inherited the Health Bill from their predecessors, so hopefully they will be able to stamp their own mark on it before it becomes law. Removing clause 10 would be one way of making that mark. The concern for those who work for the NHS and those who support it is that the clause has the potential to be exploited in future by those who would seek to move away from the public provision of healthcare. There are ample powers to enable the Secretary of State to intervene and resolve breakdowns in the provision of a health service. On clause 10, we must balance what it adds in those situations against its potential misuse by an ideologically driven Government that are determined to privatise our NHS. To remove any ambiguity and to protect the NHS from the possibility of the clause being abused by a future Secretary of State, I urge that it is dropped from the Bill.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I have tabled several amendments to the Bill, but I will hopefully keep my remarks focused so there is a good opportunity for other Members to make their speeches.

The Bill should be about fixing the front and back doors of the NHS. It offers the opportunity to bring in tangible changes for patients to address pressing problems and introduce desperately needed improvements to patient safety and experience. The primary care and social care crisis, in particular, are millstones around the neck of the NHS. But instead of addressing them, the Bill has focused on a top-down reorganisation, which risks diverting time and money away from those pressing issues, and it gives sweeping powers to the Secretary of State, which is not in itself without risk.

The Liberal Democrats would instead have put social care and general practice at the heart of the Bill—a move that would represent real reform of the health service. In particular, new clauses 54 and 56 tabled by my hon. Friend the Member for Mid Sussex (Alison Bennett) would together transform the rights of family carers through guaranteed respite care and reform of the carer’s allowance. They would put free personal care, and an end to catastrophic care costs, at the heart of social care reform.

New clause 53, tabled by my hon. Friend the Member for Epsom and Ewell (Helen Maguire), would ensure that everyone can see a GP within seven days, or 24 hours if urgent, and amendment 17 would introduce a primary care investment standard. Although general practice is the core of a patient’s relationship with the NHS, it has seen its funding decline as a share of NHS spending. Less than 10% of the NHS budget is spent on primary care, although that is estimated to constitute 90% of a patient’s direct experience with the NHS. A primary care investment standard would help to reverse that trend. Dentistry is another area of primary care that has been neglected, leading to dental deserts and dangerous DIY dentistry. New clause 18 would introduce a scheme to end dental deserts, and guarantee appointments for children and those most in need.

NHS Corridor Care

Nusrat Ghani Excerpts

Wednesday 8th July 2026 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. The speaking limit will drop to three minutes after the next speaker.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I have a correction to make. Back Benchers are on a four-minute speaking limit. We have found some more time.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

I congratulate the hon. Member for Tooting (Dr Allin-Khan) on securing this debate. Some very important points have been made. I am going to skip through some of those important points to reinforce the message, and bring forward issues raised directly with me by my constituents.

What we have heard is that what was once regarded as an exceptional state of affairs in the NHS has become so commonplace that Parliament is now debating it as a national issue in its own right. We have heard about the lack of investment and the redirection of resources, and about the issue being compounded over the many years of the previous Government. I acknowledge and recognise the efforts made by the current Government to try to address this, as well as many other challenges in the NHS. I congratulate them on their efforts to bring down waiting lists by many, many thousands; my constituents appreciate that.

We heard that more and more that patients are being treated away from clinical and sterile places: in corridors, cupboards and other places not designed for treatment. They are being denied their privacy, dignity and adequate support. One doctor described patients dying because they could not access appropriate clinical areas in time. That is not what we would class as a jewel-in-the-crown public service—but that is what the NHS is, and all of us across the House want to restore it back to being the world-class, free-at-the-point-of-need care service for every single person in our country.

For many years, hospitals under pressure often managed overcrowding by keeping patients and ambulances outside emergency departments while they waited to be handed over and moved into clinical areas. That resulted in ambulance waiting times going through the roof and many patients not receiving the emergency paramedic assistance they clearly required. Under the previous Government, that issue was displaced: from holding patients inside ambulances to moving them into the hospital building, freeing up ambulances to go and serve other patients.

I am not a medical doctor, but I am a scientist and an engineer, and what is obvious is that the 40 hospitals under the previous Government did not get delivered—not all of them were new, but that is also true of the ones that were to be refurbished and expanded. As with prison spaces, we lack the number of beds in our country that the NHS needs to provide safe and dignified care for every patient who seeks treatment.

Catherine, one of my constituents, wrote to me to say that she went into hospital with her husband. She waited in a corridor for five hours, but she saw many elderly patients with no relatives or friends with them, who had been waiting there for many hours before she arrived, and nobody was able to look after them or offer them water. They had to keep asking for water from other patients. That experience will exacerbate somebody’s medical condition and increase demand on the NHS. We have heard—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I call Sarah Hall.

--- Later in debate ---

[Dame Siobhain McDonagh (Mitcham and Morden) (Lab)]

A number of

constituents who work as nurses in the A&E department at St Helier hospital asked me to come to see for myself what they were dealing with. They asked me to come late on a Monday morning, rather than a Saturday or Sunday night as I had anticipated. What I saw was deeply troubling. Around 250 patients were coming through the department every day. Elderly people were being cared for on trolleys out of nurse sight lines. However, what really struck me was that packs of staff were wandering around A&E, with nowhere to do their job. They could not do their paperwork, sit near their patients or monitor anything.

Corridor care does not begin in the corridor; it begins long before a patient reaches A&E. For years, community services and alternatives have gradually disappeared. The walk-in centre at the Wilson hospital in Mitcham, which once treated patients every day until midnight, even on Christmas day, has gone. Out-of-hours GP services have been reduced. Those patients have not disappeared; they now go to St Helier. If we want fewer people waiting in our overcrowded emergency departments, we must invest in the services that prevent them from needing to be there in the first place. That is particularly important in communities such as mine, where people are more likely to live with long-term health conditions and greater health inequalities.

An A&E department cannot function in isolation. It depends on having the services, capacity and infrastructure around it to keep patients flowing safely through the hospital. That is why I have spent years campaigning for St Helier. I am therefore delighted that NHS London announced up to £57 million to expand and modernise St Helier’s emergency department. However, that cannot be the end. St Helier needs renewal.

Only days later, there was an announcement that disrepair in the women’s services block meant that it would have to close. I am delighted that the chief executive of the hospital trust has said that those services will return. Nevertheless, the situation is a stark reminder of what happens when hospitals are expected to serve growing populations in ageing buildings that have been allowed to deteriorate for decades.

Corridor care should never become normal in our NHS. My constituents deserve a St Helier hospital that is properly equipped to care for them when they need it most. I am determined to continue to fight for that.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I will now announce the results of today’s deferred Divisions.

On the draft Children’s Wellbeing and Schools Act 2026 (Establishment of Schools) (Consequential Amendments) Regulations 2026, the Ayes were 369 and the Noes were 102, so the Ayes have it.

On the draft Supply of Machinery (Safety) (Amendment etc.) and the EU Machinery Regulation (Enforcement etc. in Northern Ireland) Regulations 2026, the Ayes were 317 and the Noes were 103, so the Ayes have it.

On the draft Town and Country Planning (Discharge of Local Planning Authority Functions) (England) Regulations 2026, the Ayes were 283 and the Noes were 182, so the Ayes have it.

[The Division lists are published at the end of today’s debates.]

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I now call another doctor—it is easier to see a doctor here than to get a GP appointment.

--- Later in debate ---

[Sojan Joseph (Ashford) (Lab)]

We must continue to highlight corridor care, as it puts a spotlight on the pressures facing the NHS. One of the first visits I made after being elected to this House was to William Harvey hospital in my constituency. During my visit I was shown around an A&E department where 19 patients were being treated in corridors, even in the summer months, when emergency departments are typically under less pressure. That was deeply concerning, and demonstrated how under the previous Conservative Government corridor care became increasingly normalised. I have previously spoken in the House about the incident at William Harvey hospital last September, when a coffee shop had to be converted into an emergency ward to accommodate A&E patients because it ran out of corridor. That was not an isolated incident, but part of a wider pattern caused by years of under-investment and rising demand. NHS staff continue to provide outstanding care in difficult circumstances, often without the capacity, workforce or facilities that they need.

One lesson we must learn from the failures of the previous Conservative Government is that health infrastructure must keep pace with population growth. I recognise the need to build more homes to address the housing crisis that this Government inherited, but we must ensure sufficient capacity in GP surgeries, community health services and urgent care facilities. While schools and shops often come as part of a new housing development, healthcare infrastructure has too often been an afterthought. We need sufficient primary care capacity to prevent avoidable hospital visits and admissions that make corridor care more likely. Will the Minister set out what steps the Government are taking to ensure that, as new homes are built, health infrastructure planning and investment keep pace?

I welcome the Government’s commitment to end corridor care by the end of this Parliament. We should never accept a situation in which hospital corridors become makeshift wards. No patient should receive treatment without privacy and dignity, and no member of staff should have to provide care in an environment that falls below the standards they strive to uphold. Our constituents rightly expect to be treated in safe, appropriate and dignified settings.

I was pleased by the announcement a few months ago that East Kent hospitals NHS trust, which covers William Harvey hospital, will be part of the new intensive recovery programme. I am hopeful that such targeted support will help to tackle the significant challenges facing the trust, reducing waiting times, improving patient flow, and ensuring that people across east Kent receive the timely, high-quality care they deserve. I hope the programme will help to ease the pressures that have contributed to corridor care, and that the Minister will update the House on the new intensive recovery programmes.

I also welcome the forthcoming opening of an upgraded same-day emergency care unit at William Harvey hospital, which I recently had the opportunity to visit. Funded through the trust’s use of part of a £29 million investment from the Labour Government, the unit will increase capacity and help to relieve pressure across the hospital, enabling more patients to receive timely assessment and treatment. I also welcome the recent announcement by the local ICB about the single neighbourhood provider. GP services in my constituency are proactively reaching out to frail patients, which will help to avoid them going to A&E.

This Government have made important progress through additional investment, workforce expansion, improved discharge arrangements and targeted support for struggling trusts. Those steps should be welcomed, but there is more to do. If the Government are to fulfil their commitment to end corridor care, they must continue to pursue reform with urgency and determination—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I call Amanda Martin.

--- Later in debate ---

[Matt Turmaine (Watford) (Lab)]

I thank my hon. Friend the Member for Tooting (Dr Allin-Khan) for securing this important debate. The previous Government wreaked havoc on the NHS, with waiting times at an all-time high even before covid-19 hit a bruised and battered system. Under-investment and undelivered promises saw corridor care become commonplace, with its subsequent indignity and risk. It is a clear visual demonstration of a system on its knees.

This Labour Government are determined to act. The urgent and emergency care plan for 2025-26 provided more than £450 million of investment in urgent and emergency care. Additional millions of pounds of capital investment, reaching £1.9 billion over the next four years, will help to deliver it. Links between hospitals and social care are clear and critical, which is why the Government are working to implement a national care service and initiatives such as the first-ever fair pay agreement for adult social care staff.

Watford general hospital in my constituency is on the new hospitals programme, but it was previously delayed endlessly under the Conservative and Liberal Democrat coalition Government and subsequent Conservative Governments. However, under this Labour Government, it is seeing tangible action in preparation for the rebuild.

West Hertfordshire Teaching Hospitals NHS Trust has worked incredibly hard in my constituency to deal with corridor care, and I am delighted to say that corridor care has been eradicated altogether at Watford general hospital. It has not had a single incident of corridor care for six months. How has it managed that remarkable achievement?

First, the hospital has taken a whole-hospital approach to flow, making it everybody’s business and therefore everybody’s concern. The trust states:

“The simple rule is we don’t accept corridor care in our wards. We find other solutions.”

Secondly, the hospital has embraced data, embedding it into everything that it does to manage the flow of patients. It has real-time data tools such as electronic bed management, e-whiteboards and a digital command centre. Six key measures have been identified, which staff are using and which are easy to understand. Thirdly, the trust has engaged in partnership working—it could not tackle corridor care in A&E alone. There is a care co-ordination centre to reduce the number of ambulances coming into A&E for those who do not need emergency treatment; a multidisciplinary team to advise paramedics on where people should be treated; and close working with social care, treating people away from hospital, as is included in the NHS 10-year plan.

In conclusion, I place on record my thanks and admiration for the staff at the trust. Their hard work has paid off, and it demonstrates what can be achieved when working together as a team to deliver for their patients and population.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call James Naish to make the final Back-Bench contribution.

[James Naish (Rushcliffe) (Lab)]

Thank you, Madam Deputy Speaker—I appreciate being called. Before I begin my speech, I note that my hon. Friend the Member for Worthing West (Dr Cooper) mentioned coastal communities. She was absolutely right to do so, and I will refer to rural communities, because there are equal challenges with delivering healthcare to that particular demographic.

I will start with some good news for my constituents. Last year, Nottingham University Hospitals NHS trust was named among the 10 most improved trusts in England for four-hour A&E performance, and sixth nationally for 12-hour waits. That is not a small thing; it reflects genuine hard graft by staff at Queen’s Medical Centre and Nottingham City hospital, and it earns the trust a share of a £3 million reinvestment fund from NHS England. That sounds good, but I would be doing my constituents a disservice if I stood in this place and pretended that the job was done, because just over a week ago, on 29 June, NUH declared a critical incident after the recent extreme heat drove demand across the trust far beyond what its emergency department could safely absorb. What is more, it was the fourth critical incident over the past year. At its worst, during the latest incident, there were 188 patients in the emergency department and 20 ambulances queuing outside. Patients were experiencing lengthy waits on corridors, and more people than expected were medically fit but unable to be discharged.

I recently asked the Government about this issue, and the Minister’s response was clear: corridor care was “unacceptable”, and should never become normal practice. That should not even need saying, and it is only after 14 years of drift that it did. What matters now is action, and the Government have published a national definition of corridor care for the first time and started daily reporting, so that neither trusts nor we in this place can hide the problem. Thankfully, that transparency is being backed by some new money: over £450 million is going into urgent and emergency care capacity this year alone, and £215 million of capital funding is delivering 40 new and expanded urgent care sites across England. For my constituents, this means two things locally that I genuinely welcome: confirmed funding for an expanded urgent treatment centre at QMC, and a trust-funded reconfiguration of the emergency department, because our chief executive has found the money internally to get on with that work now, rather than wait.

I was particularly pleased to be able to tell this to one of my constituents, Renee, after she contacted me to tell me about her experience in A&E. As a lady in her 70s with a long-established heart condition for which she has ongoing consultant care, after a heart attack, she found herself spending nine hours waiting for care in A&E for a condition that should have been treated immediately. Nationally, A&E waiting times are at their best level in five years, and elective waiting lists are at their lowest in three and a half years. That is progress, but it will ultimately count for nothing in Rushcliffe if a bad winter, a system failure or a staffing gap can still tip a good department into crisis extremely quickly. As such, my ask of the Minister is simple: keep funding urgent and emergency care, keep the pressure on trusts that are lagging behind, and keep listening to Back Benchers, who regularly hear about this issue from doctors and constituents at our surgeries.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

Department of Health and Social Care

Nusrat Ghani Excerpts

Tuesday 30th June 2026 Commons Chamber

[Sadik Al-Hassan]

First of all, Medicines UK does not disagree with me; its members disagree that the value from the UK-US trade deal will go to people other than them. Medicines UK actually thinks that companies are not paid enough for drugs in this country. Unfortunately, you might need to go and have a chat with the association about that, because you might have misunderstood.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. You mean “the hon. Member”, not “you”—I do not need to go anywhere. I ask the hon. Member please to wrap up as soon as he can, because we have many speeches to get in.

[Sadik Al-Hassan]

In conclusion, I welcome the deal. I hope we find a way to pay for drugs correctly in this country, so that we value them properly and can value the rest of the system.

[Madam Deputy Speaker]

I will give Front Benchers a heads-up: we are not going to have a huge amount of time, so please edit your speeches accordingly.

--- Later in debate ---

[Sam Carling (North West Cambridgeshire) (Lab)]

I, too, thank the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran) for securing this debate, and I, too, wish we had more time. I also thank my hon. Friend the Member for North Somerset (Sadik Al-Hassan), who made some difficult, but really important points.

This is a timely debate, because pharmaceuticals are core both to supporting a healthier population and to delivering economic growth. The main estimates memorandum outlines an expectation of just under £2 billion of R&D expenditure over the coming year from the DHSC, which is roughly equal to the figure in the previous estimates, and I welcome that.

Of course, private investment also plays a significant role in drug development. That is why I am so pleased to see increasing confidence from the private sector in the UK as an environment in which to do impactful research. Last month, we saw AstraZeneca commit £300 million in investment across the UK, after this Government’s work to agree a pharmaceutical deal with the US enabled that investment. However, there is much more to do to create a regulatory environment that encourages investment into clinical research in the UK. I encourage the Department of Health and Social Care and the Department for Science, Innovation and Technology to consider simplifying and consolidating our regulatory landscape.

I am not here to criticise our regulators, who I believe do a very good job in their respective roles. I have regular engagement with research scientists, universities and professional bodies through my work as chair of the all-party parliamentary group known as the Parliamentary and Scientific Committee. This is the oldest APPG, which was established in 1939 to better connect scientists and parliamentarians in the interests of better policy. The overwhelming message is that, actually, regulators get it and want to enable research and growth, not hinder it, but that the overall landscape is just so complex that approvals are taking far longer than they need to.

In a contribution to the King’s Speech debate last month, I listed a range of regulators: the MHRA, NICE, the Health and Safety Executive, the Human Tissue Authority, the Health Research Authority, the Human Fertilisation and Embryology Authority, the Animals in Science Regulation Unit, and so on. That is just too many regulators and that is not even all of them. I very much hope the Government will use the upcoming regulating for growth Bill to look at how to reduce overlap and streamline the environment. Having to get so many decisions slows down research and innovation enormously, particularly when researchers have to apply for clearance from them sequentially in most cases, rather than in tandem, stretching the overall timeline.

I propose another solution. Why do we not create a single front door for study approvals: a unified application process that collects all the information that different regulators might need, so that researchers can fill in one form, and a team of recruited staff whose job it is to liaise with all the regulators, establish who needs to approve the individual study in question and pass along the information necessary, ideally in tandem rather than each approval being sequential and relying on the last?

I hope the Minister will take some of those ideas on board. There are many reasons to be optimistic. The UK has been, and in many areas still is, a world leader in drug development. Let us keep building on that.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson, who I thank for agreeing to make a very short speech.

[Helen Maguire (Epsom and Ewell) (LD)]

Today we are being asked to approve a motion on the main estimates for the Department of Health and Social Care for 2026-27, in which pharmaceutical spending is not separately identified, in either the estimate or its accompanying memorandum. We are being asked to approve spending without clear visibility of exactly how much is budgeted for medicines. That is against the principle of estimates day, which is to scrutinise spending before it is authorised.

This is yet another example of the lack of transparency around the murky UK-US pharmaceutical deal. It was drawn up in secret and the Government are refusing to publish the impact assessment. The Government must be clear on how much is budgeted for medicines, how much they expect the deal to cost and the risks to the frontline associated with diverting money from elsewhere in the NHS.

The UK-US pharmaceutical deal should never have been allowed to go ahead. The deal will see the NHS paying out at least £1.5 billion more in higher medicine costs by 2028, rising to over £9 billion by 2036. The Government have made it clear that there will be no additional money to fund that over the next spending period. That means frontline NHS services will be plundered at the behest of a foreign Government, while patients suffer in crammed hospital corridors and cannot get a GP appointment.

We must support the British life sciences sector. We can find ways to achieve that, but it must be a domestic matter for the UK Government to solve holistically through negotiations with the sector. It should not be dictated from Washington. The Government refused to publish an assessment of the impact of the deal. What are they trying to hide? The bottom line is that medicine procurement should be based on sovereign health needs. This is not a matter of being pro or anti the pharmaceutical industry. We need to find a solution that works for patients, the NHS and the life sciences sector.

Rather than defund vital NHS services in a knee-jerk deal, the Liberal Democrats would take real action to strengthen our life sciences sector by: developing a long-term plan with the sector to ensure certainty on issues such as VPAG—the Voluntary Scheme for Branded Medicines Pricing and Access—and rapid licensing by ensuring that the needs of our society are reflected in the approach of NICE and other regulatory bodies; promoting investment into upscaling UK life sciences manufacturing; encouraging investment in vaccine, medicine and antibiotic medicine manufacturing plants; reviewing the relationship between research and development tax credits and manufacturing; and establishing a fellowship programme for scientists working on health conditions, such as cancer, so they can continue the research Trump has defunded in the US. We would also cut the cost of visas for researchers, as well as boost R&D funding to 3.5% through a decade-long programme of public investment. Rather than spending billions to pay off a bully in the White House, the Liberal Democrats would oppose the deal, develop a plan for our life sciences that reflects our national interest and invest money in vital frontline services that are in dire need of funding. The Institute for Fiscal Studies has indicated that the deal could cost as much as £9 billion by 2036. That money would be transformative for so much of the NHS: it would end corridor care, hire thousands more staff, buy countless radiotherapy machines, or deliver high-quality care and help for elderly and disabled people.

Any choices over money spent in our NHS must be made by the British people, not Trump. It is unacceptable that Trump thinks he can meddle in our NHS, and, worse still, that the Prime Minister lets him. That is why the Liberal Democrats wrote to the Prime Minister in December, demanding that the deal was put before Parliament for a vote. If the Prime Minister cares as much about the NHS as he claims, I encourage him to set the record straight, show his true feelings on the deal and, at the very least, bring it before the House for approval.

This House, and the voters who elected us, decide matters of national importance, not the White House. That is why the Liberal Democrats tabled new clause 76 to the Health Bill, which would bring the deal before the House for a vote. Any deal that diverts billions of pounds away from NHS frontline services must be subject to democratic process and parliamentary scrutiny.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

--- Later in debate ---

[Dr Evans]

Or guesstimates day, for want of a better pun. That is part of the problem. If the Government are so confident, why do they not produce the impact report so that they can justify this? At the end of the day, we have seen that those decisions are not isolated; they are different companies, making different decisions, but all with the same concern. It is a pattern: tax rises, more regulation, more red tape—a more toxic concoction.

The Government will say that the deal is part of the answer, but Ministers cannot point to potential benefits while avoiding certain costs. The House of Commons Library is clear that the Department’s main estimate for 2026-27 does not include budget cover to meet the expected increase in pharmaceutical spending associated with the UK-US arrangement. That is the central problem. The Government say that the total cost in the current spending review period is expected to be around £1 billion, but the former Minister, the hon. Member for Glasgow South West (Dr Ahmed), also said,

“Total costs over the Spending Review period are expected to be approximately £1 billion. The final costs will depend on which medicines NICE recommends and the actual uptake of these.”

That is an important admission, because the final cost depends on future NICE decisions and uptake, and other estimates are higher.

The Library briefing cites analysis suggesting that spending could be around £1.7 billion by the end of 2028, and around £14 billion by 2036, depending on the assumptions. Is the £1 billion the central estimate, and if so, what are the lower and higher ends of the estimate range? Why will the Government not publish the modelling so that we can see? My next question is even sharper: where is the money coming from? We know from leaked WhatsApp messages that Labour MPs have been asking who they can tax to pay for benefits, so where is the money coming from? Both the House and the public are right to ask.

The Government have said that additional costs will be funded from existing NHS budgets, with future funding settled at the next spending review. However, if the money is coming from existing NHS budgets, it is coming from somewhere within the NHS. It might be the workforce, services, capital or future growth, but it will not be cost free. As Jonathan Benger, the chief executive of NICE, put it,

“If they choose to spend money on defence, they’ve got to pay for that somehow, either by raising taxes or removing money from somewhere else. If they choose to spend money more on medicines, similarly, that has to be paid for.”

That is the reality.

The former Secretary of State told the House that the Government would not cut NHS budgets to fund the pharma deal, but the former Health Minister, the hon. Member for Glasgow South West, later turned around and said:

“The deal will be funded by allocations made at the Spending Review, where record funding for the NHS was secured. Future funding will be settled at the next Spending Review.”

Those statements need reconciling. If it is funded from NHS allocations, that is NHS money. Can the Minister rule out any cuts from the frontline?

Finally, I will turn to transparency. I want to point out that the UK-US pharmaceutical arrangement is not a treaty-based free trade agreement. It has not been through the Constitutional Reform and Governance Act process. We have not seen what is going on. The Government need to publish their impact assessment, and yet they cite commercial sensitivity. Of course, there is a way round that: the Minister could redact it and give that to the Committee so that we and this House can see what is going on.

I will cut my speech short there. I will simply pose—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Very quickly, shadow Minister. Ten seconds.

[Dr Evans]

What is the policy’s true cost? How will it be paid for? What will be displaced in the NHS to make it happen?

--- Later in debate ---

[Layla Moran]

I am frustrated, because everything the Minister is saying is in the press release. Can she please answer the question? Will the Government release the impact assessment? If they will not, will they at least allow a Select Committee to see it confidentially?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. We are running out of time. Minister, please respond as briefly as you can.

[Preet Kaur Gill]

I recognise the Committee’s request for the impact assessment, but the analysis is scenario-based, contains commercially sensitive assumptions and remains linked to live policy development. Officials should be able to produce confidential advice for Ministers to inform trade and other negotiations, and we will not apologise for maintaining such confidentially where doing so is in the national interest.

[Madam Deputy Speaker]

I call Layla Moran to wind up the debate briefly, in under a minute.

[Layla Moran]

I am happy not to.

Question deferred (Standing Order No. 54).

Neuropsychiatric Conditions: PANS and PANDAS

Nusrat Ghani Excerpts

Thursday 25th June 2026 Commons Chamber

[Wendy Chamberlain]

I am sure the Minister can address that in her closing remarks. We absolutely need to ensure that. As the right hon. Member has said, amoxicillin might be one of the antibiotics that could be used. It is straightforward to use, and in the vast majority of cases it works, but if it does not, potentially PANS and PANDAS could be ruled out.

Too many families face rejected referrals, long waits and, in some cases, misdiagnosis. Only a small proportion of cases are diagnosed within the NHS, and many people are forced to travel long distances or turn to private care. That is not possible for all families; getting the private care needed for their child can bring families to their knees. To give an example from my constituency, in the same GP practice, one GP will provide support and the other does not recognise the condition. That makes things very difficult.

A number of families whom I have engaged with have had to seek private support, and that makes me ask—I hope the Minister is sympathetic to this—what about the children from families who are reliant on NHS support, and do not get the diagnosis? They may be absent from school for long periods. Their family may be written off as problematic, and the children as having problematic behaviours, when ultimately the condition could be at the root of the problem. From the point of view of our ongoing economic wellbeing, we need to support children’s being in education as much as we can. That is why the research is so important—because we need to ensure that families can get the support that they need, no matter their financial situation.

A National Institute for Health and Care Research-funded evidence synthesis is under way; that has changed since the last time this topic was debated. It is already highlighting significant gaps in our understanding, particularly around effective treatments. Also, with other members of the all-party parliamentary group on PANS PANDAS, which I chair, we met doctors some time ago who are researching how the brain functions. Their work suggests that there may be biomarkers that indicate a higher likelihood of developing the conditions, and they have produced fascinating research that I encourage colleagues to read. We need to understand how severe the impact of PANS and PANDAS can be on a child. It is clear that further research is urgently needed to aid both diagnosis and treatment, which often needs to be ongoing.

Awareness and training are fundamental. Without them, as has been mentioned, healthcare professionals miss the signs, and teachers misinterpret symptoms. Children who experience sudden neurological decline are too often viewed through the lens of behaviour, anxiety or neurodivergence, rather than as having a medical emergency. From the children that I have engaged with through the youth board, I have learned that it is a terrifying experience for a young person to deal with those symptoms.

I am pleased to say, however, that we are at an important turning point. The UK clinical guidance, which the hon. Member for Harlow (Chris Vince) mentioned, is expected later this year, and there has been significant work since the last debate, which I held in September 2023, to bring PANS and PANDAS further into the policy landscape. I pay tribute to PANS PANDAS UK for that, because the charity has been the key driver in making that happen. Guidance alone will not be enough, however; it must be consistently embedded across the NHS, so that we end the postcode lottery in diagnosis and care. I suspect that we will hear about some of that from other Members. The consequences are profound; the human cost of delay and misdiagnosis is devastating. Children lose the ability to attend school, lose previously secure skills, and experience severe psychiatric and physical symptoms.

Just a few months ago, I hosted a roundtable in Parliament, at which the PANS PANDAS UK youth board members were able to speak directly to MPs about their experiences. As MPs, we engage with parents in the first instance, but it was very powerful to hear directly from children who are experiencing the condition. They might not be in the Gallery, but many of them will be voting; as we were informed, they are the voters of the future and are paying attention to what we do right now. It was an eye-opening session, particularly for those who had not heard of the condition. The children spoke about wanting to be believed and understood, and wanting to get help more quickly. Their message was clear: earlier recognition could change everything. They explained how PANS and PANDAS have impacted their lives; they described watching their peers progress, while they feel stuck behind, and being too unwell to attend school and so having to repeat years. That adds to a feeling of isolation. We can all remember when we were younger and times when childhood was quite cruel.

Families have described watching their child disappear in front of them. Parents leave work to provide care: 36% report having to stop working entirely, and many families face financial losses as a result, as well as from seeking private care. At the youth board roundtable, we also heard from the siblings of children diagnosed with PANS and PANDAS—I believe that my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) has a constituent in Parliament this afternoon who is part of the sibling community. It was a stark reminder of how these conditions impact entire family units; there is the financial impact of having to seek healthcare, and of a parent leaving their job, and the impact of home becoming an unstable and unpredictable environment.

The conditions also have a devastating effect on learning. Nearly half of affected children miss more than six months of school, and over a third miss more than a year. They often experience the sudden loss of core learning skills. Under the current system in England, which is designed to support gradual, stable learning needs, rather than acute onset, as well as under aspects of the proposed special educational needs and disabilities reforms, there is a real risk that those children are misunderstood. Without clear guidance, education professionals default to familiar frameworks. A sudden loss of skills can be misinterpreted as a behavioural issue or neurodivergence, leading to inappropriate support and a delay in the medical intervention required. That is why the alignment between health, education and local authorities is so critical.

I obviously speak as a Scottish MP. We must ensure alignment across the UK, so that there is no postcode lottery in the level of support available. My Scottish Liberal Democrat colleague Adam Harley, the new MSP for Strathkelvin and Bearsden, recently raised a constituent’s case in the Scottish Parliament; I was particularly disappointed in the response of First Minister John Swinney, who referred to PANS/PANDAS as a “rare disease”. It was clear that he knew nothing about it. Despite my own correspondence with his Government, we have seen limited progress in Scotland. I must emphasise that it is not a potentially rare disease; it is an undiagnosed one. I genuinely believe many children with PANS/ PANDAS have not been diagnosed and are therefore not getting the support they need. That underlines the need for close engagement with devolved Governments to ensure a truly joined-up approach to improving support.

Today’s debate will largely focus on children and young people with PANS/PANDAS, but it is equally important to recognise the challenges faced by adults. One adult with PANS/PANDAS shared with me that she has experienced mostly neuropsychiatric symptoms, rather than physical ones. Research shows that PANS and PANDAS can be associated with systemic inflammation and autoimmune responses affecting the whole body, including conditions such as arthritis and other inflammatory diseases. In that person’s case, tests revealed ongoing systemic inflammation that has damaged tissues and organs over time, as the immune system mistakenly attacks healthy cells, rather than protecting them. Too often, the symptoms that PANS/PANDAS can manifest are put in the “too difficult to deal with” basket.

These are the practical steps that we are asking the Government to consider. First, when the UK clinical guidance is published later this year, there must be a clear commitment that steps will be taken to ensure that it is embedded consistently across the NHS, not left to chance, and that appropriate stakeholders are engaged to support its dissemination.

Secondly, we need training for healthcare professionals and those working in education, so that symptoms are recognised early and acted on appropriately. Thirdly, we must have a renewed commitment to research funding, building on the work of the National Institute for Health and Care Research, to address the significant gaps in evidence and improve treatment pathways. I ran the London marathon—my first ever—at the end of April, and one of the charities I was fundraising for was PANS PANDAS UK. It should not take fundraising to deliver the funds that are needed for the research that will provide the right support for these children.

Finally, there must be clear signposting and alignment with the forthcoming local authority guidance to ensure that schools and services are equipped to meet their legal duties. As one clinical psychologist working with a young person with PANS has stated,

“Without training…pupils risk unnecessary and avoidable long-term loss of skills.”

I will be pushing on exactly this matter in Scotland.

This debate is an opportunity to put these issues firmly on the record, to raise awareness across Parliament and to ensure that families living with PANS and PANDAS feel heard. I am grateful to colleagues here today and look forward to hearing their contributions and the Minister’s response.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I am in awe of the hon. Member for running the marathon and, of course, for raising funds for PANS and PANDAS.

--- Later in debate ---

[Freddie van Mierlo]

I wholeheartedly agree with the right hon. Gentleman. There are very few downsides of prescribing an antibiotic, especially in this instance, given the seriousness of the condition. As he says, there is really no good reason to withhold this medication.

A second challenge facing families is the impact on a child’s ability to participate in education, as they miss months of school because they are too unwell to attend. That not only affects their learning but limits opportunities to socialise, make friends and have a community beyond home. Every child has a right to an education. PANS/PANDAS does not limit ambition or ability, but our education system is placing limits on children with the condition. Section 19 of the Education Act 1996 is in place to stop that happening, and it requires local authorities to arrange suitable education for children who cannot attend school due to illness. However, the provision is not always effective for children living with PANS/PANDAS, and parents still need to be advocates for their own rights, rather than being proactively told them and guided through the process.

There is a wider point. Families are often left fighting for support from multiple systems at the same time, including healthcare, education and local authorities, while trying to take care of a very unwell child. It is the last thing they need. There are steps that the Government can take to limit the challenges. First, PANS/PANDAS must be researched in greater depth. It is currently unknown how many people are affected by PANS/PANDAS in the UK, and there is no official guidance on the diagnosis and treatment of those conditions in the NHS. Secondly, we need training of health professionals to recognise and treat the condition. PANS and PANDAS are conditions with a high risk of long-term disability, exclusion from society and failed education. Families express that if only their children’s condition had been recognised sooner by health professionals, it could have had a significant impact on their child’s wellbeing and outcomes.

Thirdly, we must improve the support offered to children in education. The publication of local authority guidance is anticipated this summer, and it is important that it ensures that schools and services meet their statutory duties for children with PANS/ PANDAS. Thousands of families are fighting for support from multiple systems while taking care of unwell children. It is time for the Government to do their part, and eliminate the barriers to diagnosis and treatment for those living with PANS/PANDAS.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Albie is a superstar, as is his mum!

I call the Liberal Democrat spokesperson.

[Susan Murray (Mid Dunbartonshire) (LD)]

I am grateful to my hon. Friend the Member for North East Fife (Wendy Chamberlain) for securing this debate, and for all her work to raise the profile of these childhood conditions. I also thank the Backbench Business Committee for selecting this topic for debate.

As she said, my hon. Friend first raised PANS/PANDAS in this House more than three years ago and has pushed for change ever since. Indeed, I was pleased to meet the impressive PANS PANDAS UK youth board on their visit to Parliament. For families, the onset of PANS/PANDAS is often sudden and deeply distressing. A child who was well one week can, the next, be gripped by anxiety, tics or obsessive behaviours. What follows is too often not treatment, but a search from GP to specialist and back again for someone who can provide a diagnosis.

Almost three years ago, my hon. Friend asked the Government for a small number of reasonable things. I am sorry to say that families still have not seen the change that they are entitled to expect, but I hope that what we heard earlier means that it will be coming soon. The Department of Health and Social Care has said that it does not hold data on how many children are affected, and NICE has not yet produced guidance, after concluding there was insufficient evidence to produce useful guidance. Clinicians are still left without a clear national pathway to follow, even if they are aware of the conditions.

The result, as we have heard, is a postcode lottery. A survey for PANS PANDAS UK found that just 2% of families said their GP even considered PANS/PANDAS as a possibility for their child’s symptoms. Families who can pay go private to see specialists; children whose families cannot pay, lose their childhood, miss school and fail to thrive. Such delays are not administrative inconveniences; they are a risk to children’s lives. According to PANS PANDAS UK, 43% of parents say that their child has talked about taking their own life, and 61% say that their child has expressed a desire to no longer be here. These are young children, made desperately unwell by a treatable condition, yet they are waiting months or years for someone simply to recognise what is wrong.

There are two mothers in the Gallery today, one from my constituency of Mid Dunbartonshire, and one from just next door. Both have been forced to spend significant sums of their own money on diagnoses and treatment, including travelling down to London to see specialists in private clinics. As we have heard, that is not unusual. Nearly a third of affected families report a financial impact of more than £50,000, and one in eight report an impact of more than £100,000, simply to get their child diagnosed and treated. We have a system in which a recognised diagnosis is reserved for those who can afford to pay for it, and those who cannot are often left behind.

Two weeks ago, my Liberal Democrat colleague Adam Harley MSP, who represents many of the same families that I do, raised one of the cases with the First Minister in the Scottish Parliament and called for properly recognised NHS guidance. Health is a devolved matter, but families across Scotland face the same barriers as families anywhere else in the UK, and they frequently end up in England to access treatment. Has the Minister had any discussions with the Scottish Government on taking a unified approach to tackling the issue? Given that we are expecting clinical guidance to be released in August, I am sure that families in Scotland would greatly appreciate co-operation between the Governments in Holyrood and Westminster to help bring the postcode lottery they currently face to an end.

PANS/PANDAS are treatable conditions, and children can get their childhood back. To make that happen, I urge the Government to help plug the current gaps in evidence and knowledge around these conditions, including the number of children affected, through supporting research. The Liberal Democrats have called for an increase in research and development spending to 3.5% of GDP to help drive British research, to develop a greater understanding of conditions like PANS/PANDAS, and to evidence the efficacy of available treatment.

An effective treatment can change a child’s life—children like Isa and Hugo—for as little as £9. Effective diagnosis and treatment will save the NHS money. Our NHS was founded on the idea that it would treat according to need, not ability to pay. Sadly, in the case of children with PANS/PANDAS, too often that principle is not being upheld. Families simply trying to find treatment for their children are being failed and we must rectify that, wherever in the UK they live.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister and welcome him to the Dispatch Box.

--- Later in debate ---

[Mrs Hodgson]

I thank the right hon. Gentleman, who I have worked closely with on a number of health matters over a number of years, and he mentions the work that we did together on mesh. I studied my speech after listening to your earlier intervention and the conversation about antibiotics—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. It was not my intervention, but that of the right hon. Member for New Forest East (Sir Julian Lewis).

[Mrs Hodgson]

Thank you, Madam Deputy Speaker. I should know better after 21 years in this House; it just goes to show—you can always teach an old dog new tricks.

Following the right hon. Gentleman’s intervention on antibiotics, I noticed that there was nothing about that in my speech, so I have come to the conclusion that that will come forward in the guidance later this year. I will be looking for that closely, and I am sure that my officials heard the point mentioned in the debate. As the right hon. Gentleman says, if a simple course of antibiotics is going to make all the difference, we would want to ensure that it is provided.

In closing, I want to emphasise that the experiences of children and families affected by PANS/PANDAS are real and significant, and that we are taking action to strengthen the system and deliver meaningful change. Our responsibility is to respond with compassion, to listen carefully, and to ensure that support is accessible, timely and appropriate. By strengthening clinical awareness, improving integration across services and continuing to build the evidence base, we can move towards a system that delivers better recognition, more effective support, and improved outcomes for children and young people, and their families.

Puberty Blockers

Nusrat Ghani Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Esther McVey (Tatton) (Con)]

I thank the hon. Lady for giving way; I am listening to her very intently. Does she know what a measure of success would be in this puberty blocker trial? If 80% of the children on it were happy with the outcome, would that be a success? What are the ultimate measurements of success?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. The hon. Member for Luton North (Sarah Owen) is making an important speech, but before she gets back to her feet, I must tell her that I need to get 12 more Members in to speak.

[Sarah Owen]

I know that further details will be coming from the Secretary of State as to what a marker of success is, but I think we have to ask ourselves what a marker of success is for the individuals and families. For some, staying in their sex from birth may look like success. For others, that will not be the case. This is very much on the individual.

--- Later in debate ---

[Rebecca Paul (Reigate) (Con)]

I frankly cannot believe that we are here again. When the Pathways clinical trial was paused earlier this year, I felt that there had finally been—[Interruption.]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Forgive me—there is a five-minute time limit, which is the only way that I can incorporate all the Back Benchers who wish to contribute.

[Rebecca Paul]

Yesterday, even the Secretary of State for Health and Social Care conceded—the second one to do so—that he is “uneasy” and even “uncomfortable”. I suggest that his discomfort is nothing next to the lifelong damage that the trial will potentially do to an extremely vulnerable cohort of children, whom we should be protecting. That funny feeling in his stomach—[Interruption.] Oh, he has left. That feeling is his good judgment trying to be heard—he will not hear this if he has left—and it is not too late for him to listen to it. I agree with what one of my hon. Friends said yesterday: he is a good man who is being placed under intolerable pressure on this issue. But he needs to find his courage.

The number of children and young people presenting to the NHS with gender distress increased dramatically in the years after 2009, with an exponential rise from around 2014. What is behind the increase among Gen Z is unclear, but the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, the increased acceptance of trans identities, or even peer social and cultural influences. Over the past 20 years, groups such as Stonewall and Mermaids have called for better access to treatment and more rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands.

--- Later in debate ---

[Rebecca Paul]

I thank the hon. Member for that excellent question. I obviously always respect and listen to different clinicians, but what is happening with this debate is that one set of clinicians with one view is being listened to. Let me remind everyone about lobotomies. Lots of very respected people came out for lobotomies; in fact, the person behind the idea won a Nobel prize. I think we would all agree that those clinicians got that wrong, so it is incumbent upon us in this House to always question. It is absolutely right that we listen to clinicians, but unfortunately we are seeing only one set of clinicians with one set of opinions being listened to here.

A Finnish study was published in April that looked at more than 2,000 adolescents and young adults who had been referred to gender services. It found that medical interventions did not reduce psychiatric problems and may even be associated with worsening mental health. How many times have we heard it said that puberty blockers offer a pathway towards improved mental health and reduced psychiatric distress for those struggling with gender identity? I have lost count. But there is hard evidence that not only says different; it says the opposite. I would be keen to understand from the Minister and the Secretary of State whether that study was taken into account before deciding to go ahead with the trial.

I want to point out that children and young people who grow up to be same-sex attracted are over-represented in this cohort, and that is something we need to think about. If we look at the case of Keira Bell, she was a lesbian struggling with her sexuality, and instead of people saying, “It’s okay to find other women attractive—there’s nothing wrong with that. You do not need to change your body,” they said, “Ah! You’ve got gender dysphoria.” They put her on puberty blockers, and then she went on to testosterone shots. She then had her breasts removed in a double mastectomy, and then she detransitioned. This is a deeply homophobic approach to healthcare. Those on the other side of the argument think they have the progressive position. I am sorry, but you are repeating mistakes that have been made historically—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Obviously, I have not said anything, so I am not repeating anything. No “yous” and “yours”.

--- Later in debate ---

[Olivia Blake (Sheffield Hallam) (Lab)]

It is a pleasure to follow the hon. Member for Edinburgh West (Christine Jardine), and I agree wholeheartedly with her comments about homophobia.

I remind the House that I am a former biomedical scientist, and I have probably read lots more medical publications than many in this Chamber. I have also volunteered many times for medical research, either as a healthy patient in my younger years or as a patient now in my slightly older years, so I know the process from both sides. I think it is really important that we recognise that the UK has some of the highest standards for medical research, especially when it involves patients. There is talk about why there is no placebo, but sometimes it is not ethical to do a placebo-based trial. If we are withholding a form of medical intervention from someone just to prove that the next best thing will be the next best thing, that is not ethically right, because we are withholding medical care when someone needs it. That is very different from a healthy patient model, in which we are treating healthy patients to see if there is a biological change that would be harmful to all patients.

All too often, healthcare for the trans community is marked by lengthy wait lists, inconsistent treatment and discrimination—we have heard some of that stigma today—and there needs to be a concerted effort to change that. We have heard a lot about safeguarding children, and I think everyone in the Chamber agrees that that must be paramount, but I fear we are dividing trans children from other children when it comes to their medical needs and what support should be in place.

I am pleased that my right hon. Friend the Secretary of State for Health and Social Care confirmed yesterday that the Pathways trial will go ahead. We have heard many Members mention that young people getting better is a way through this, but that is very stigmatising for those who do hold on to their trans identity into adulthood. In fact, very many—the majority—of young trans people will go on to be trans adults, and we also know that those who detransition do in some instances retransition, because they detransitioned for the social reasons of not having a supportive family and other social pressures. This is not as static as some may think, and in fact young people often raise that fluidity with me.

Young trans people need this trial to move forward. For many, this represents the only legal route to access puberty suppressants at the moment. A pathway can be profoundly impactful, and we have heard people describe it as lifesaving. This has not fallen from the sky. There are well-established scientific and clinical precedents for the use of puberty-suppressing hormones, supported by decades of research and medical practice, and for a variety of different conditions. Even fertility clinics use these drugs in some of their regimes with certain patients. As I have mentioned, placebos are not the solution to making this a safer trial.

Puberty-suppressing hormones are not new and they are not experimental. They have been used safely since the 1980s, and we have decades of clinical experience of supporting their use in controlled settings. But instead of engaging seriously with the potential benefits of such a trial, the Opposition have framed the issue as part of a broader culture war that is trying to erase trans children’s identities. By removing healthcare, we are not going to remove trans children; they will look for alternative access to treatments, including, as we have heard, starving themselves to prevent puberty starting. That is horrific to hear—as someone who has been very active on eating disorders, that is really quite terrifying.

We should be focused on ensuring that the voices of those people who will be most impacted—the young people and their families—are part of the discussion. The way in which the trial has been put together is of course not perfect—no medical trial is perfect—but it is really, really important, and the risk of harm from not going ahead with the trial has to outweigh the risk of harm from doing the trial. We need the data and the understanding, so we can make the right decisions when designing the clinical interventions and services that should be available to young people. Anyone who is denying that should think again about why they are making that argument. This issue is not about whether trans young people exist; it is about whether we choose to respond with the real—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I call Carla Lockhart.

--- Later in debate ---

[Sir John Hayes]

That experience clearly contradicts the Cass review’s findings, but it is for the hon. Lady to have that debate, no doubt, with Dr Cass.

What is certain is that we have no indication from the Government about what success in the trial will look like. When challenged on that subject, answer came there none. How will we gauge whether the trial is a success or a failure? Are these children really guinea pigs to be used to provide the evidence that the hon. Lady says is already freely available in her anecdotal experience of communicating with her constituents and others?

We know that there is certainly evidence from other countries. Have the Government looked to draw on that, rather than engaging in this dangerous trial? We know that there is evidence too from the 2,000 or more children who went through Tavistock. Some have suggested that we should look at the data already available rather than putting any more children at risk. Yet despite the Secretary of State’s agonised decision—I do not intend that to be sarcastic or pejorative; I appreciate that the Secretary of State was completely straightforward about how difficult it was to make the decision—the trial goes ahead. I accept that there are additional safeguards—this is not Tavistock; it is something different—but none the less it brings immense risk alongside the determination to try to gain facts. Instead, let us look at Finland and Denmark and at other countries that have already gathered evidence. Let us look at what we know of those who have already been through this process.

G. K. Chesterton said:

“children are innocent and love justice”.

I fear that this trial will steal their innocence and deny them justice. I hope that even at this late stage the Government, recognising that, will abandon this awful trial and save innocent children from that fate.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

We come to the wind-ups; I invite the shadow Secretary of State.

Isle of Wight Dementia Patients: Discharge to Mainland Care Homes

Nusrat Ghani Excerpts

Tuesday 16th June 2026 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Preet Kaur Gill)]

I am grateful to my hon. Friend the Member for Isle of Wight West (Richard Quigley) for raising this very important issue, and I recognise the deeply concerning experiences that he has highlighted of families on the Isle of Wight, including the story of Maggie Bennett and the café that she runs.

For people living with dementia or complex disabilities, being moved away from their homes and loved ones can be profoundly distressing. Familiar surroundings, routines and relationships are often central to their wellbeing, and it is entirely understandable that families feel anxious when those links are disrupted. The Government are clear that people should be discharged from hospital safely, promptly and with appropriate care and support in place. This is essential not only for patient outcomes but to ensure that hospitals can continue to treat those in greatest need.

Local authorities have a statutory duty under the Care Act 2014 to shape their local care markets, ensuring that there is a sufficient range of high-quality, person-centred services available to meet local needs. Decisions about care placements are made at a local level based on clinical need, the suitability of available services and the individual’s circumstances. Where a person requires specialist or higher-intensity support, it is essential that the placement meets those needs in full.

However, I do recognise that local capacity pressures, particularly in geographically isolated areas such as the Isle of Wight, can mean that suitable placements are not always immediately available. My hon. Friend spoke about the impact of care home closures in his constituency and shared Phyllis’s story. While temporary placements further away are necessary to ensure that a person is discharged safely and without delay, those situations clearly have a huge impact on families.

On the Isle of Wight, local partners are working to improve access to more seamless pathways across health and social care so that people can move more easily between services and receive the support that they need. This includes strengthening co-ordination and expanding care in the community so that wherever possible people can be supported at home or close to home. As my hon. Friend said, because of the island’s size and physical isolation, that also requires close working with mainland partners to ensure that residents can access the full range of care that they need, including specialist provision where it is not available locally.

We will continue to explore and build on opportunities to deliver services for the benefit of the Isle of Wight community so that care can be delivered at the right place at the right time. We expect local systems to plan for demand and work with providers to strengthen capacity, including for people with dementia and complex conditions.

As we heard from my hon. Friend, it is vital that when a difficult decision is made to close a care home, the process is handled as sensitively as possible. Local authorities should have procedures in place to minimise disruption, with time allowed to support a safe transfer that supports the wellbeing of individuals, families and carers. Providers should ensure that proper arrangements are in place to support the transition of residents to their new position. Our expectation is that every effort should be made to provide care as close to home as possible and to take account of family connections and personal preferences wherever practicable. It is also essential that individuals and their families are involved in decisions about discharge and ongoing care. The guidance is clear that planning should begin early and that patients and carers should be supported to make fully informed decisions where appropriate.

We know that people who are discharged in a timely way with the right care and support in place experience better recovery and health outcomes. That is why we expect local systems to work together to ensure discharge processes are as effective as possible, particularly for people with dementia and other complex needs. The Government are therefore working with the NHS and local authorities to strengthen the local health and care system so that it can better meet those challenges.

Through the better care fund, more than £9 billion is being used to support integrated working between the NHS and local authorities, enabling more joined-up services and improving the planning of care outside of hospital. We will also reform the better care fund to support more effective joint planning and delivery between health and social care. That will be focused on improving how services are co-ordinated and supporting care that helps people regain their independence, reduces unnecessary hospital stays and enables people to receive care closer to home.

We also recognise the importance of improving care and support for people living with dementia. According to NHS data, NHS Hampshire and Isle of Wight integrated care board recorded that as of March more than 18,000 people had a diagnosed form of dementia. The Government want a society where individuals with dementia and frailty receive high-quality, compassionate care from diagnosis through to the end of life. That is why we will deliver the first ever modern service framework for frailty and dementia to deliver rapid and significant improvements in the quality of care and productivity. That will be informed by phase one of Baroness Casey’s independent commission into adult social care, which is under way and expected later this year.

We are committed to feeding into the NHS and local government planning cycles in September and aim to publish the full framework by the end the year, as recommended by Baroness Casey. We intend to engage with a range of partners over the coming months and will ensure that the voices of people with lived experience are at the centre of our work to develop the modern service framework.

I thank my hon. Friend for bringing his constituents’ voice to the House. I reiterate that we recognise the very real concerns raised by families on the Isle of Wight, particularly when people with dementia or complex needs have been moved away from their homes and communities. While there will be circumstances where temporary placements further from home are necessary, care should be provided as close to home as possible in a way that respects the individual’s needs, preferences and connections to their family and community.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I did not have time to congratulate the Minister, a fellow Brummie, on her promotion. It is good to see those from Birmingham here in the Chamber.

Question put and agreed to.

Health Bill

Nusrat Ghani Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Interventions are going to make it very difficult for everyone to speak in the debate. I call Dr Beccy Cooper.

[Dr Beccy Cooper (Worthing West) (Lab)]

I will try to keep my remarks brief. The NHS is one of the most unifying institutions in our country today. It is a huge employer, a major source of pride, and a safety net for us all at our moments of greatest need. We all know that it has been creaking under significant strain for some time now, so it is good to see new life and new energy in the 10-year plan. I welcome this Bill as a response to some of the purpose outlined in the strategy.

A lot of the detail in the Bill has been covered by colleagues already and will doubtless be covered further in the Bill Committee, so I will limit my remarks to single patient records and the role of public health in the Bill. I am fully supportive of a single patient record finally being realised. Our health and care system should revolve around patients, rather than patients revolving around it. It is over 20 years since I was a junior doctor, but I still remember my and my patients’ frustration when I once again had to ask them for their clinical history after they had already told it to the GP, the paramedic and the triage nurse.

This endeavour has been tried several times before. The financial cost of NHS Digital and the litany of platforms, software and systems that have been tried and abandoned provide a wealth of lessons learned to ensure that it is successful this time—which, let us face it, is long overdue. Public trust is very important for health data systems. We could consider new safeguards such as a public interest test for sharing data or bringing back requirements to report to Parliament. The NHS must ensure that the technical know-how is sound, as well as being fleet of foot.

I turn to the role of public and population health in this NHS Bill. Public health must be front and centre to provide the right health services in the right place at the right time. At an ICB level, there is now an explicit requirement for population health considerations to be understood. Integrated care boards will be responsible for commissioning the vast majority of our local NHS services, so they need to know the population health need.

That has been demonstrated in my ICB area of Sussex over the past couple of weeks. In the discussions about proposed sites for neighbourhood health hubs, it became clear that the population needs of my constituency of Worthing West had not been entirely understood when considering sites: there is a large area containing several villages with an ageing population and limited access to transport, whose requirements had not hit the radar of the ICB.

To be clear, this is not about blame—anyone who thinks that planning for population health needs is straightforward is welcome to sit the public health exams in epidemiology and statistics. Expertise is there to be used, and we should draw on it. I therefore suggest that we require a statutory appointment of a lead director of public health to represent the area covered by each integrated care board.

Finally, to guard against a focus solely on reorganisation, alongside this NHS Bill and as a key focus of the 10-year strategy we must have a whole of Government approach that recognises health as a strategic and shared asset—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. To ensure that the final four speakers can get in, the speaking limit will become two and a half minutes.

--- Later in debate ---

[Sureena Brackenridge (Wolverhampton North East) (Lab)]

Given the lack of time remaining in this debate, I will focus my remarks on the long-overdue move to a much-welcomed single patient record.

Many Members will have had constituents get in touch with casework, raising blunders and delays that stem from fragmented patient records. When they have been in severe pain or at their most vulnerable, patients have been asked to repeat the same medical history again and again to different clinicians, whether in hospital or in the GP setting. It is frustrating, and in some cases distressing, especially if the patient is elderly or with neurological conditions such as dementia. A single patient record will ensure that clinicians have the right information at the right time, including on allergies, medications and previous diagnoses, so that they are better placed to make the right decision quickly. Today, we have heard of surgeons who have had to cancel operations because patient histories were incomplete or did not arrive quickly enough. There is consensus that a single patient record will make a significant difference in A&E, for paramedics at the roadside and even in routine care, where small details can have significant consequences.

I must, however, also make clear the concerns of many of my residents in Wolverhampton North East. Bringing together such large volumes of highly sensitive personal data into a single system will inevitably raise questions about cyber-security and data protection. We know that patient data in the UK would be extremely lucrative to some, and many will be acutely aware of international interest in getting hold of our data-rich NHS in order to profiteer. As such, can the Minister set out in more detail the safeguards that will be built into the system from the very start to guard against cyber-attacks and unauthorised access? How will this be controlled, and what oversight will exist to ensure that public confidence is maintained if threats evolve?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

Tobacco and Vapes Bill

Nusrat Ghani Excerpts

Consideration of Lords amendments
Monday 23rd March 2026 Commons Chamber

Consideration of Lords amendments

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I inform the House that Lords amendments 21, 22, 29, 32 to 34, 37, 38, 43 to 48, 51 to 59, 62, 77 and 78 engage the Commons’ financial privilege. If any of these Lords amendments are agreed to, I will cause the customary entry waiving the Commons’ financial privilege to be entered in the Journal. I call the Minister to move the motion. I believe it is her debut, so congratulations and welcome—enjoy.

Clause 1

Sale of tobacco etc

[The Parliamentary Under-Secretary of State for Health and Social Care (Mrs Sharon Hodgson)]

Thank you, Madam Deputy Speaker. I beg to move, That this House agrees with Lords amendment 1.

[Madam Deputy Speaker]

With this it will be convenient to discuss:

Lords amendments 2 to 27.

Lords amendment 28, and Government amendments (a) to (c) consequential on Lords amendment 28.

Lords amendment 29, and Government amendments (a) to (c) consequential on Lords amendment 29.

Lords amendments 30 to 123.

[Mrs Hodgson]

Before I address Lords amendment 1, I would like to take this opportunity to pay tribute to my predecessor, my hon. Friend the Member for West Lancashire (Ashley Dalton), for her work on the Bill and the wider prevention agenda. I also extend my thanks to Baroness Merron for her work in the other place, ensuring that the Bill was expertly steered through the legislative process.

This is a landmark Bill, and I am honoured to have taken on responsibility for it as the House considers the amendments made in the other place. Creating a smoke-free generation is the most significant public health intervention since the ban on smoking in public places in 2007, under the last Labour Government. Tobacco claims around 80,000 lives every year, and in England it is responsible for a quarter of all cancer deaths. Someone is admitted to hospital almost every minute as a result of smoking, and up to two-thirds of deaths among current smokers can be attributed directly to smoking. Those are not abstract figures; they represent lives cut short by an entirely preventable harm.

The Bill also takes decisive action to tackle the rapid rise in the use of vapes and other nicotine products, particularly among young people, protecting a new generation from nicotine addiction. All the amendments to be considered today have been accepted by the Government, starting with Lords amendments 1, 2, 39 and 40, which change the parliamentary procedure for age verification regulations from negative to affirmative in England and Wales, and in Northern Ireland. The regulations will set out how retailers may ensure compliance when verifying a customer’s age. The changes were made as a result of a recommendation from the Delegated Powers and Regulatory Reform Committee, which the Government accept.

--- Later in debate ---

[Mrs Hodgson]

We are content that the measures in the Bill, which are intended to apply to Northern Ireland, are compatible with the obligations under the Windsor framework. I hope that answers the hon. and learned Gentleman’s concern.

We hope that the review will be a clear demonstration of the Government’s commitment to monitoring progress against our smokefree ambition. Finally, Lords amendments 5, 8, 36, 41, 60 and 61, 63 to 76, 79, and 81 to 88 are technical amendments, some of which are consequential to the commencement of several other Acts. They also improve consistency in drafting across the Bill.

I encourage all Members to support all the amendments. These are meaningful changes that strengthen the Bill and respond to concerns raised by Members across the House and in the other place. The Government amendments tabled today will return to the other place for consideration, and I look forward to their timely agreement, and to the Bill completing its final stages.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I welcome the new Minister to her place; she is stepping in and taking the Bill through this stage, like a technical finishing substitute. I, too, have been substituted for my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who spent a huge amount of time going through the Bill in Committee. I place my thanks to her on the record. Because of what she did, I have not had to do it, which has been a relief.

Eradicating smoking among young people is a public health priority. There may be differences in how we would achieve that, but the objective is shared by Members across the House, and we will not divide the House on the Bill tonight. There has been important common ground. As my colleague Lord Kamall said in the other place, smoking is harmful, vaping is less harmful than smoking, and not vaping is better than vaping. I think we can all agree that those principles should guide this legislation.

Those principles underpinned the Bill introduced by the previous Government. Since then, it has expanded, and at times it risks losing focus on its central aim of reducing smoking, particularly among young people. The Opposition have been concerned, for example, about measures that have placed additional burdens on hospitality and retail, and about restrictions on vaping that could undermine its role as a quitting tool for adult smokers. I therefore welcome the changes made in the House of Lords and the Government’s acceptance of them.

Further, the exemption of the adult mental health in-patient setting from the ban on vapes vending machines is a sensible and compassionate decision. Ministers were right to respond to concerns raised by peers, including my colleague Lord Moylan, and mental health charities, and we welcome the changes to clause 12. It is also right that local authorities will be able to retain proceeds from fixed penalty notices to support enforcement under the amendments to clause 39.

However, the Bill marks not the end of the process, but simply the end of the beginning. Key questions remain, including about the regulation of flavours and descriptors, advertising, and the designation of vape-free places. Those decisions will pretty much determine whether the Bill works in practice. It is therefore essential that the Government proceed in a way that is proportionate, enforceable and sustainable. We have already seen the importance of that balance. I welcome the decision to drop proposals to extend restrictions in pub gardens, which would have placed further strain on the hospitality sector. However, Ministers should take note. Restrictions should be targeted at areas where there is a clear and significant risk to public health. Possible considerations include restrictions outside schools and playgrounds, and I gently ask the Minister to reflect that approach as further regulations are developed.

The Lords also strengthened the Secretary of State’s powers in relation to cigarette filters, enabling more effective regulation of components that contribute to environmental harm. In addition, a series of technical amendments were agreed to, aimed at clarifying definitions, improving compliance mechanisms and ensuring that secondary legislation is subject to the appropriate level of parliamentary scrutiny. For example, Lords amendment 1, relating to age verification regulations under clause 1, requires the affirmative procedure to be used, increasing oversight of a core part of the Bill. Those are sensible improvements that reflect the spirit of constructive scrutiny.

A key and central issue raised throughout the passage of the Bill has been the risk of unintended consequences, and particularly the growth of the illicit market. Whether we are for the Bill or against it, one concern unites us all: the black market. If regulation is too restrictive or poorly enforced, it will drive consumers away from the legal market and into illegal supply, which would undermine both public health and enforcement. The Opposition proposed an annual report on illicit tobacco and vaping activity, which the Government rejected. Given the concerns raised throughout the passage of the Bill, I would be grateful if the Minister could set out clearly how the Government will monitor and respond to changes in the illicit market.

We support the broad objectives of the Bill, but we will be watching closely. Its success depends not on its intentions, but on its delivery. When it was first introduced, I spoke about my experience as a junior doctor on a respiratory ward—my first hospital job. I saw patients struggling for breath, families in distress, and moments when, despite everything, there was little more that could be done. The true test of the Bill is simple: in years ahead, fewer families should have to experience the same pain, suffering and despair. Let us hope this works.

--- Later in debate ---

[Mary Kelly Foy]

I totally agree with my hon. Friend. We must keep in mind the fact that it is smoking that causes harm and death, not vaping, which can be a very successful cessation tool. I hope that the Bill will continue to push that.

Powers in the Bill cover marketing, display, packaging and product design, as well as flavours and their descriptions. However, there is a crucial balance to strike: reducing youth appeal without limiting access or effectiveness for those using the products to quit smoking. We must keep the harms of smoking firmly at the forefront of our minds.

A review after four to seven years feels appropriate to assess how the regulations are affecting usage and the market, and whether we are striking the right balance. This should be considered alongside the disposable vape ban and the forthcoming vape excise tax. I would welcome reassurance today that the review will place the harms of smoking and the needs of smokers at its centre.

Many of the other amendments are technical in nature. I welcome the comprehensive definition of tobacco coming into force on Royal Assent, through Lords amendments 89, 90 and 91, as there is no need for a transition period. The exemption for vape-vending machines in Lords amendments 3 and 4 is also welcome, as others have noted, because we must ensure that vulnerable smokers are supported as much as possible to quit.

As my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) has recently taken up her role, I welcome her to her position as Minister for Public Health. I look forward to working with her as this Bill, soon to be an Act, progresses, so that we can continue our work, and hopefully set out a road map for a totally smokefree country and to look again at introducing a polluter pays levy.

Finally, as someone who has spent many years advocating for a smokefree future, free of death and disease from tobacco, I know from speaking and listening to many people affected by smoking just how much the public want and need this action. We have already shifted the social norms around smoking and now, thanks to the work of organisations such as Action on Smoking and Health and Fresh, and the work of colleagues across the two Houses, a smokefree future is now possible. That is truly something to celebrate.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

I also welcome the hon. Member for Washington and Gateshead South (Mrs Hodgson) to her position as Minister for Public Health. I had the privilege to serve on the Bill Committee, as other hon. Members did—indeed, I see some familiar faces in the Chamber. One of the things that struck me most was when the chief medical officer gave his evidence: he said that the Bill was not only the most significant piece of public health legislation in 30 years, but probably the single of piece of legislation that will most help to address inequality. Inequality is multifactorial, but one of the main factors in the difference in life expectancy between certain wealthier areas and certain more deprived areas is the rate of smoking. This Bill will have a huge impact, especially on the communities for which we are really trying to improve life expectancy.

I am very pleased that the Government accepted so many amendments in the Lords. Some of the amendments that the Liberal Democrats are really keen on are regarding fixed penalty notices and require all the money from those fines to go to local public health initiatives, as directed by local authorities. We know that public health is so important, yet funding for such organisations is usually extremely limited, given the pressures on local authorities. Without the Lords amendments on fixed penalty notices, the money would go straight back to the Exchequer. We fundamentally believe that if we are serious about making a meaningful difference to people’s lives, that money must be used in local smoking-cessation initiatives.

As the mental health spokesperson for the Liberal Democrats, I am acutely aware of the benefits of the Lords amendments that support those with long-term mental health conditions, who have higher rates of smoking than the general public. We know that going cold turkey is simply unrealistic and can even be dangerous. The exemption on vape vending machines in secure mental health hospitals ensures that people are supported professionally in quitting in a sustainable and maintained way that will not further damage their mental health.

I welcome the Lords amendments on regulating filters, which have cross-party support. Not only are filters an environmental issue, but they provide a false perception of safety to smokers. Ensuring that there is awareness of the lack of protection that these filters provide and of smoking as a whole is imperative if we are to ensure that people can make informed decisions about their health and wellbeing.

I am very pleased to support this Bill as it goes through Parliament; it is momentous and significant. We really appreciate the Government’s accepting the Liberal Democrat Lords amendments, which will slightly improve how the Bill will be delivered. We are very pleased that this will be a strong and impactful Bill. We hope that it will deliver meaningful change on public health for generations to come and that we will have a smokefree generation growing up.

Palliative Care

Nusrat Ghani Excerpts

Thursday 5th March 2026 Commons Chamber

[Alison Bennett (Mid Sussex) (LD)]

I thank all hon. Members for their thoughtful and moving contributions this afternoon. The hon. Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer) spoke so movingly about their own very personal loss. Of course, we would not be holding the debate were it not for the hon. Member for York Central (Rachael Maskell), who set out the frame of this debate so brilliantly and has done so much outside the Chamber to strive for better palliative care.

The hon. Member for York Central concluded her remarks by talking about bereavement support, and that is where I will begin mine. Last week, I was out in Burgess Hill. I saw an elderly gentleman who was standing by the edge of the pavement holding on to a walking frame. I got talking to him, and it turned out that he was waiting for a lift to St Peter and St James hospice, where he was going to a bereavement café. He told me that he had lost his wife two and a half years ago, but he had no recollection of the first two years following her loss—I think it had been a blur for him. For the past six months, he has been going back to St Peter and St James for the bereavement café, and he is beginning to feel a little better with that support each week. My thanks go to St Peter and St James, and to all the hospices that support our constituents, for what they do.

Our palliative care system is at tipping point, with a funding cliff edge approaching. Some 75% of hospices are running a deficit, two in five are planning reductions in clinical services in the year ahead, and 380 hospice beds across England lie empty, not because there is no need for them, but because there is no funding to staff hospices, as many hon. Members have said. Around 300,000 people are cared for by hospices every year, yet around 100,000 more need it. One in three of those who need hospice care miss out, and demand is rising sharply.

Over the next decade in England, just over 5.75 million people will die. Around 90% of them—an estimated 5.18 million people—will have palliative care needs. New research commissioned by Marie Curie and published earlier this month showed that nearly one in three dying people have both unaddressed symptoms and concerns and insufficient access to GP services at the end of life. That equates to nearly one person dying with unmet needs every three minutes. Without intervention, around 44,400 more people are projected to have unmet palliative care needs in 2050 compared with 2025. That is the scale of the challenge before us.

Hospices are essential pillars of our health and care system, especially at a time when the NHS is under such immense strain. The economic case for funding them properly is overwhelming. Approximately 15% of all emergency hospital admissions in England involve people in their last year of life—nearly 1 million admissions in 2023 alone. Those patients account for around 30% of all emergency hospital bed days. In the last six months of life, around 360,000 people spent a total of 8.4 million days in hospital. With the average acute bed day costing around £500, and with roughly 40% to 50% of the NHS budget concentrated in acute settings, the potential for a more appropriate allocation of resources is obvious.

Around 69% of people are admitted as in-patients in the final six months, with a median stay of 13 days, and 80% of those who die in hospital had an emergency admission in their final month of life. These are real people—people who, with better planning and properly resourced hospice, community nursing, GP, pharmacy and paramedic services, might have experienced a calmer, more dignified end of life and spared the NHS considerable cost. But the very sector that relieves this pressure is itself under extraordinary strain. Between 2022 and 2024, there was a £47 million real-terms cut in hospice funding. As the hon. Member for Cannock Chase (Josh Newbury) noted, the disastrous rise in employer national insurance contributions alone is costing hospices in England an estimated £34 million a year.

Hospices collectively raise about £1.4 billion themselves. Government funding amounts to just over £500 million—barely a quarter of the income—and in some areas, hospices receive as little as 8% of their funding from NHS grants. There is no robust national methodology underpinning these variations. It is a postcode lottery and, as the right hon. Member for New Forest East (Sir Julian Lewis) noted, the variation in funding for children’s hospices is even more acute than that in the adult hospice sector. Access to compassionate end-of-life care should not depend on geography, the strength of an area’s ability to raise funds or whether someone is an adult or a child.

Hospices, of course, welcome the capital funding from the Government, but it quite simply does not pay nurses’ salaries. Staff account for around 70% of hospice costs. Without revenue funding for core services, capital investment does not keep beds open or prevent service reductions. This is a national, structural problem, but it is also a very real one for all our areas across the country, particularly for my area in Sussex, where the Southern Hospice Group is consulting on how to cut its costs.

Marie Curie and others have warmly welcomed the Government’s commitment to developing a palliative care and end-of-life care modern service framework, with an interim report expected in the spring and a final report in the autumn. It will be the first national plan for palliative and end-of-life care since 2008. That is, of course, good news. The Government have rightly identified five core challenges: delays in early identification, inconsistent commissioning, workforce shortages, gaps in 24/7 provision, and limited uptake of personalised and advance care planning. But those are not new problems that need solving—we have known about them for some time—and if this framework is to succeed, it must go further.

My Liberal Democrat colleagues and I are campaigning to double the funding for bereavement support payments, reversing the last Conservative Government’s cuts since 2017. We would also reduce isolation following a bereavement, by improving access to social prescribing and through the work of a dedicated Minister for tackling loneliness. We would improve support for children who have lost a parent by appointing a Cabinet member for children and young children, and extend pupil premium plus funding to children in kinship care. The Government must provide stronger national leadership and oversight, and they must place palliative and end-of-life care at the heart of plans for a neighbourhood health service, looking beyond hospices. They must deliver a new funding and commissioning model that ends the postcode lottery. They must invest properly in the workforce, and scale up proven models of care that shift support from hospital to community, improving patient experience and delivering better value for taxpayers.

The Government seem happy to talk about moving care from hospitals to the community, but we need a material change. The Liberal Democrats believe that the Government have a choice: they can allow hospices to drift from crisis to crisis, with beds closed, staff lost, and unmet need rising year after year, all while still struggling to plug gaps left by the struggling NHS; or, they can seize the moment, through the modern service framework, to build a sustainable system that matches funding to need and delivers dignity for all. No one should face death in avoidable pain, no family should be left unsupported, and no responsible Government should ignore the evidence that properly funded palliative care is both the compassionate and the economically responsible choice.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Secretary of State.

--- Later in debate ---

[Rachael Maskell]

Will the Minister give way?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The Minister has finished speaking, but the hon. Member does get to wind up the debate.