Health Bill (Fourth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Karin Smyth]

I can tell the right hon. Member that we expect that NHS England coming into the Department will deliver up to about £1 billion in annual savings by the end of the Parliament, driven primarily by reductions in headcount, calculated using the average staff costs—about £77,000 per staff member in the Department and £94,000 per staff member in NHS England—including all pension and employer costs, which I think should help contribute to those numbers. As I think he knows, we will publish all accounts in the usual way.

I commend the three clauses to the Committee.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 and 3 ordered to stand part of the Bill.

Clause 4

Reducing inequalities

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

I beg to move amendment 13, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—

“1C Health improvement and health inequalities duty

(1) In exercising any functions relating to the health service, Secretary of State must have regard to the need to—

(a) improve the health of persons in England,

(b) reduce inequalities between the people of England with respect to their ability to access health services, and

(c) reduce inequalities between the people of England with respect to the outcomes achieved for them by the provision of health services.

(2) Health inequalities ‘between the people of England’ means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.

(3) ‘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.

(4) Under subsection (3) ‘general health determinants’ are—

(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 economic security;

(d) 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;

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.”

This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 29, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert—

“1C Health improvement and health inequalities duty

(1) When considering whether or how to exercise any functions, the Secretary of State must have regard to the need to—

(a) improve the health of persons in England,

(b) reduce health inequalities between persons in England, and

(c) reduce inequalities between persons in England with respect to their ability to access health services and to the outcomes achieved for them by the provision of health services.

(2) Health inequalities ‘between persons’ living in England means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England.

(3) ‘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.

(4) ‘General health determinants’ are—

(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.

(5) In subsection (1)(a), the reference to improving the health of persons includes a reference to mitigating any detriment to health which would otherwise be occasioned by the exercise of the Secretary of State’s functions.

(6) In subsection (1)(b), the reference to reducing health inequalities includes a reference to mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.”

This amendment would amend clause 1C of the National Health Service Act 2006 to introduce a duty on the Secretary of State to have regard to health improvement and health inequalities, reflecting the duties placed on combined authorities and CCAs in the English Devolution and Community Empowerment Act 2026.

Amendment 34, in clause 4, page 3, line 29, at end insert—

“(c) reducing inequalities between the people of England with respect to hospital transportation access.”

This amendment would create a duty for the Secretary of State to have regard for reducing inequalities in England with respect to hospital transportation access when exercising functions in relation to the health service.

Amendment 30, in clause 4, page 3, line 29, at end insert—

“(2) In discharging this duty the Secretary of State must have regard to the need to involve all departments of government in reducing health inequalities, and must take reasonable steps to ensure that other all departments consider the impact of their policy proposals on health inequalities.”

This amendment would require a whole government approach to addressing health inequalities by requiring the Secretary of State to involve all departments in the discharge of their duty in relation to health inequalities and took reasonable steps to ensure other departments consider the impact their policies might have on health inequalities.

Clause stand part.

New clause 19—Health improvement and health inequalities strategy—

“(1) Within six months of the passage of this Act the Secretary of State must publish a health improvement and health inequalities strategy.

(2) In preparing the strategy under subsection (1) the Secretary of State must consult all bodies which they consider appropriate.

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

(a) long-term targets related to health improvement and the reduction of health inequalities in England,

(b) provision for the establishment of a public authority with functions for additional monitoring and reporting on progress towards the targets set by subsection (3)(a), and

(c) any other provisions the Secretary of State considers appropriate.

(4) All Ministers of the Crown must have regard to the strategy under subsection (1) in carrying out their functions.

(5) Within 12 months of the publication of the strategy under subsection (1), and every 12 months thereafter, the Secretary of State must prepare and publish a report on the implementation of the strategy.

(6) ‘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.”

This new clause would require the Secretary of State to publish a strategy for health improvement and the reduction of health inequalities.

[Peter Prinsley]

I apologise for being a little delayed, Sir Jeremy. I am moving the amendment on behalf of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). It would place a clear duty on the Secretary of State to have regard to health improvement and health inequalities when exercising functions.

Between 2011 and 2021, the UK was one of only five high-income countries where healthy life expectancy fell. Over the same decade, we faced a cost of living crisis, the covid-19 pandemic and economic decline across the post-industrial regions. We cannot shy away from the fact that ill health is rising. Economic inactivity due to sickness is at its highest level since 2012, and we witness a widening disparity in health outcomes. People living in the most deprived areas of the UK, on average, live just 52 years of healthy life. There is now a 16-year gap in life expectancy between the richest and poorest parts of the UK. Even within individual constituencies, the life expectancy gap can be as wide as seven years between local postcodes.

The purpose of the amendment is to ensure that decisions taken at the highest level of the health system consistently reflect the reality that health outcomes differ sharply depending on where someone lives, the conditions that they live in and their opportunities to achieve good health. The amendment would require the Secretary of State to have regard to the need to improve the health of persons in England. The intention is that this duty would include the need to reduce inequalities in health. That is in addition to the duties that are already in the clause, relating to inequalities in access to and outcomes of healthcare.

At present, the Bill brings together old duties on the Secretary of State and NHS England to reduce inequality in access to and outcomes from NHS services. Those are too narrow and do not reflect the wider determinants of health that the Government have pledged to tackle through their 10-year plan. The amendment would strengthen the duty to reflect the wider cross-Government goals for health improvement and health inequalities. That would make an important statement of the Government’s commitment to improving health and tackling health inequalities, and would set in train an important step towards achieving them.

The amendment also provides a clear definition of “health inequalities” and “general health determinants”. 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, including housing standards, environmental factors, public transport, economic factors and other wider determinants of life expectancy. The amendment has been drafted to mirror the wording of the newly enacted section 45 duty on combined authorities in relation to health improvement and health inequalities under the English Devolution and Community Empowerment Act 2026.

Accepting the amendment would ensure consistent focus on the mission of creating a fairer country where everyone lives for longer, from the top of Government to regions and neighbourhoods. By setting this out explicitly, the amendment would ensure that future Secretaries of State cannot overlook the wider conditions that shape health outcomes. In sum, the amendment would require that when decisions are made, the Secretary of State must consider their impact on health improvement and on distribution of health across the population.

The amendment is supported by the Health Equals coalition, including 27 organisations that wrote an open letter to the Minister on 15 June. Those organisations range from the Health Foundation to the King’s Fund, Ramblers UK and the Wildlife Trusts, showing the breadth of support from across the sector. The cross-party Health and Social Care Committee also recommended that the clause be amended in this way.

Embedding this duty in legislation would strengthen accountability and ensure that the reduction of health inequalities is treated not as a secondary consideration, but as an integral part of how the health system is led and managed. If accepted, the new duty would ensure clear alignment at national and local levels about the importance of prevention.

[Joe Robertson (Isle of Wight East) (Con)]

It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on.

On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later. I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning.

If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health services difficult, not least for reasons of physical access; the entire population within an area with an older age demographic is affected. The Isle of Wight has a small local authority. We are fairly unique, in that we are surrounded by water and have a higher age profile, which, taken together with other challenges, makes health equality a challenge for the entire population, not just older people. The issue is aggravated by other considerations, primarily relating to geography.

Amendment 34, tabled by the hon. Member for Winchester, refers to hospital transportation access. That can mean a lot of different things in different places. I support at least the aim of putting more pressure on the Secretary of State and the Department and encouraging them to recognise and eradicate inequalities in hospital transportation access. For my constituents, accessing specialist services means crossing a body of water, which is not only a physical barrier—a ferry has to be taken—but a cost barrier, because ferries cost money. I understand where the hon. Gentleman is coming from, given the challenge in my constituency, but of course other places have different but challenging hospital transportation issues.

Amendment 30, tabled by the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, refers to cross-departmental working to ensure that health inequalities are taken into consideration. I think this is key. Of course the primary responsibility for health inequalities rests with the Department of Health and Social Care, but it is by no means the only Department with that responsibility. The more we think about the various inequalities that exist in this country, the more we realise that other Departments have considerable responsibility. We hear from politicians—of all parties, but particularly the Labour party in government—about better joined-up working between Departments, but without something more concrete in Bills such as this one, that will remain one of those aspirations that many talk about but few actually achieve.

The most obvious Department to help achieve the reduction in health inequalities is the Ministry of Housing, Communities and Local Government, given its responsibility for local government funding. Of course, local government has primary responsibility for delivering social care and public health within its area. It is a well-known feature of the system we have in this country that healthcare is free at the point of use and delivered effectively by central Government, while social care is a combination of different provision but private funding and local government have the largest role to play, and too many people fall through the gaps in those fundamentally different ways of funding two parts of the system. Unless MHCLG is bound into the way we reduce health inequalities, even with the best intentions of the Secretary of State for Health and Social Care, it clearly will not be delivered in a comprehensive and holistic way.

I refer again, as an example, to my area, which has a higher age demographic but a small unitary authority with a lower funding base. It is a matter of public record that the funding decisions made by the current Government at the beginning of this year have meant an effective reduction in funding for my local authority, notwithstanding its responsibility for an older population and the existing challenges in delivering social care. That is an argument that I and my constituency neighbour, the hon. Member for Isle of Wight West (Richard Quigley), are making to the Government in an ongoing conversation about how we can resolve that issue. We are having that conversation with MHCLG, notwithstanding the fact that it has a very direct impact—the biggest impact, in my view—on health inequalities in my constituency and the effectiveness of the Government’s 10-year health plan and their intention to improve the general health of the population. That is the probably the key departmental relationship that will be relied on to deliver the reduction in health inequalities.

The Department for Transport also has responsibility for this. If we refer to its responsibilities for reducing health inequalities outside the context of this argument, people might scratch their heads and wonder what we are talking about. but as soon as it is brought into a real-life example within this debate, it makes sense that the Department for Transport has some responsibility for reducing health inequalities. However, we will not achieve all we want to unless that responsibility is made more obvious and specific, named somewhere in some Bill. We have an option to achieve our intention to have joined-up decision making, and to ensure that every decision in any Department that has the potential to impact health inequalities is considered, whether in a formal impact assessment or just in the ordinary day-to-day decision making and mindset of the relevant Ministers, Secretary of State or departmental officials.

--- Later in debate ---

[Karin Smyth]

The hon. Lady pre-empts my next comments. I absolutely agree with her, and so do the Government. That is why we are improving living conditions through the new decent homes standards, which set standards across all rented sectors. Awaab’s law requires social landlords to act promptly to fix housing hazards. Since coming into government, we have launched the warm homes plan, the Keep Britain Working review and the homelessness strategy. In April, we published a renewed women’s health strategy, marking a decisive shift to ensure that women and girls receive the care, respect and outcomes that they deserve. Last November, we published England’s first ever men’s health strategy, to improve the health and wellbeing of all men and boys. Within the Department, we are reviewing the Carr-Hill formula and the Advisory Committee on Resource Allocation to ensure the funding matches need.

However, there is much more to do. The Minister for Public Health and Prevention, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), will continue to engage with key stakeholders, including representatives of Health Equals. I have a meeting with representatives of that body this week.

I sympathise entirely with the motivation underpinning amendment 13, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, and I commend hon. Members for working on this important agenda, but I am not convinced that the amendment is necessary. I note that it draws on the duty that was recently placed on combined authorities by the English Devolution and Community Empowerment Act 2026, with a view to creating a similar duty for central Government.

Fortunately, I can reassure hon. Members that the Secretary of State already has a duty to secure improvement in the health of people in England, and the power to take such steps to improve public health as they consider appropriate. We would not want to narrow the definition of the existing duty, because health inequalities come from many causes, as has been discussed. As I have said, we are already working across central Government and local government to address those wider inequalities, including in housing and air quality, and by getting more people into work.

The hon. Member for Sleaford and North Hykeham said that innovation might expand inequalities across our country, but we have seen a shocking expansion in the inequality gap across our country. That is what we are seeking to reverse, as we have made clear in our 10-year health plan, and the Bill will ensure that that happens. That is why we say that we will take the best to the rest; we are not about taking people down.

Finally, I turn to amendment 34 in the name of the hon. Member for Winchester. He has spoken before about his constituents’ experience, and I have spoken with him about the new hospital programme, his constituents’ reliance on transport to access hospital appointments, and the difficulties experienced in more rural areas, which the hon. Member for Isle of Wight East also mentioned. That is why, in our 10-year health plan, we are very clear about our strong commitment to rural and coastal communities—we are the first Government to do that.

We agree that reducing inequalities in hospital transport is important. The Bill already places a duty on the Secretary of State to

“have regard to the need to…reduce inequalities between the people of England with respect to their ability to access health services”.

Inequalities in access to transport to receive care fall under the scope of that duty. As such, the amendment is superfluous.

I also offer the reassurance that NHS England has been implementing a range of actions to reduce inequalities in patient transport, including the speeding up of reimbursement for patients eligible for the healthcare travel costs scheme. I also inform the Committee that the cancer plan included a commitment to provide up to £10 million a year to pay for the travel costs for cancer care for children and young people, and their families, as people have long campaigned for.

Some important issues have been raised in this debate, and I am sure that we will return to them. In the meantime, I ask my hon. Friend the Member for Bury St Edmunds and Stowmarket to withdraw the amendment. I commend clause 4 to the Committee.

[Peter Prinsley]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 4 ordered to stand part of the Bill.

Clause 5

Patient involvement and choice

[Dr Johnson]

I beg to move amendment 59, 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 who are 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 meaningful 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 to support an informed choice, including for each available provider—

(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 would be incurred by the patient in travelling to or receiving the service at that 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),

and may include diagnostic services, audiology and hearing aid care, podiatry, dietetics and nutrition, physiotherapy, ambulatory cardiac monitoring and such other services as the Secretary of State may specify.

(5) 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.

(6) 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.

(7) 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.

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59.

The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing.

Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.

[Peter Prinsley]

Does the hon. Member recognise that there are circumstances in which independent provision within a district has the effect of disabling the NHS service? A pertinent example is the ophthalmology world. Services have become difficult to deliver in NHS hospitals because large numbers of NHS staff have chosen to work in the independent sector. That makes the comprehensive provision of a service in an eye department difficult, as the staff are all off operating on cataracts.

[Gregory Stafford]

I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.

--- Later in debate ---

Currently, NHS England has a legal duty to promote innovation. That is set out in section 13K of the NHS Act 2006, which was it was inserted by the Health and Social Care Act 2012. As the Government are abolishing NHS England, that duty will disappear. The Government have chosen for clause 6 of the new legislation to place the duty on the Secretary of State instead. If innovation is encouraged and supported across the health service, it can unlock better outcomes and higher productivity, which is good for the Government, taxpayers and patients.

[Peter Prinsley]

Does the shadow Minister accept that, in order to encourage innovation within the health service, we need to do whatever we can to support clinical academics? It is within the academic departments of universities, where people are working in hospitals and teaching in medical schools, that we see the most fruitful innovations.

[Dr Johnson]

The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those.

We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.

--- Later in debate ---

Education and training

[Peter Prinsley]

I beg to move amendment 33, in clause 7, page 4, line 31, at end insert—

“(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.”

This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 50, in clause 7, page 4, line 32, at end insert—

“(4) After subsection (2) insert—

‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”

This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years.

Amendment 54, in clause 7, page 4, line 32, at end insert—

“(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care.

(5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.”

This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care.

Clause stand part.

New clause 44—Medical training places—

“The Secretary of State must double the number of medical school training places to 15,000 by 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 45—Data collection: clinically trained staff—

“(1) The Secretary of State must collect and publish data on the numbers and proportion of NHS staff are qualified to deliver nursing and clinical care who delivering nursing care, or clinical care of any kind, and those who are not.

(2) Information under subsection (1) must be collected according to HCAS pay scales.

(3) Information under subsection (1) must include numbers of nursing and midwifery staff.

(4) Information under subsection (1) must be published quarterly.

(5) The NHS and ICBs are under a duty to comply with any requests from the Secretary of State for data for this purpose.

(6) Information under subsection (1) must include the proportion of time spent delivering clinical care as a proportion of the individual’s total working hours.”

This new clause would require the Secretary of State to collect and publish data on the numbers and proportion of clinically qualified staff who are delivering clinical care, broken down by HCAS pay band.

[Peter Prinsley]

As the Committee knows, my hon. Friend the Member for Worthing West (Dr Cooper) is one of the five medical doctors in the parliamentary Labour party. It is a great pleasure to move the amendment, which she tabled.

The amendment is about education and training. My hon. Friend would like us to consider whether there should be an additional subsection after proposed new subsection (1)(a), which is about ensuring that

“there are sufficient people with appropriate education and training to meet the workforce needs of the health service”.

My hon. Friend would like to include within that specific training about wider health determinants, which, as we discussed earlier this morning, consist of things like housing, air quality, occupation, and substance abuse—tobacco, alcohol and so on. Her opinion is that that needs to be specifically incorporated into the legislation.

[Gregory Stafford]

I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised.

I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good.

Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency.

Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world.

Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care.

I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.