Health Bill (Thirteenth sitting)

Peter Prinsley Excerpts

Tuesday 7th July 2026 Public Bill Committees

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

The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.

There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin—and that is being generous.

The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well.

A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point.

As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if there is a problem with the Care Quality Commission once HSSIB has become part of it? I think we rightly expected a fairly clear answer on that. The answer was a rhetorical response:

“‘What happens if the problem is this organisation or that one?’”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.]

That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.

If there is a problem with another organisation, HSSIB can investigate it; if there is a problem with the CQC now, HSSIB can investigate it; but when HSSIB becomes the CQC, there will plainly be a problem with investigating the CQC. When that question was put to the author of the report on whom the Government are relying, no answer was provided. The reply to my hon. Friend the Member for Farnham and Bordon was a rhetorical question.

I urge the Minister to reflect. There is a major issue here that has not been addressed. Until she, or those on whom she relies, can articulate the answer, I urge her to delay these proposals.

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

It is a pleasure to serve under your chairship, Ms Lewell.

The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully.

For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us.

Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working.

As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.

[Karin Smyth]

I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it.

To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report.

The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at.

Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape.

Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

[Dr Prinsley]

I listened carefully to what the Minister said about a change of culture. A change of culture can certainly happen. In the surgical world, we used to bring patients into the operating theatre, check that the patient was on the operating table and do the operation. Sometimes, we operated on the wrong patient and on the wrong part of the body. We then introduced the World Health Organisation checklist, which checked absolutely everything before we started. It was a complete change of culture in the operating department. We made sure that we had the right prosthesis, the right patient and that we were operating on the right part of the patient. Now, the WHO checklist is a universally adopted process. I am absolutely sure that the culture in the health service can change.

[Karin Smyth]

I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.

--- Later in debate ---

[Edward Argar]

I will confine my remarks to group 47, conscious that the next group will give us an opportunity to discuss local arrangements, so I will stick to the national ones.

We are all aware of the significant role that Healthwatch England plays, as well as its popularity and the trust that many people place in it. As a former Minister in the Department, I was on the receiving end, on occasion, of some sharp—or firm—suggestions from Healthwatch England, but that is what it was there for. It was there to be the grit in the oyster. It often made useful suggestions, and its independence meant that it could put reports not only to me but to the public—it published them. It could give them, for example, to my hon. Friends who served on the Health and Social Care Committee and, if it wished, go to the media to make sure that that voice was heard.

That is where, for me, the challenge with what is proposed comes in, because a new directorate in the Department, staffed by civil servants, will simply not be able to do that. We all know that those who work in a Department, however excellent they are, report upwards ultimately to the permanent secretary and to Ministers. They are answerable to the political leadership of the Department. Would they be able to decide that something was coming through regularly from patient feedback and publish it independently, without ministerial approval or that of the permanent secretary, or hand it to the media? Would that director be able to champion the patient voice by going on television, irrespective of any ministerial approval?

The reality is, of course, that they could not. It would all be kept in-house in the Department, part of a closed process that would not alter decision making in reality, because that is already happening in the Department. The Department should already be looking at reports from Healthwatch England as part of decision making by Ministers and senior officials. What this simply does is remove the independence. It weakens that voice by making it something that happens within the Department rather than in the public sphere because, quite rightly, those officials will not be able to have their own independent voice out there, irrespective of the leadership of the NHS or the Minister.

I genuinely worry that what we see here is the continuation of a theme that has run throughout other aspects of this legislation—a theme of centralisation, of removing independent external challenge and bringing it inside the system, be it the Department or the NHS. When that happens, my fear is that the people who will lose out will be the patients, whose voice will no longer carry as loudly.

[Dr Prinsley]

I rise to speak to new clause 74 on behalf of my hon. Friend the Member for Rugby (John Slinger), who is in the Gallery, and also to some extent on behalf of my predecessor, Jo Churchill, who was the Member of Parliament for Bury St Edmunds and Stowmarket before me, and was also a Health Minister. This is about Healthwatch and the patient voice. The amendment tabled by my hon. Friend the Member for Rugby suggests that the Secretary of State create an impact report within 12 months of the Bill passing through Parliament to assess what the impact of the amalgamation or integration of the functions of Healthwatch into the ICB would in fact be, and in particular look at the effectiveness of the complaints procedure and the way in which complaints were responded to.

The theme is also that which we spoke about this morning on whether an organisation can successfully interrogate itself. I believe that with the appropriate safeguards it probably could, but I do think that the suggestion that there ought to be a formal report on the impact within 12 months is something worth considering.

[Gregory Stafford]

It is a pleasure to serve under your chairmanship again, Ms Lewell. I think right hon. and hon. Members will be disappointed to know I am not going to speak too long on this, but they need not worry: in the next grouping, usual service will resume.

I want to pick up a few points on the abolition of national Healthwatch. When we took evidence from Sarah Woolnough of the King’s Fund, I asked her a fairly open-ended question about when she gave evidence at the Health and Social Care Select Committee. I put it to her that she

“seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.]

She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied:

“Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 16, Q24.]

We already know from the evidence that we received, unprompted, from National Voices and the King’s Fund that the abolition of NHS England will not solve the problems that the Minister, the Government and the Department think are there, and indeed it could be done in a different way.

I listened closely to the hon. Member for Lichfield. He seemed to be presenting a number of problems, but the solution that the Government have come up with does not hold water. As right hon. and hon. Friends have said, the removal of Healthwatch England and the introduction of a director for patient experience simply does not work because the independence—which is so fundamental to the HSSIB that we talked about— of local healthwatches, which we will talk about, and of Healthwatch England is fundamental to the ability of that organisation to do its job.

In a previous career I worked for the Getting It Right First Time programme in the NHS. When that programme first started, it sat outside the structures of what was then NHS Improvement, latterly NHS England. At that point we could make recommendations to the NHS— I do not mean this flippantly —in a way that was unrestricted. As soon as we were brought into NHS England, into a governmental structure, the recommendations that we put forward were looked at and scrutinised and we were told often, “We do not have the money to afford that”, or, “That is not in our plan.” And that is precisely what will happen if recommendations are put through the director of patient experience. As others have said, when this director of patient experience arrives at a Select Committee, he or she will be there to represent and defend the Department and Ministers, understandably, because that is who he or she will work for. They will not be able to stand up, go on television or the radio, do the broadcast interviews or make representations, because they will be a creature of the system rather than a scrutineer of the system and an advocate for patients. That is a fundamental problem, and while I accept that there may be ways to improve Healthwatch England, as Members have outlined, this simply will not do it.

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[Helen Morgan]

I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring.

I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch.

The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try the local services is, I think, missing the point.

With the Ockenden report on Nottinghamshire a couple of weeks ago, we also saw that the hospital trust commissioned several reports into its own maternity services, which found that it was failing. Instead of acting on them, it brushed them under the carpet and commissioned another. The suggestion that providers are capable in the current culture of dealing with those issues does not, I am afraid, hold true in the way it should across every trust.

[Dr Prinsley]

Is it the hon. Member’s belief that that is something that Healthwatch would have been able to deal with, support and prevent?

[Helen Morgan]

The hon. Member will know that Healthwatch was introduced almost as a direct consequence of the Francis review of Mid Staffordshire, so that was certainly the intention. I have discussed the variability of healthwatch organisations across the country and the fact that they are not as well funded as was originally intended. Although I take the point that they have not effectively delivered that alarm-raising service in every case, if they were properly funded and used in the way that they were envisaged to operate, they would be able to spot such issues.

[Dr Prinsley]

rose—

[Helen Morgan]

I am going to go on and give some examples. Central to the value and success of the Healthwatch network is its local focus and the fact it is centred in communities. Where it has worked well, that has allowed Healthwatch to earn trust and build relationships, especially with harder-to-reach communities, as we have discussed. I take the Minister’s point that we know about those harder-to-reach communities, but the reality is that we are not engaging with them, and that is important.

--- Later in debate ---

[Dr Chambers]

The size of the contract would be pretty much irrelevant; what matters is the implications arising from the contract being signed. Does a contract potentially compromise our data sovereignty? Alternatively, if a contract failed for any reason, whether it was because of the action of a state actor or a non-state actor, would the service continue to function?

[Dr Prinsley]

I am grateful to the hon. Member for taking my intervention and I am sorry that it is late in the afternoon. The question we are faced with is this: what is the best system to serve our patients? If the best system turns out to be a system that is procured from another country, would he in principle always object to that?

[Dr Chambers]

I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly.

There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty.

I have a few questions for the Minister, which I would appreciate some comments on. How do the Government intend to build trust in the single patient record to make sure that it is not undermined, rather like the federated data platform has been? Does the Minister agree that the poor reputation of Palantir and distrust has been an important element in the slow roll-out of the federated data platform? Has she considered undertaking a risk assessment with a national security focus of current NHS digital and tech contracts? Does she agree that, in an ever more turbulent world, building domestic capability in this area is central to the security of our country?

Does the Minister agree that the domestic life sciences and tech sector is more than capable of developing and scaling many of the systems that we rely on foreign companies for at the moment? The Government have very much positioned AI and technology as the NHS’s white knight. We agree that the potential is huge, but do the Government not think that the NHS needs a long-term digital strategy to support a joined-up development and roll-out of these systems and technology? An analogy to this is how the defence investment plan and future defence procurement can help prioritise and boost economic growth in the UK. We think this is another way that economic growth could be nurtured.