Health Bill (Sixth sitting)

Peter Prinsley Excerpts

Committee stage
Thursday 25th June 2026 Public Bill Committees

[Karin Smyth]

Primary care is the front door to the NHS and is critical to delivering our neighbourhood health agenda. The neighbourhood health service will bring care into local communities, ending fragmentation and preventing unnecessary hospital admissions. To support that, alongside clause 14, which I will discuss shortly, we have tabled new clauses 22 and 23 and new schedule 1, to strengthen action in the event of local pharmacy challenges and streamline the appeals process.

On new clause 22, many hon. Members will know how the closure of a local pharmacy can significantly affect a community. Pharmacies close for a range of reasons: voluntary closure, business failure or emergencies affecting the premises or surrounding area. Even where a pharmacy remains open, unforeseen or unexpected events can disrupt access for local people.

The NHS Act 2006 sets out how ICBs should commission pharmaceutical services in normal circumstances and what can be done if those arrangements fail. Section 133 of the Act is intended to deal with exceptional situations where standard commissioning processes are too slow and rapid action is needed to restore provision while long-term solutions are put in place, if required. However, the current wording of section 133 is widely interpreted as applying only to large-scale national emergencies, as it refers to inadequate provision affecting a significant number of people. It is unclear whether that would cover more localised situations, such as a village cut off by flooding following a bridge collapse, or where the only pharmacy serving an area closes unexpectedly, creating an urgent unmet need, as we have seen happen. It is also unclear how the Secretary of State would authorise alternative arrangements.

To address those issues, new clause 22 ensures that ICBs can respond swiftly to exceptional circumstances, regardless of scale. It removes the unnecessary provision for the Secretary of State to make arrangements himself and clarifies that authorisation to ICBs should be given through directions. The directions will be limited to six months, with the possibility to extend further if required. This change maintains appropriate national oversight while preventing misuse of the powers. It is a sensible and proportionate amendment that gives the system the flexibility it needs in exceptional circumstances while retaining proper safeguards.

New clause 23 and new schedule 1 simplify the appeal framework for NHS pharmaceutical services by allowing appeals that are currently split between different routes to be heard by a single appeal authority. At present, where concerns arise about a pharmacy contractor, different appeal routes may apply depending on whether a case is characterised as one of fitness or of performance. In practice, however, that distinction is not always clear and the current system can create unnecessary complexity and duplication.

New clause 23 and new schedule 1 address that problem, providing for such appeals to be heard through a single route, which we intend to designate in regulations as NHS Resolution. It is a practical and proportionate change; NHS Resolution already has substantial experience in handling disputes involving NHS pharmaceutical services and is well placed to provide a clear, consistent and independent route of appeal. Importantly, this measure does not change the position in relation to the fitness to practise of individual pharmacy professions. Cases concerning individual practitioners will continue to be dealt with separately by the General Pharmaceutical Council.

By simplifying the framework, this measure will help to ensure that related issues can be considered more coherently, reduce fragmentation in decision making and support the effective oversight of NHS pharmaceutical services. In short, it aligns the appeal system more closely with operational practice, reduces unnecessary complexity and preserves the appropriate safeguards for individual practitioners.

The remaining Government amendments are consequential on those changes, or are technical changes that have emerged as necessary following drafting of the wider Bill. I will speak to new clause 21 in particular, as it updates section 132 of the 2006 Act so that the legislation reflects current commissioning arrangements for pharmaceutical services. Section 132 currently allows, in addition to retail pharmacy business, arrangements to be made with individual doctors and dentists for the provision of pharmaceutical services.

That wording reflects an early model of care. In practice today, arrangements for primacy medical services are made with GP practices, not individual general practitioners, and patient lists are held at practice level. New clause 21 therefore brings the legislation into line with the way services are already commissioned and delivered. It will mean that, where such arrangements are made with dispensing doctors, they are made with GP practices rather than individual GPs. It also removes provision to make such arrangements with dentists, to reflect the fact that that provision is redundant.

In summary, new clause 21 is a technical amendment, which does not change current practice but simply updates the statute book to reflect modern NHS arrangements. Patients in rural areas eligible to receive medicines from the dispensing doctors will continue to receive that service as they do now.

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

I have received representations from rural dispensing practices in my constituency about the provision of vaccination services. I understand that dispensing general practitioners are having difficulty securing the funding to provide vaccinations, particularly the new meningitis vaccination for young people. Does the Minister envisage that the change being proposed will have any effect on that arrangement?

[Karin Smyth]

The changes here, as I have outlined, are bringing practices in line in terms of the regulation. I think the issue my hon. Friend really addresses is the arrangement between those local practices and the ICB as the commissioner on where the service is provided. Ordinarily a commissioner would seek to make sure that a rural area had provision from somewhere in particular; I am happy to talk to my hon. Friend outside the Committee if there is a problem in his local area.

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.

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[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.

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[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.

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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.

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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.

Health Bill (Fifth sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

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

Before the lunch break I was saying that, in essence, clause 7 states what the Secretary of State’s job is. It moves the function of planning the workforce from NHS England to the Secretary of State, which is a reasonable thing to do. I talked about the previous Government’s record on opening new medical schools and how that has helped with the number of clinical staff.

We also talked about workforce planning. The Government are due to produce a workforce plan, but it is not clear when it is due to come out. It was due to come out at the end of last year, but it did not; it was then due to come out in the spring, but now it is the summer. Given the Prime Minister’s resignation, it is not at all clear when it will come out. Will the Minister let us know whether it will come out before the summer recess, this week or whenever?

I quoted some of the concerns of the Royal College of Nursing, the British Medical Association, of which I am a member, and others. Those concerns include the workforce plan. Those organisations have seen what we have not seen, so they have been asked to comment on something that we have yet to see. That brings me to new clause 44, which is in my name.

Before the general election, Labour promised that it would double the number of medical school places. The now Chancellor of the Exchequer promised to double the number of medical school training places, as did the now Secretary of State for Science, Innovation and Technology. Once the general election had passed and Labour was in government, the promise was reiterated. At oral questions in October 2024, the now former Health Secretary said:

“This Government are committed, as we were in opposition, to doubling the number of medical school places”.—[Official Report, 15 October 2024; Vol. 754, c. 683.]—

but there has not really been any progress.

During a debate this year on the junior doctors’ foundation programme, I asked the Minister for Care whether the Government’s intention was still to honour that pledge. He said:

“Yes, that is the Government’s intention.”—[Official Report, 22 April 2026; Vol. 784, c. 133WH.]—

only to later submit a written correction stating that the Government had never committed to doing so. Are they going to, or not? It is not clear.

Labour promised to double the number of medical school places, but now that pledge appears to have been airbrushed out of history. Can the Minister please explain why she and her colleagues deemed the workforce pledge essential before the election but not after it? Can she tell us whether it is Government policy? In essence, my new clause 44 asks Members on the Government Benches to vote for what they promised before the election and have promised since.

New clause 44 is very simple: it stipulates that the Secretary of State must double the number of medical school training places by 2031-32. That is what Labour promised, so it should be fairly easy for Labour Members to vote for it. I hope that the Committee will support the new clause, which only requires Ministers to do what their party promised before it came into government.

If the Government are not keen on committing to clear targets, they can at least commit to full scrutiny of their workforce plans. Of course, there is a risk that the House has been misled. Either the promise was made or it was not. The Minister for Care said that it was promised and then submitted a written correction to say that that was inaccurate and that it was never Government policy, but if it has been stated by the Secretary of State at the Dispatch Box, representing the Government, then it is Government policy. Can the Minister help to clarify that point? If the House has been misled by either her former boss or the Minister for Care, perhaps she can clear that up for us. Perhaps the vote will help.

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

Does the shadow Minister agree that if we doubled the number of medical students, we would simply not be able to accommodate those people as young doctors unless we also doubled the number of training places? After five or six years, those medical students become young doctors. If we are to correct any problem with the medical workforce, it is insufficient to simply state that we will double the number of medical students.

[Dr Johnson]

The hon. Gentleman is right. When all the new doctors that the Government have promised have been trained, they will need jobs and postgraduate medical training, and there are issues with that. Nevertheless, the Government asked the public to vote for them on the basis that they would double the number of medical school places. Many of the hon. Gentleman’s colleagues produced little videos to that effect, which can be viewed on Twitter. They toured the newsrooms saying, “Please vote for us, we’re going to double the number of medical school places.” They suggested that there would be a revolution in Government to make sure that there were enough doctors. This is important—more doctors would help.

All new clause 44 does is ask the Government to commit to doing what they have said that they will do—or to say that they will not. Either way, we have had the Secretary of State saying one thing and a Minister saying the opposite and then correcting it, so we need clarity. The public deserve that. The Minister herself said that they would double the number of medical school places so that we have the doctors that our NHS needs. If they do not double the number of medical school places, it follows that they will not have the number of doctors that the NHS needs. Presumably that is in their workforce plan, but it needs to be cleared up.

Amendment 50 would put a duty on the Secretary of State to publish independently audited forecasts of the NHS workforce every five years. The logic is straightforward: if the Government believe that their plans are sufficient, they can be compared to an impartial assessment of the workforce. The previous Government published a workforce plan in 2023, setting out how to tackle existing and future workforce challenges over several years. That included doubling the number of medical school places. Yet three years later, this Government are on course for a new plan that is reportedly far less ambitious—we will find out in a minute.

The workforce affects whether patients can be seen on time, maternity wards are safely staffed and elderly patients get the dignity they deserve. It is the difference between the NHS meeting the challenge of an ageing population or slipping into decline. If Labour Members are confident that the Minister’s workforce planning is robust, I expect that they will support my amendment, which requires an independently audited forecast. If they are not willing to support it, that suggests that they know this Government cannot be trusted to deliver the workforce that patients need.

Amendment 54 and new clause 45 were also tabled in my name. Amendment 54 would require the Secretary of State to look at the amount of clinical work that NHS managers undertake. As a clinician, I have increasingly noticed that highly qualified clinical practitioners come in, become the person on the ward who can be relied on, and then go off because they get promoted to a nine-to-five job that is easier and pays more, but does not deliver clinical care.

The chief medical officer, for example, still delivers clinical care, and the amendment probes the Government to consider how many nurses and clinicians in hospitals are delivering clinical care. I asked that in written questions, and the Government did not know the answer. It is materially important information, particularly when looking at the Dash report, which talks about an explosion in the number of people who are clinically trained but not providing clinical work—instead, they are creating guidelines and monitoring whether other clinicians are doing the work. If more of those people were engaged in clinical activity, that might improve the quality of both the guidelines and care, because more junior staff would have senior staff around to help them.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

I thank hon. Members for bringing this discussion before the Committee. The Government are committed to ensuring that the NHS has the right people in the right place and with the right skills to care for patients when they need it. We will be publishing our 10-year workforce plan imminently. I cannot give the shadow Minister any more details on that at the moment, but it will set out the action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan. High-quality education and training for the NHS workforce will be fundamental to that, and clause 7 is in keeping with that commitment.

Before turning to the clause, I will address some of the issues raised during the debate and in the amendments. I understand the intention behind amendment 50, but I cannot accept it. The 10-year workforce plan will set out the staffing needs of the NHS for the next 10 years. That goes further than the amendment calls for and will be updated every two years in line with our manifesto commitment to publish regular, independent workforce planning. It is only because the Government have set such a clear direction for the service through the 10-year health plan that we can credibly set out a sustainable approach to staffing the NHS over the long term.

As hon. Members will understand, workforce planning is a complex topic. It is closely related to the wider service planning, which is why we have engaged so widely with independent experts to develop our forthcoming workforce plan. To divorce the process of workforce planning from service planning in the way that is suggested by amendment 50 would not produce a more reliable or useful set of forecasts. However, it would reduce the potential for innovation and reform of the kind that is needed and which the Government have set out so clearly in the 10-year plan for the NHS. I can only conclude from listening to Opposition Members that they really did learn absolutely nothing from their time in office or, indeed, from the problems with their workforce plan, which focused on headcount but notably did not reform care, did not look at new patterns of care, did not look at retention or training, and created some of the bottlenecks and problems that we have had to deal with.

Our commitment will be guided by the workforce plan, which is why we cannot accept new clause 44. Decisions on training numbers must be guided by workforce need, and that will have to be considered as part of the forthcoming plan. Adding to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, whatever the Government’s position on the number of medical school places that will be required in the future, fixing a number in primary legislation would be unhelpful as it would limit our ability to adjust target training numbers subsequently to reflect any changes in workforce need.

I was asked about correcting the record. The last Government did double places in their 2024 workforce plan, and I commend the movement of medical schools across the country. If the former Secretary of State is reported in Hansard as having said something contrary to the correction of the record by my hon. Friend the Minister for Care, we will of course pick that up.

Amendment 54 and new clause 45 look to reduce flexibility and increase bureaucracy for a workforce that is simply trying to deliver what is best for patients. On amendment 54, I think we can all agree that we need strong leadership and management to deliver national priorities, including the 10-year plan’s three shifts. Having a clinical voice in management positions is vital and many of our board-level and senior leaders are also clinicians. While some choose to carry on with clinical practice, others might prioritise their managerial role, and it is right that they should have that flexibility. Prescribing that all NHS managers with clinical experience must also undertake clinical care risks reducing board capacity and expertise, including clinical leadership, and disincentivising opportunities for management experience at a time when the NHS has seen a reduction in the number of managers per NHS staff from 2010 to 2025. We do not think that simply prescribing that requirement would benefit clinicians, managers or, crucially, the wider health service, so we oppose the amendment.

New clause 45 would require the collection of further data on the proportion of time spent on clinical care. Detailed statistics on the number of staff working for NHS provider trusts broken down by profession and pay band are already published by NHS England on a monthly basis. Adding requirements to that is not simple. There is not a centrally held collection of data about NHS staff time, and setting one up would have costs both centrally and for NHS trusts to collect specific data. It is also not easy to separate out clinical care meaningfully. Clinicians spend time in supervision, education, safeguarding, quality improvement and clinical leadership, and the amount of time they spend on different activities can vary from month to month. The new clause risks putting more burdens on NHS staff if they are being asked to record what they are spending time on beyond existing procedures. We therefore cannot accept it.

I turn to amendment 33, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, on workforce training. It would require the Secretary of State to intervene in the content and design of healthcare programmes. Standards of proficiency, conduct and performance of registered professionals are the statutory responsibility of independent healthcare regulators, although universities and practice partners develop the specific content and design of programmes to meet those standards. It is vital that the independence of regulators and universities is maintained to respect their expertise in designing standards and curricula that ensure public safety.

We have published our 10-year health plan setting out major NHS reforms, including moving from sickness to prevention. Supporting healthcare workers to address the wider determinants of health will be essential to delivering that shift. That is why we are providing the “All Our Health” e-learning on critical public healthcare topics for people working in the health and care sector, and revitalising the “making every contact count” approach to ensure that every contact that a person has with the healthcare system supports a shift to prevention.

I assure colleagues that our upcoming 10-year workforce plan will set out plans for ensuring that we train the staff we need so that we have the brightest people and the right skills to support patients. For those reasons, I ask my hon. Friend to withdraw the amendment.

Finally, I turn to clause 7. The Secretary of State already has an overarching duty in relation to the education and training of the NHS workforce. Currently, that duty is partially delegated to NHS England. NHS England also has a duty to ensure that there are sufficient numbers of appropriately trained healthcare workers across England. Clause 7 will simply merge those existing duties into a single, robust education and training duty on the Secretary of State.

The Secretary of State will be entirely responsible and accountable for exercising relevant functions with a view to ensuring that there is an effective system for the planning and delivery of healthcare education and training, and that we have enough healthcare workers with the right training to meet England’s health service needs. Bringing those duties directly under the responsibility of the Secretary of State will reduce bureaucracy, streamline oversight and enable the Government to provide national strategic leadership across the NHS workforce.

I reassure colleagues that accountability will not be diluted. Bringing these responsibilities into the Department will create clearer, stronger lines of accountability with the education and training of the NHS workforce. Ultimately, the Secretary of State will continue to be accountable to Parliament for the health service in England, including for the planning of education and training and ensuring sufficient numbers of trained healthcare workers. I commend the clause to the Committee.

[Peter Prinsley]

I am happy with those assurances, so I beg to ask leave to withdraw amendment 33.

Amendment, by leave, withdrawn.

Amendment proposed: 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.’”—(Dr Caroline Johnson.)

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

Question put, That the amendment be made.

--- Later in debate ---

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason.

As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences—a bit like the deregulation of buses. In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers—that has worked well to bring down elective waiting lists, for example—the provisions to protect the mix are important.

I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.

[Peter Prinsley]

It is true that the situation in ophthalmology is now quite serious, but is the hon. Lady aware of the problems in radiology and pathology? Some hospitals are unable to recruit histopathologists or significant numbers of radiologists, who provide key services, because the personnel necessary to run those services have been attracted into a private system, although they are contracted to the NHS. That jeopardises the ongoing services for urgent and emergency care.

[Helen Morgan]

The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence.

Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?

Health Bill (Second sitting)

Peter Prinsley Excerpts

Committee stage
Tuesday 16th June 2026 Public Bill Committees

[Laura Kyrke-Smith]

Q I come from a county with really significant health inequalities—people in the wealthy parts of the county live 10 or 12 years longer than people in some of the more deprived parts of Aylesbury, which I represent. I would love to hear your thoughts on how we ensure that local authorities, ICBs and the voluntary sector continue working well together through this, and specifically how we do that in a way that drives the reduction we need in health inequalities.

Maria Higson: I think we are all agreed that working at the neighbourhood level is absolutely the right way to go about that. That is where health inequalities can best be addressed, because that can be most nuanced and tailored. Working on that smaller footprint is really important. You mentioned voluntary, community and social enterprise organisations, and I think that is a hugely important part that has broadly been missed out from the conversation around these changes. We work closely with VCSE partners and we know they deliver huge amounts for the communities and understand the communities in which they are embedded very well, so making sure that the VCSE voice is part of those neighbourhood teams will be important for that nuance and tailoring in the local element.

Councillor Wright: I agree entirely. Local authorities are in a good position to engage the voluntary and community sector. But again, we are fighting for a voice with the NHS and they are fighting for a voice with us, so we need some honest conversations with ICBs, and a real strategy looking at those health inequalities and what is driving them. It will not purely be access to hospitals; it will also be access to meaningful employment, housing, transport, mental health or social isolation—there will be so much driving those wider determinants of health that are affecting healthy life expectancy. Local authorities are in a prime position to do that, and they need to be listened to. I think the challenge will be how we collectively say, “What needs to be done, other than implementing the Bill? How do we look at the whole health inequality picture and address it?”

Sally Burlington: I would agree with the others: tackling health inequalities is really difficult. Doing it the same way in every area would not work, particularly in a world where there is not enough resource to do everything we would all like to do. You have to tailor how you approach local service delivery and what is needed locally according to local needs, the local community capability, how people work and what their preferences are locally, and the neighbourhood health agenda is our best shot at tailoring in that way.

I think you will come on to Healthwatch, but we would have concerns that, in separating the Healthwatch duties to look at NHS and social care, we risk missing some of those who are most likely to need both, and that that could exacerbate health inequalities rather than make them better.

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

Q Which organisations or people do you envisage running the neighbourhood health centres? Will they be run out of general practice organisations, or will the local authorities themselves be best placed to run them, so as to join up hospital care with community services?

Councillor Wright: That is quite interesting; I was at a session this morning looking at communities, and there was a comment that for the NHS communities are about buildings, whereas for the local authority they are about people. I think it would be the ICBs and whoever they commissioned to provide neighbourhood health centres. I hope there would be enough input from the voluntary sector, the local authority, adult social care and public health—from everyone—but I see the ICBs as the commissioners and the people who organise them.

[Peter Prinsley]

Q So the ICB will commission it, but somebody will have to run it. Who should run a neighbourhood health centre?

Maria Higson: If we want to be as open to change as possible, my argument would be that that should be decided locally. Would it not be fantastic if, for example, some of them were led by VCSEs that worked in close partnerships and had clinics where GPs came in? You can envisage a whole number of different scenarios, led by local communities and local organisations. This plays back to the health inequalities point, but that is how you do it, although it relies on you being open to different models and not trying to do a one-size-fits-all, which is really tricky when you are trying to implement.

[The Chair]

Last word, Sally Burlington.

Sally Burlington: I strongly agree with that. If you were asking who is best placed to run them, the answer would be that it probably looks different everywhere, because it will rely on local leadership and local capability and capacity, which varies across all our sectors, so this is a really good opportunity to make the most of that leadership ambition and skills and capacity locally.

--- Later in debate ---

[Sojan Joseph]

Q I was listening to Dr Byrne’s concerns about confidentiality and trust. I want to declare that I have worked in the NHS in the mental health sector for many years. I worked in one of the biggest mental health trusts, Kent and Medway mental health NHS trust. We use an electronic patient record called Rio. As Dr Cocker said, before anyone is given access to the record, they have to have training on information governance and data protection, and access is given based on their role. That system creates an audit trail, so patients can request to see how many people have accessed their information in the last month or two—there are facilities on the system to check that. Is staff training and raising awareness among patients important for creating trust and confidentiality?

Dr Byrne: Those things are very important, yes. There are some technical solutions. Again, the SPR is an opportunity to look at that across the system, because systems vary greatly in the sophistication of their audit function, for example. Even when there is an audit function, if someone has legitimate access through their role as a doctor or a nurse, it can be difficult to know whether their access in any particular case is legitimate. These are not common occurrences, but it is extremely distressing for patients if their confidentiality is breached for any reason.

It is not simply a matter of technical controls. We need to look at how we build stronger, more effective deterrents across the system by having effective sanctions when incidents do occur. I am keen to look at that and delighted that the Department of Health and Social Care and NHS England are, I think, very interested in having that conversation with me. At the moment, it certainly seems that there is a variable response across the system to inappropriate access.

Looking ahead to the SPR, we need to look at that make improvements, so that the public can have faith that, given the harm that it can cause them, it will be taken very seriously if anyone does access their records inappropriately. There are technical, cultural and system aspects to think about here. The SPR is definitely an opportunity to do that, and I am very keen to work with other stakeholders on that.

[Peter Prinsley]

Q I am an ENT surgeon. What do you think about giving the patient ownership of the single patient record as well as discretion over whether the information in that record is revealed to the clinical team?

Dr Byrne: It is an interesting idea, but I am not sure. I heard your question earlier about data controllership specifically in this regard. You will not necessarily like my answer. There are two ways of answering the question; perhaps straightforwardly, legally, but also clinically. I will start with the legal answer, which in some ways is easier. Data controllership in data protection law is a very technical term; it is determined by who is making the decisions about processing the means of the data. An organisation running and controlling an electronic patient record would be the data controller. Obviously, this is ultimately a question for the regulator and the Information Commissioner’s Office to determine, but that would be the legal position, nevertheless.

Clinically, we have to come back to thinking about what a patient record is for. Primarily, it is to provide good care in the context of the clinician-patient relationship. If you prioritise the needs of either side of that relationship, I think it is problematic; the needs of one must not outweigh the needs of the other.

The clinical record is there to enable clinicians to record what someone is presenting with, the difficulties they are having, what investigations are appropriate, the findings and what the plan is. It needs to be there for that tool to work. To take you on a slight thought experiment, if it was entirely held within a patient’s control—however loosely we use that term, legally or otherwise—and we could all amend, correct, change or add our diagnoses, findings and treatments, that might be clinically problematic. That may not be the answer you want, but it is the straight answer, if I am honest, from both a clinical and legal perspective.

[Peter Prinsley]

Q I would love to amend the figures in my bank account—I would like to be able to go into my Lloyds bank account and add a nought to the end of the balance figure—but I cannot, because the bank controls that. But I am the one who has access to the data.

Dr Byrne: I totally support that ambition. Patients and the public having more agency in their care, strengthening that relationship, and them being able to access their information through the NHS app is a great thing. That is hugely helpful, and there is real potential with the SPR to strengthen that. We have landed on agreement.

[Dr Johnson]

Q Do you have any thoughts on the separation of elements of the record such as safeguarding records and sexual health records? We have heard about carers being able to see parts of the record. Surely there are circumstances where we may want people to see parts of the record but not others, or people may wish to share some parts and not others. Are you aware of any provision being made for that?

Dr Byrne: At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.

Health Bill (First sitting)

Peter Prinsley Excerpts

Tuesday 16th June 2026 Public Bill Committees

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

I am co-chair of the Unison group of MPs, which is linked to Managers in Partnership.

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

I am a retired ENT surgeon and a fellow of the Royal College of Surgeons.

[The Chair]

Thank you very much. It will be helpful if you reiterate those declarations at the start of any speech or question, if they are relevant.

Examination of Witness

Dr Penny Dash gave evidence.

--- Later in debate ---

[Helen Morgan]

Q Jacob, how prepared are ICBs and local authorities to take on the healthwatch functions? Is there a concern that splitting the local healthwatch function will lead to a lack of joined-up focus on health and on the social care element that resides with local authorities?

Jacob Lant: I will pick up the second part of the question first. The majority of the worst experiences of care—the worst incidents, where people feel most lost—tend to be in the gaps between services. Hospital discharge is a really good example of where the transfer between the NHS and social care services does not always work in the best interests of patients. That sort of insight will be lost entirely under the current structure, unless we build in a requirement for ICBs and local authorities to share the intelligence that they are hearing and to work collaboratively to understand patient and care user experience. That then raises the question, “Why are we splitting them?” If they have to work closely together to comment on the worst experiences of care, I do not understand the rationale for splitting them.

In terms of preparedness, I said earlier that ICBs will not have any additional resource for doing this. They have their own engagement teams at the moment, but even those that have been doing this very well have been leaning on their healthwatch for many years to help them engage with seldom-heard communities and build additional capacity. I worry about the capacity of ICBs to deliver once that is cut, particularly given the headcount and budget reductions in ICBs generally.

Local authorities are probably more experienced in doing direct community engagement and more confident about their ability to pick up the responsibilities. Indeed, I suspect that many of them will continue to commission some sort of external support to help them do this, but their budgets will be restricted. They will get only half the money for healthwatch, so that will be a concern.

[Peter Prinsley]

Q I am an ENT surgeon. Why has there been no effective single patient record in the past? If there were such a thing, who would you give ownership of the data to?

Sarah Woolnough: We have had developments over many years in the direction of a single patient record. We have shared care records; we have attempts in different parts of the country to move in that direction. On the one hand, we have been held back by legitimate concerns about trust, privacy and the right safeguards, but some practical barriers have also held us back. For example—and this is really important to make the single patient record a success—what does it take to ensure that we achieve interoperability, that the data is cleansed and that penalties are followed through if providers are not sharing data? We need to back up any legislative and policy intent with the resource and measures needed to make it happen. That is perhaps a bit of the history of why it has not happened. Sorry, what was the second part of your question?

[Peter Prinsley]

Q Who would the data belong to? Would it belong to the patient or to the healthcare provider?

Sarah Woolnough: My reading of the legislation is that perhaps this issue is not quite resolved; the legislation does not seek to shift necessarily from having the GP as the data controller. Of course, there will be concerns as the record is brought together nationally. Ultimately, the data should belong to people and patients, but they rightly want to feel that it is protected and safeguarded appropriately through the system.

There are a couple of other points to make as we design this. This is a work in progress, so it is not neat in the sense that you cannot say, “This is exactly what a single patient record is, and this is exactly what it will be for evermore.” I think the policy intent is to build and develop it over time. To give one example, patients and the public being able to understand who has access to their records, and for what purposes, might be really helpful in the process of building trust and belief that their data is being well looked after.

[Peter Prinsley]

Especially if it were the case that the patient were the data controller.

Sarah Woolnough: Yes.

Jacob Lant: Whoever ends up being the data controller, the most important thing is that patients have a right to express how their data is used. That is where it is really important to keep things like the national data opt-out up to date, and to ensure that it is clear and accessible for patients to express how their data is used for secondary purposes.

That becomes much harder in a direct care scenario. If you restrict the sharing of data for direct care, you could inadvertently create a second-class system for people who are not in that. It is a really clear distinction. For secondary uses, we need a very clear opt-out, where people can understand how their data is used and express a preference.

[Gregory Stafford]

Q Sarah, when we were at the Health and Social Care Committee, you and your fellow panellists seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation. Could you delve into that a bit more and tell us why you think that is the case?

Sarah Woolnough: The Government have an incredibly ambitious agenda, which is partly articulated in the 10-year plan. Our ongoing concern has been that some of the biggest-ticket items that the Government rightly want to achieve to fundamentally shift power to patients—delivering a shift towards prevention, moving care closer to home and allowing more digital enablement—do not require this kind of legislation or a reorganisation.

I go back to my first answer: what is honestly the opportunity cost of doing some of this at the expense of more focus and attention on, for example, delivering care closer to home? There is a lot of energy and activity in that area, but the Government want to make really good progress over the next few years. To take that example, if you are really serious, you need to understand what the barriers are to delivering more care in the community, closer to people and patients, and wrapping services around patients. It requires you to flow money differently and to have a different incentive scheme, but that is nowhere near this piece of legislation.

Our worry has been about what is not in the Bill, and what is the rightly and fantastically ambitious agenda to improve health for people and patients, versus the opportunity cost of a largely technical piece of legislation that reorganises some central functions.

Health Bill

Peter Prinsley Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

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

I know of a quite frail diabetic patient with cancer, who underwent several operations as well as complicated chemo in London. He eventually decided that he was well enough to take a short holiday, so he went to Cornwall on the train. Unfortunately, shortly after arriving he was found in a state of collapse by his daughter, and taken to the nearest hospital late on a Saturday night. The doctors had no access to his medical notes, and no answer when they called the hospital in London, so they were puzzled. That situation is familiar to doctors. Patients are incredulous when they are told that we are unable to see all their medical records: “Surely everything is on the computer?”

As a surgeon before becoming an MP, I worked in at least three different hospitals. There was no compatibility between the records, which meant that transferring care was complicated and hazardous. I would be asked to advise on a patient from another hospital, relying on a dictated note from the referring doctor, but I could not access the clinical records, the results of investigations such as the pathology test, scans or, crucially, the operating records. Consultations were delayed as I stared at creaking computers, with numerous software programmes, each individually protected by ever-changing and forgettable passwords, that slowly booted up. That obviously needs to change.

I would link the NHS number to an unique single patient record. I would give ownership of the record to the patient, and let the patient be the custodian and the gatekeeper. That is the truly revolutionary idea. If someone could easily look at their medical record, with appropriate physician safeguards, they could monitor everything—blood pressure, heart rate—and perhaps there would be an incentive for them to look after their health a little better.

Let us imagine for a moment the power of anonymised medical data for a population of 70 million people. The NHS is perhaps the largest complete set of health data on a whole population in the world. That is a huge resource for informing health policy and medical research. By tracking the health outcomes of millions of our fellow citizens, we can sort out all kinds of diseases, such as heart disease, cancer and mental health disorders. I can think of no greater innovation, or more helpful measure to improve the health care of this nation, than a single patient record.

[Martin Wrigley]

All the features that the hon. Member is asking for are available to people within the Greater Manchester area. Exactly those things are there and work today, even down to the remote monitoring he mentions.

[Peter Prinsley]

I am grateful for that intervention, and I am aware that in various bits of the country such systems do exist. I would like to see a single patient record that is genuinely single, so that when my hon. Friend the Member for Stroud (Dr Opher), who is sitting next to me, writes something in the record, I can see it, and when I write in my record, he can see it, and no letters are passing back and forth between us. That is why I am sure that legislating for the mandatory single record is what we must do, and as a surgeon who has worked for 40 years in the NHS, I will do everything I can to help.

[Dr Simon Opher (Stroud) (Lab)]

It is a pleasure to speak in support of the Bill, which I believe has the power to transform patient care in the NHS. Particularly after the remarks of my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), the House will be aware that I also have a vested interest in this, as I have been a working GP in the NHS in Stroud for at least the last three decades. Indeed, I did a surgery last Friday, and I excitedly told the other doctors that we are going to have a single patient record. Instead of being excited, they said, “It’s about time.”

Those of us working in the NHS have been calling for a single patient record for years, so it is about time that a patient can tell their story just once, and about time a GP knows what a consultant is saying and the consultant knows what the GP is saying. It is about time that, when a patient gets admitted to A&E, the doctors know what the GP has already done, and that, when a patient gets referred to a psychiatrist, they know which antidepressants have been taken. As my hon. Friend said, patients struggle to understand how all the doctors do not know what is going on. We got rid of the fax machine in our surgery only last year, so we are fairly behind on communication, but the Bill lays the foundation for that to be remedied.

The benefits of the Bill for patients are huge—their medical knowledge at their fingertips, just as they are for clinicians and for integration. We cannot have integration without a decent single patient record. On research, our data is a national asset. I fear that a company such as Palantir owning our data is a derogation of our duty, and that we should use that data as a fantastic resource. I am also worried about Palantir’s involvement with death in Gaza and the infringement of civil liberties under the Immigration and Customs Enforcement agency in America. Also, at the Chelsea and Westminster hospital, it seems that the benefits that Palantir said it would bring to the operating theatre were not provable. The data is owned at the moment by GPs, and if there is a spillage of data, GP practices are unlimitedly liable. We must change that; otherwise, no one will become a GP partner. We must also be careful, because excessive and over-the-top safeguarding could obstruct the single patient record, and that would harm patient care.

[Peter Prinsley]

Does my hon. Friend agree that we must have a single patient record, not simply federated records from other sources?

[Dr Opher]

I do agree, although that is a much bigger job. At the moment, mental health uses a different system from the hospital, and it would be great to unite them. I agree with that, but whether it would possible in the next couple of years, I am not so sure.

Let me quickly go on to NHS England. The administrative burden on GP surgeries from NHSE has been huge, as my hon. Friend has mentioned, and it will be fantastic to get rid of that. When GPs undergo CQC inspections we have to do pointless protocols to fulfil the criteria, and they involve weeks of work. I want to make a little bid here for a much more supportive, lighter touch approach when looking at proper data around GP surgeries, which we would not have to prepare for. That would be very popular with GPs.

I warmly welcome this Bill. It is about time we reduced the ridiculous administration around patients and allowed clinicians to properly care for patients, and it is about time we had a single patient record.

Junior Doctors’ Foundation Programme

Peter Prinsley Excerpts

Wednesday 22nd April 2026 Westminster Hall

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

I beg to move,

That this House has considered the Foundation Programme and its role in supporting and retaining resident doctors.

Thank you, Mrs Barker, for chairing today’s debate. First, I must thank everyone for coming and say something about my interests. As many know, I am an ear, nose and throat surgeon and I have a son who is a registrar in accident and emergency medicine. I am a fellow of the Royal College of Surgeons, I have an MD from the University of East Anglia, and my medical school was at Sheffield.

This debate is to consider the foundation programme and its role in retaining resident doctors. It is a privilege to introduce the debate, and I am grateful to all the colleagues who have come along this morning. As we all know, our resident doctors just spent six days on the picket lines; the wards were covered by others, operations were postponed and patients’ appointments were rescheduled. When the strikes ended, as they did just over a week ago, the problems did not go away. That is why I asked for the debate. If we are serious about resetting the relationship between this Government and the medical profession, as I believe we all are, we must begin somewhere, and in my view we should begin where every doctor begins: at the foundations.

[Jim Shannon (Strangford) (DUP)]

From this morning’s papers—perhaps the hon. Member will wish to refer to this—it seems that the Health Secretary had engaged with the British Medical Association and had an agreement with its leader. Does the hon. Member share my disappointment that even with that agreement, it went ahead with the strikes? When it had agreed a wage packet for doctors that could be anything from £50,000 as a starting wage to £100,000, it seemed that we had the recipe for an agreement, yet it was all thrown away by, it seems, the BMA.

[Peter Prinsley]

I heard the same thing; indeed, I met Dr Fletcher from the BMA yesterday myself and heard exactly this story, so the situation is intensely frustrating, but I believe that we can get ourselves back to a position in which an agreement can be reached.

My argument this morning is simple. The foundation programme, the first two years of a doctor’s working life, is, in its present form, not supporting and retaining doctors as it should. The problem is that the doctors are treated like numbers on a spreadsheet rather than the people they are, and some of our brightest young doctors, at precisely the moment when they need the most support, are considering leaving the NHS altogether.

Let me set out what the system does, why it is failing, what we have learned from recent attempts to reform it and what I believe we ought to do instead; but let me first refer to a Royal College of Physicians survey of resident doctors that was done in 2025, which has some interesting findings. Only 44% of the resident doctors stated that they were satisfied with their clinical training. Just 26% of the respondents felt ready to move on to the next step. About 20% of the doctors thought that the recruitment process was fair, which meant that 80% of them thought that it was unfair. About half of them want to work less than full time and, most alarmingly, only 65% of them said that they thought they would be working in the NHS in five years’ time.

[Alex Easton (North Down) (Ind)]

I thank the hon. Member for securing this debate. Given that the foundation programme is typically the first full-time frontline post for doctors and often coincides with the period when they are most vulnerable to stress and burnout, does he agree that the Government should be doing more to address their workload?

[Peter Prinsley]

Certainly we must address the workload but, as I will reveal later in my speech, there are many things that we can do to help the situation.

Let me say a bit about my own experience, which admittedly was a long time ago—

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

No!

[Peter Prinsley]

I know—it is hard to believe. I was a medical student in Sheffield, and my first jobs were at the Royal Hallamshire hospital and the Northern General hospital. I have fond memories of the time that we started there. There was, for instance, a doctors’ mess with hot food. There was somewhere for us to live; we had residences. It is ironic that the name “junior doctors” was changed—just last year, I think—to “resident doctors”, because that is the very last thing they are. The residences have all disappeared—they have been sold off—and the doctors work shift systems, sometimes with absolutely nowhere to rest.

We had six-month rather than four-month rotations, which meant that we got to know the teams we worked with. We worked with named consultants. We had a distinct pyramidal team, with senior registrars, registrars and senior house officers, and we knew the people we were working with. They were people we had known as medical students; they were often the people who had taught us. That meant that there was a sort of support network for young doctors as they started in their careers. On the whole, the newly qualified doctors of today do not experience anything quite like that.

[Jamie Stone]

It is great to hear a qualified doctor talking about this matter. Health is devolved in Scotland—I must put that on the record—but in my constituency one finds that an awful lot of social care workers are calling it a day and walking away, with all sorts of unfortunate ramifications such as delayed discharge. Crucially, the support for doctors that the hon. Gentleman is talking about is not there or has been reduced. Does he agree that, if we boosted social care workers’ pay and conditions and retained them, that would help doctors?

[Peter Prinsley]

I absolutely agree that doctors are only part of a much bigger healthcare system. We certainly need to look after all the people involved in health and social care. Of course, that is more of a problem in geographically remote districts such as the hon. Gentleman’s constituency, where I believe it is difficult to recruit professions of all sorts.

I do not want only to sound nostalgic this morning, although of course I am. I am not arguing that absolutely everything was better in my time, because it certainly was not, but in one important respect it was better: it was designed around human beings. It understood that newly qualified doctors are individuals, not one of a herd to be simply moved across a map by a computer. It also recognised that pastoral support and clinical teams matter, and that the transition from medical student to doctor is a particularly vulnerable moment in a medical career. Let us come back to that point soon.

Today, we have a thing called the foundation programme. In 2024, the foundation programme office replaced the application process with something called preference informed allocation. What happens is that medical students list the foundation schools in order of preference, and are each assigned a computer-generated rank. The rank is not informed by academic achievement, personal circumstance, where the student trained or what they did; it simply works through the ranks and places the student accordingly.

The UK foundation programme’s 2026 figures show that of the 10,810 graduates allocated this year, 82% received their first preference. Superficially, that sounds quite reassuring, but I do not really think it is. Every year, a minority of graduates—this year it is roughly 1,900 young doctors—end up somewhere other than their first choice. The minority who do not get their first preference find themselves, aged 22 or 23, packing up their lives for a city where they know nobody. As I put it in the Chamber last month, it is a

“crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich.”—[Official Report, 26 March 2026; Vol. 783, c. 452.]

That is what we mean when we talk about a lottery. It is not a figure of speech, but a literal description of how the system works.

There is another reason why this headline figure flatters to deceive: the system incentivises what we call strategic preferencing. The students know the ranking system is random and that a high rank does not protect them tomorrow, so they game it. They preference the foundation schools they think they can realistically get, rather than the ones they actually want. A high first preference rate is, in part, a measure of the student lowering their ambition to protect themselves against a coin toss. That is not a system working; that is a system being worked around.

Let me say a bit about couples. Medical students often form a couple with other medical students or other people who work in hospitals, because that is the nature of a hospital. The foundation programme offers something called linked applications, but the unfairness is particularly acute. Two medical students in a relationship can choose to link their applications so that they are allocated together, but the pair is placed using the lower of the two ranks, so that if one of them is lucky in the ballot and the other is not, both are placed in the worst ranked situation. Should the algorithm be unable to accommodate both in a single school, the link is broken. A student cannot unlink once they have applied, and there is no appeal. The system quite simply cannot see that these are two people trying to begin their careers side by side. It just sees two records on a database.

That has knock-on consequences throughout the rest of the service. When foundation doctors are disorientated, unsupported and demoralised, their work does not disappear; it flows upwards to the more senior doctors, who take more and more of it on themselves. Young doctors should not be deployed by ballot into strange cities, with only limited account taken of their circumstances—their partners, their dependants, their health or their need to be near home. The claim that the current system is somehow fairer than the one it replaced is, I am afraid, one we cannot accept.

Let me talk about how we got here and the recent reform. The old system was not perfect. For many years, medical students competed on a combination of academic decile and a national examination known as the situation judgment test. The SJT was quite unpopular: it was stressful, it had unpredictable validity and there was a documented score gap that consistently disadvantaged candidates from ethnic minority backgrounds. That was a real and serious unfairness, and those who reformed the system were right to try to address it. When the students lobbied against the SJT, they had a good reason to do so, but they did not ask for a random number generator—yet that is essentially what they got.

In 2024 the SJT was abolished and academic achievement stripped out. In their place came PIA, underpinned by a computer ranking. It is hard to think of a clearer case of throwing the baby out with the bathwater. Students asked for fairness, and they were given randomness. Those are not the same thing. Fairness takes account of circumstance; randomness ignores it. Fairness rewards merit and responds to need; randomness does neither. What we have is not a reformed system, but an experiment that has gone wrong.

That is not just my view. The medical training review led by Professor Stephen Powis and Professor Chris Whitty, published last October, drew on more than 8,000 responses, 6,000 of them from resident doctors. Its very first recommendation was that

“a reform of postgraduate medical education and training is undertaken as a matter of urgency.”

It also recommended that recruitment to medical training be reviewed so that it is

“fair and equitable to all candidates”.

It is not sufficient, on any reading of the report, for allocation merely to be random. Random is not fair.

The BMA has taken a big interest in this question, which is not surprising, and I will read out some of its recommendations:

“The BMA is calling for: meaningful improvements to working lives with greater access to support services, supervision, rest and mess facilities; increased flexibility in rotations, including the option to swap placements; a guarantee that all UK graduates will be offered a foundation post, with full details provided at least 12 weeks before the start date; and any review of the allocation system to include proposals for a new recruitment process developed with meaningful consultation with students.”

There is another group of doctors that we should consider: those who will progress to become academic doctors. There is a crisis in this country of clinical academics, the doctors who teach the next generation of doctors. It has become very difficult to recruit into clinical academia. The career pathway for clinical academics has become very uncertain, and we have an emerging crisis—a real and present crisis—that must be addressed. One way to do that is to think about how we recruit foundation doctors into academic programmes.

Here is a straightforward proposal, which I hope colleagues will improve rather than simply accept. Let us return to a firm-based model for the first year of training. The F1 placement should be arranged by the medical schools, not by a centralised national algorithm, with each new doctor placed alongside peers they already know with consultants who have taught them. That is the system we had so many years ago. Medical schools know their students; they know who has the caring responsibilities, who has a linked partner, who has health needs, who has a strong reason to stay close to home. They are in the best possible position to start designing a year that makes sense for each individual.

That does not preclude movement later. F2 can broaden horizons, and specialty training will often mean relocation, but in the critical first year, when doctors are doing their first on-calls up at night by themselves, writing their first prescriptions and being present at their first deaths, they should not be alone in a city where they do not know anybody. They should be doing that with the support of their friends, teachers and colleagues they already trust. I do not think that would be particularly expensive; it might even cost less than the centralised allocation machinery we run today. Whatever we do, I offer one principle: medicine is the most distinctly human of professions and it is futile, and somewhat ironic, to try to reform it with an algorithm. The reform must be human.

Let me close where I began. Resident doctors have just come off picket lines. I do not think that in this debate we can rehearse the pay dispute, which is a matter for another day, but the strikes are not just about pay. At root, they are about a sense that the profession has been treated as though it does not matter. The individual doctor has become invisible behind the workforce spreadsheet. The Government have taken one very important step, with the Medical Training (Prioritisation) Act 2026 giving UK graduates the rightful priority for specialist training places—and that matters. Today’s debate is an opportunity to take the next step to fix the starting point itself.

We have in medicine one of the most extraordinary workforces in the world. Young doctors are among the best trained, most dedicated and most compassionate professionals. We owe them and, more importantly, the patients who depend on them, better than a lottery. We owe them the fair, well-supported, human start they deserve. I believe that would go a long way to resetting the Government’s relationship with the profession, and towards ending these damaging rolling strikes.

--- Later in debate ---

[Peter Prinsley]

Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.

[Dr Johnson]

I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.

You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.

One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.

There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?

The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?

--- Later in debate ---

[Peter Prinsley]

I thank all hon. Members who came to speak in the debate. I particularly thank the hon. Members for Strangford (Jim Shannon) and for Birmingham Perry Barr (Ayoub Khan), who gave very interesting Back-Bench contributions. I also thank the Minister and the Opposition spokespeople—the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Winchester (Dr Chambers)—for their contributions. It is quite true that the shadow Minister and I grew up on the same street—probably about 10 houses apart, but many more than 10 years apart.

This has been an interesting debate, whose purpose was to highlight the plight of foundation doctors. As we have said, if we can fix the foundations, we will be able to fix the problems we have with our young doctors. I definitely think that this industrial dispute, which has been rolling and rumbling on for several years, is solvable. It sounds as though we were close to solving it and particularly to attending to the conditions of young doctors.

[Paula Barker (in the Chair)]

Order. I remind the hon. Member that this is not a chance for a second speech; it is just a winding-up speech.

[Peter Prinsley]

I will wind up, then. I thank everyone very much, and I look forward to seeing success in the future.

Question put and agreed to.

Resolved,

That this House has considered the Foundation Programme and its role in supporting and retaining resident doctors.

Oral Answers to Questions

Peter Prinsley Excerpts

Tuesday 14th April 2026 Commons Chamber

[Stephen Kinnock]

We will publish those data and statistics in August, in the usual way, but I can tell the hon. Lady that we have created a safety net for urgent dental care. Following the reforms that kicked in on 1 April this year, there is now a requirement for all NHS dentists to deliver 8.2% of their contract in urgent care. We absolutely recognise that more needs to be done in cases such as that of her constituent, and that is what we are focused on with fundamental dentistry contract reform.

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

May I congratulate the ministerial team, the University of East Anglia and the Office for Students on finally getting the new dental school at the university over the line? It will admit 25 students from September next year and will go some way to dealing with the dental deserts that we inherited in Norfolk and Suffolk. In the meantime, what progress has been made with the General Dental Council to increase exam capacity for dentists coming from overseas to help with the present crisis?

Ehlers-Danlos Syndrome and Craniocervical Instability

Peter Prinsley Excerpts

Thursday 26th March 2026 Westminster Hall

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

It is a pleasure to serve under your chairship, Ms Furniss. I was not going to talk in this debate until last week, when a lady came to my surgery at Bury St Edmunds. I used to hold surgeries all the time for patients with ear, nose and throat disorders; now I hold surgeries for constituents who come with political difficulties. This young lady was in a wheelchair, and told me she had Ehlers-Danlos syndrome and that she had been to Germany to get a diagnosis, after many years of failing to get one in this country.

Ehlers-Danlos syndrome is a disorder of the protein that is involved in the making of the connective tissue—which is the tissue that joins us all together—particularly the elastic bits. When I was a medical student there were four types of Ehlers-Danlos syndrome, and it was quite a favourite topic for examine questions. But now I see from the Ehlers-Danlos Society that there are 13 recognised types of the syndrome. We always thought of it as the double-jointed disease, and one would loosely test it by seeing whether someone could take their thumb and put it against the side of their arm—I increasingly cannot even get mine to a right-angle now.

It is a rare disorder. To give hon. Members a flavour of the different sorts of Ehlers-Danlos syndrome, there is a hypermobile Ehlers-Danlos, which is the double-jointed person. That is about one in 5,000 people. The classical Ehlers-Danlos, which is where people get this very stretchy skin that kind of falls away, is about one in 20,000 people. The really frightening Ehlers-Danlos syndrome is the one that affects the lining of the blood vessels. The blood vessels have an elastic lining, and if the elastic lining fails, they begin to expand, causing aneurysms. The most frightening aneurysms are those of the main aorta, which in some patients can rupture, leading to sudden death. They can occur all over the body, however, and therefore cause all sorts of curious neurological or gastrointestinal symptoms depending on where the aneurysms are happening. That is about one in 100,000 people. There is even a dental Ehlers-Danlos syndrome, which causes the teeth to loosen and fall out. That is about one in a million people.

Given that there are many different types of Ehlers-Danlos syndrome, it is not surprising that it can be difficult to diagnose. To diagnose something, one has first to think of it. In my long career as an ENT surgeon, I saw very few cases, but I am certain that I missed many cases. I did some brief research into ear, nose and throat surgery and Ehlers-Danlos, and there is a particularly frightening situation that occurs in patients who need to have their tonsils out. Ehlers-Danlos syndrome is associated with this instability of the neck vertebrae—the cervical vertebrae; the axis and the atlas bones. When one does a tonsillectomy, one anaesthetises a patient and tips their head right back to open the mouth as wide as one possibly can. I saw a report from 2013 by Agarwal of a child who developed quadriplegia after a tonsillectomy. The tonsils were taken out, and when the child woke up, the arms and legs would not move, because the spinal cord had been compressed by the subluxation of the vertebrae.

Diagnosis is difficult, and we must first think of it. We should do what we can to educate people, particularly clinicians in medical schools and nursing schools, and even the general population. A debate such as this is certainly helpful in that respect. Research is essential. Specific genetic mutations are associated with many of the varieties of Ehlers-Danlos syndrome—sadly not the most common sort, but certainly many of the other sorts. The Minister may know that there is a proposal for universal genome sequencing of newborns and young people in this country. I do not think that future generations will have this problem of odd clinical symptoms accumulating over decades before somebody works out what has happened, because in future, people will be able to access their genomes. We will be able to predict what will happen.

However, just because we can predict it and identify the genes that are causing it, that does not mean that we will come up with magic treatments. We will certainly need to provide services for all the people with this condition into the future. Diagnostic pathways and well-organised arrangements for the clinical care of people with this presently completely incurable condition are essential.

Resident Doctors: Industrial Action

Peter Prinsley Excerpts

Thursday 26th March 2026 Commons Chamber

[Wes Streeting]

I thank the shadow Secretary of State for his response and questions. Beneath some of the criticism of the Government was a consistent message about the unreasonable and unnecessary position of the BMA, but let me address his criticism none the less.

The shadow Secretary of State accused me of “boasting” yesterday about the progress this Government are making on the NHS. For once, I cannot say we are following the pattern of our predecessors, because of course, they did not make any progress. From the moment they entered government, we saw the NHS begin to slide in the worst direction, to the extent that we went into a modern health emergency—the pandemic—woefully underprepared, leaving our country more damaged as a result. I am proud of the progress we are making. We know that what we have seen in terms of results and patient satisfaction are grounds for optimism, not cause for complacency. What we are trying to do as a Government is absolutely essential for the country, to give it back an NHS that is there for people where they need it, when they need it. That is why the BMA’s position is both disappointing and self-defeating for all of us.

The shadow Secretary of State talked about the approach I took in opposition. There is a difference between the approach that this Government have taken and the approach of our Conservative predecessors. We have always been prepared to get around the table; we never close the door. As I said from the other side of the House, the power to end strikes does sit with the Government when they are willing to compromise, willing to negotiate and willing to treat the workforce with respect. That is what this Government have done, in contrast to our Conservative predecessors, which is why it is so disappointing that with a deal available—a good deal—the BMA is turning away.

The BMA should reflect not just on the contrast with the past, but on the contrast with the future. There is no more pro-NHS, pro-doctor Health Secretary or Government waiting in the wings. I am not even sure that the alternative is a Conservative Health Secretary; that person may well come from Reform UK—the party whose Members occasionally turn up and sit in the corner, when they can be bothered and when they are not flouncing out in a hissy fit. Catch them on a good day and Reform Members may even say the quiet bit out loud: they do not believe in the NHS. They do not believe in it as a public service free at the point of use, and they are certainly not going to treat the BMA or resident doctors with more respect or generosity than a Labour Government. I think the BMA needs to reflect on that.

The shadow Secretary of State asked about affordability. One of the great things about the deal that we agreed is that it is affordable because it involves productivity gains—not just the productivity gains that we have already achieved in the NHS, the target being 2% and the reality that we have achieved 2.7%, but the productivity gains built into the pay structure reform.

The shadow Secretary of State asked about the jobs. I will be honest, and I am sure NHS chief executives will want to say more about this. The fact is that I and Jim Mackey have had to do a considerable degree of persuading and arm-twisting to persuade NHS trusts to create additional specialty training places, because they have not been convinced of their necessity or utility. Part of their reservation has been about the conduct of resident doctors and the BMA. I have had a hard job to do to sell that. Those jobs will not materialise if the BMA rejects this deal, I am afraid. There is a not a “something for nothing” culture here.

I say to the crab people who still believe that they are pursuing a really effective “bank and build” strategy that they should look at what they are confronting now, and look their members and their colleagues in their eye. This is not bank and build any longer; this is a high-and-dry strategy, and it is not going to work. That is why it is important that we end this dispute and that we do it together, in the spirit of partnership. There is still time to do that—there is still a week. The door is not closed; the offer is still there, and I urge them to take it before it goes.

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

I share the frustrations of Ministers and of the Government. I know that they have worked really hard on this. Dr Fletcher of the BMA has also worked hard, and I am sure that there is a deal to be done somewhere. The Medical Training (Prioritisation) Act 2026, to prioritise UK graduates, was very welcome, but I wonder whether we can also do something to fix the foundations of medical careers, by devising a much better system than the crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich. That would be a great expression of good will. Meanwhile, I am sure that my colleagues in the NHS will work around this strike—our patients will be safe—and I am sure that our NHS will continue to improve under this brilliant Labour Government.

[Wes Streeting]

I thank my hon. Friend for his support in trying to influence a more constructive approach, for the advice that he has given me and members of the resident doctors committee, and for the experience that he brings to these exchanges. He is right to praise Jack Fletcher for the constructive approach that he and his officers have taken. It has not been easy, but I know that officials have enjoyed the constructive engagement, and I thank enormously the officials who have worked tirelessly on this. I think all those involved in the discussions, on both sides of the table, are disappointed by the outcome, and that is why I urge the BMA to seize the offer before it is too late.

My hon. Friend talks about other changes, such as to placements and rotations. I think that BMA officers recognise my desire to not only do this deal, but to create a new business as usual with the BMA, where we have people around the table on a regular basis looking at what we can do to improve the health service for patients and staff and to make real progress on those issues. We cannot do that if we are in conflict. That is the tragedy of the position we find ourselves in. I think we have built trust through engagement and dialogue with the BMA committee officers. It is only disappointing that members of the committee are not prepared to get around the same table as me, because if they did, they might realise the sincerity and the opportunity.