Health Bill (Fifteenth sitting)

Sojan Joseph Excerpts

Committee stage
Thursday 9th July 2026 Public Bill Committees

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning.

We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.

[Sojan Joseph (Ashford) (Lab)]

I was pleased to take part in the debate in the Chamber yesterday. I raised some examples from my local hospital, which is expanding its same-day emergency care because of the funding that we received from the Labour Government. We also have a safe haven for mental health patients who do not need to go into accident and emergency. Lots of work is happening in my local hospital area, which will make a big improvement to corridor care and wider emergency care pressures. Does the Minister agree that that is what we need to do, and that the Labour Government are doing it?

[Karin Smyth]

My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement.

In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see.

Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that.

On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards.

The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published.

Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them.

In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent.

New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so.

To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided.

We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most.

I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital.

Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.

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[Dr Chambers]

Yes, I sat on the Tobacco and Vapes Bill Committee for six weeks, going through the legislation line by line. One of the most interesting things about that Bill is not only that it will improve public health and life expectancy, but that it is probably one of the single most impactful pieces of legislation in terms of improving inequality and especially socioeconomic health outcomes. So many of the disparities in life expectancy between wealthy people and those living in relative poverty are due to levels of smoking—it is not just smoking, but that is a significant factor. It is good of the hon. Gentleman to highlight that.

During the coalition, the Tories recognised that the approach I described would send a powerful message that public health is the responsibility of all Government Departments. When it was scrapped, the then shadow Health Secretary, the right hon. Member for Makerfield (Andy Burnham), said that we could tackle Britain’s looming obesity crisis only if all Government Departments pulled together. We completely agree with that statement.

New clause 79 tries to address some of the issues that occurred back then, including by placing requirements on ministerial attendance and giving the Liaison Committee oversight to drive accountability. I am sure the Minister will agree that greater cross-Government working is needed. What are the Department’s plans to support that? If we want to tackle the various public health crises facing our country, we cannot do so without proper cross-Government working.

In my professional life, I was made an honorary lecturer at Bristol University veterinary school in the area of One Health, recognising that animal health, human health and environmental health are completely interlinked. It is difficult to improve one without looking at the factors that improve the others, and we need that kind of approach throughout all Government Departments.

[Sojan Joseph]

It is good to see you in the Chair, Ms Lewell. I strongly believe that public health is very important to our health system because it focuses on prevention, so that people do not end up in A&E or in hospital beds. Unfortunately, over the last 10 or 15 years we have seen the opposite. If we are serious about improving the nation’s health, prevention must sit at the heart of every decision we make.

Public health professionals bring a vital perspective—one that looks beyond treating illness to understanding and tackling its root causes. They consider the wider determinants of health, from housing and education to inequality and the environment, and they help us design services that keep people well, rather than responding only when they become unwell. We need to identify our priorities, ensure resources are allocated appropriately and develop a long-term strategy.

New clause 79 proposes to create a new committee. As somebody who worked in the NHS for many years, I have seen that there is no shortage of committees, senior leaders, management or meetings in our healthcare system. In fact, there are too many. What is missing are people to work on the frontline; that is what we saw over the 14 years under the Conservatives—and the Lib Dems were part of that.

One reason why I became active in politics was that I saw the frontline struggling. I worked as a nurse on the frontline in mental health services, and what we saw was money being diverted to create more senior leadership, more groups, more meetings and more management, while we were missing the people who actually did the work on the frontline. The new clause asks us to create a new committee, but we have enough committees and managers. In fact, through the Bill, we are trying to modernise the system by getting rid of some of those managers—that is the most important thing I can identify in the Bill. However, lots of the new clauses I have seen today and in the last Committee sitting have proposed creating more committees and directors. We are missing a point here. The Committee has an opportunity to reform our health system. If Members speak to a nurse or doctor who works in a hospital in our system, they will say, “We need more nurses, healthcare assistants and doctors, not more managers or directors.”

Not only in this new clause, but in many of the new clauses we are talking about, we need to think about embedding the public health voice within integrated care boards. Stronger integrated care boards will enable us to act early, reduce health inequalities and deliver care closer to home.

[Natasha Irons (Croydon East) (Lab)]

My hon. Friend is making powerful comments. I was struck by his argument that we need to focus more on what we do in communities. In Croydon East, a community diagnostic centre has opened, which is important because people in my community have a healthy life expectancy 10 years lower than that of people living a mile down the road. Does my hon. Friend agree that we should be focusing on those real, tangible interventions at the heart of the communities that need help the most? That is what this Government are trying to do.

[Sojan Joseph]

I absolutely agree, and I can give an example. Last week, as part of the ICB’s new independent neighbourhood health centre, one of the GP practices in my constituency started to proactively go and see all elderly patients. It is not just giving those patients appointments when they fall ill; it is proactively visiting them. We need that kind of support so that we can prevent illnesses and prevent people from needing to go to hospital.

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

Does my hon. Friend agree that, as well as the physical aspects of health and extending life expectancy, we need to look at preventive measures for mental health? That will ensure that people live as good and full a life as they can, and receive the treatment they need. Does my hon. Friend see that as integral to any public health strategy?

[Sojan Joseph]

My hon. Friend makes a sensible comment. I work closely with her on mental health, and she is absolutely right. Some of the policies the Government have introduced, such as giving children early access to mental health provision, will be absolutely vital to prevent them from becoming unwell later on. The Government are also rolling out a new mental health strategy focused on prevention, which will be important. We need to be more lean and productive, rather than creating more managers and committees.

[Edward Argar (Melton and Syston) (Con)]

The hon. Gentleman will probably be aware of the King’s Fund report from late last year, which covers the years 2010 to 2025. It highlighted that the growth rate was only 5% for managers during those 15 years, but 94% for children’s nurses and 55% for doctors, and other groups had similar increases. We are seeing investment and workforce increases in the right areas.

It is right that we acknowledge, as I suspect the hon. Gentleman will, that the one group where we have not seen that same growth is community health visitors and community health workers. Alongside the massive investment and increase in doctors in the past 15 years, that group, and the role it plays, deserves focus from whichever party is in government.

[Sojan Joseph]

I agree. We need more band 5 nurses or healthcare assistants who can check blood pressure or blood sugar in patients’ homes. When someone rings their GP surgery, they should be able to meet a nurse or a healthcare worker to carry out some basic checks, rather than being delayed from seeing somebody until, a few weeks, months or a year later, they end up in A&E. That is where the focus should be.

I do not support the new clauses, and I urge the Committee to think about some of the other new clauses that propose creating more directors or committees. We need to focus on making our health system more productive.

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[Gregory Stafford]

I certainly agree with the hon. Gentleman’s penultimate point: we need to support home-grown clinical academics and the life sciences industry in this country. As he has drawn me down that line, I declare that my wife works in the life sciences industry in the UK. I entirely agree with him on that point. However, if he is saying that a corollary is that we should not do pharmaceutical trade deals with other countries, I do not agree, because UK patients need the best medicines no matter where they come from. If that was not what he was saying and I am putting words into his mouth, I apologise, but that is how it sounded to me. I agree that we should support the home-grown, but obviously we need access to medicines from around the world.

That brings me to my concerns about new clause 76. I understand why the hon. Member for Winchester supports it, but the way it is written means that, for the lifetime of the Act, any trade deal with America would have to follow those strictures. Although I accept that he does not like the current deal or the incumbent in the White House, it seems odd that we are singling out in statute, and putting a stricture on, one country over every other. I still probably would not have voted for it, but the new clause might have been more acceptable had it referred to any trade deal with any country, or even a group of countries—I know he is a big fan of one particular group of countries. That might have made it difficult. It would be dangerous essentially for the Bill to put a stricture on a trade deal with one specific country—especially one that is probably our strongest ally. I think that sits very badly.

[Sojan Joseph]

Does the hon. Gentleman agree that the existing constitutional arrangements already provide mechanisms, ministerial accountability and parliamentary scrutiny? Singling out one country is a politicising measure, and it will have long-term consequences for our relationship.

[Gregory Stafford]

Yes, I agree entirely with the hon. Gentleman. It would be a very slippery slope to write that into legislation. I understand the motivation—as I often do—behind Liberal Democrat new clause 76, but I do not think its drafting is appropriate in this context, and I cannot support it.

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[Dr Johnson]

This group of new clauses is about carers and how we look after them. They do so much work for so many people across the country by looking after their loved ones. Many of them are not necessarily in good health themselves, and some are even children. These new clauses have a positive intention: to try to improve carers’ lives and make sure that they are recognised.

I congratulate the hon. Member for Winchester on his success in keeping open his respite care centre. Perhaps he could share his notes with me, because the Reform county council in Lincolnshire is currently trying to close Swallow Lodge, a respite care centre that provides for people of working age who have severe disabilities. The council wants to close it, and the people there are devastated by that suggestion. We had a public meeting, which many people came to, and they had not been consulted at that point. I think that an assumption was made that they are not able to communicate, but many of them are able to do so with support. However, that communication had not happened.

It has caused fear for people. They are worried about where they will go instead and whether it will be suitable. What about the people they made friendships with at the centre? Many of them have elderly parents—in their 80s, in some cases. It is also economically short-sighted, because people may end up going into full-time care, which will ultimately cost the council more.

The council has now been persuaded to do a full consultation, which will happen over the next few months. If the hon. Member can share anything with me that was successful for him that could help me keep Swallow Lodge open against the Reform county council’s changes, I would be very grateful.

[Sojan Joseph]

As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers. I have seen so many vulnerable patients benefit from the enormous amount of work that carers do. In some services, such as the mental health service, there is already provision for identifying carers, carers’ assessments and support for carers. Carers provide extraordinary support, often at great personal sacrifice.

Although the intention here is to make the wellbeing of carers a statutory duty, we need to be careful that we do not put any statutory responsibility for that on the NHS and create more administrative burden for it. I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.

New clauses 16 and 17 would impose new obligations on integrated care boards to promote carers’ wellbeing and to identify and record unpaid carers whenever they come into contact with NHS services. I want to make it clear that we should not create any more administrative burdens for NHS frontline services. Although identifying and supporting carers is important, the requirement would add to the administrative burden on NHS organisations at a time when they should be focusing on delivering frontline care.

We should be cautious about creating new statutory duties that divert resources and staff time away from patients. The proposal for a national respite care scheme is similarly well intentioned, but it risks imposing a centralised, one-size-fits-all model across a system that already makes local authorities and health boards responsible for assessing local needs and delivering support. Again, although we need more support for carers, we should be careful that we are not duplicating any of the services that are already available. Some charities also do a brilliant job of supporting carers. The provisions in these new clauses should be looked into, but we need to be cautious that we do not create more burdens for our existing systems.

[Joe Robertson]

I am grateful to the hon. Member for Winchester for introducing these new clauses and for the debate that that is allowing us to have. Unpaid carers are too often a silent and fundamentally unappreciated part of society, which the system could not cope without. They are family members who are thrown into the role of looking after their loved ones, which they did not expect to have to do. Most of them have no formal qualifications, but through love and family ties, they provide unpaid support, which in many cases has a negative effect on the financial wellbeing of the household and involves a huge amount of emotional toil.

The crisis in social care has lasted for decades under different Governments, who have struggled to tackle it, and it is putting increasing pressure on family carers. Many do not see themselves as a carer—they see themselves as a husband, wife, daughter, son or friend—but they provide millions of hours of care and support, year in and year out. My former role was at a national nursing charity that seeks to support the families of those living with dementia. I saw for myself how much wraparound care can achieve in relieving pressure and unnecessary suffering, not just for the person living with dementia—it does not have to be dementia, but that is what I have experience of—long-term frailty or conditions that require support, but for their family and carer. Very often, the biggest care need for the person living with dementia is the biggest need their family carer has; if we can sort the family carer’s biggest need, they can go on and do so much more for the person they love.

I thank the hon. Member for Winchester for allowing us to have this debate. I urge the Government, if they do not adopt these new clauses, to do all they can to relieve the pressure on unpaid carers up and down the country and to provide support for them.

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[Sojan Joseph]

I pay tribute to all the parents and schoolteachers who engaged with me last summer, following the White Paper and the SEND consultation. It has been a huge problem in Kent. Kent county council has been under Conservative administration for the last 25 years. In recent years, it was in special measures because of its SEND provision. Parents really struggled. My inbox is filled with these issues. We know that 98% of SEND provision tribunals rule in the parents’ favour. There has been a long wait. Does the Minister agree that, whether we accept the new clause or not, we need to look into how the NHS and local authorities can work together to make it easier for children, families and schools to get proper provision in place?

[Karin Smyth]

I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals.

The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.