Public Bill Committee: Health Bill (Thirteenth sitting)

The Committee consisted of the following Members:

ChairsSir Roger Gale, Dr Rupa Huq, † Emma Lewell, Sir Jeremy Wright

† Argar, Edward (Melton and Syston) (Con)

† Brackenridge, Sureena (Wolverhampton North East) (Lab)

† Chambers, Dr Danny (Winchester) (LD)

Daby, Janet (Lewisham East) (Lab)

† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)

† Irons, Natasha (Croydon East) (Lab)

† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)

† Joseph, Sojan (Ashford) (Lab)

† Kyrke-Smith, Laura (Aylesbury) (Lab)

† Morgan, Helen (North Shropshire) (LD)

† Prinsley, Dr Peter (Bury St Edmunds and Stowmarket) (Lab)

† Robertson, Dave (Lichfield) (Lab)

† Robertson, Joe (Isle of Wight East) (Con)

† Smyth, Karin (Minister for Secondary Care)

† Stafford, Gregory (Farnham and Bordon) (Con)

† Twist, Liz (Blaydon and Consett) (Lab)

† White, Jo (Bassetlaw) (Lab)

Sanjana Balakrishnan, Rob Cope, Committee Clerks

† attended the Committee

Public Bill Committee

Tuesday 7 July 2026

(Afternoon)

[Emma Lewell in the Chair ]

Health Bill

Clause 59

Transfer of HSSIB’s functions to CQC

14:00:00

Question (this day) again proposed, That the clause stand part of the Bill.

The ChairI remind the Committee that with this we are discussing the following:

Amendment 55, in schedule 8, page 110, line 23, at end insert —

“(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)—

(a) should not be exercisable in relation to certain premises in which there is a Crown interest, or

(b) should not be exercisable in relation to certain specified premises for other purposes,

those powers are not exercisable in relation to those specified premises.

(7) In this section, “Crown interest” means—

(a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department;

(b) an interest belonging to His Majesty in right of the Crown;

(c) an interest belonging to His Majesty in right of the Duchy of Lancaster;

(d) an interest belonging to the Duchy of Cornwall.”. This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill. Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9). This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance. Amendment 5, in schedule 8, page 120, line 16, at end insert—

“(2A) After paragraph 6(8) insert—

“(9) A committee of the Commission is to be appointed in accordance with regulations.

(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.

(11) The committee is to be operationally independent from the Care Quality Commission.

(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair. (13) A majority of the members of the committee must not be members of the Care Quality Commission.

(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.””. This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC. Schedule 8.

Clauses 60 and 61 stand part.

New clause 42— Funding for Care Quality Commission (CQC) investigations —

“The Secretary of State has a duty to make provision for adequate funding and resources for patient safety investigations conducted by the CQC, including some initiated by the CQC themselves.”.

I believe Dr Caroline Johnson was mid-intervention.

Dr Caroline Johnson (Sleaford and North Hykeham) (Con)My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.

Joe Robertson (Isle of Wight East) (Con)The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan.

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

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

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

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

“‘What happens if the problem is this organisation or that one?’” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.] That was the response from Dr Dash. But we are not talking about whether there is a problem with this organisation or that one; we are talking about the CQC, the organisation that HSSIB will become.

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

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

Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)It is a pleasure to serve under your chairship, Ms Lewell.

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

The Minister for Secondary Care (Karin Smyth)It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB.

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

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

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

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

Joe RobertsonWill the Minister give way?

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

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

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

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

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

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

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

Dr JohnsonWill the Minister give way?

Karin SmythI want to make some points first. I will pick up any outstanding points I do not cover.

The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action.

Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said:

“by bringing HSSIB into the CQC, you can align the work of the two.

For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.] to enable best action. These organisations can learn better from each other. Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.

14:15:00

The safe space issue is really important. I have said it before, and I will say it again: the Bill protects safe spaces. Safe space protections will continue to apply following the transfer of the investigation powers to the CQC. Sensitive information obtained by the CQC during the course of an investigation may not be disclosed to a third party by the CQC or its investigators, as is currently the case for the Health Services Safety Investigations Body.

The Bill sets a high bar for exceptions to this prohibition on disclosure. The Opposition raised that issue, so I wanted to address it. The limited circumstances in which disclosure may be permitted are set out in the Bill, and the CQC will appoint a designated responsible person—we envisage it being the chief executive—who will be responsible for decisions relating to the disclosure of protected information, ensuring that any such decisions are made consistently and in accordance with the statutory framework. The CQC has provided assurance that the high bar for decisions to disclose in exceptional circumstances will be upheld. That will ensure that disclosure to the regulatory function may only occur when a statutory exception is met, providing confidence to stakeholders that safe space is maintained at the same level and strength as under HSSIB and that it will continue to be an integral principle to investigations.

The other issue that was raised by Opposition Members concerned the CQC looking into itself. I reassure the Committee that the CQC’s investigatory function will be empowered to do that if necessary. The investigations function within the CQC will have autonomy to launch investigations into any part of the health system, including other parts of the CQC if required, and make recommendations to any part of the system, just as HSSIB does now.

Edward Argar (Melton and Syston) (Con)On that point, will the Minister briefly give way?

Karin SmythNo.

There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that.

I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.

Joe RobertsonWill the Minister give way?

Karin SmythI am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership.

I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that.

The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit.

Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.

Dr JohnsonMy understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?

Karin SmythI am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction.

The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies.

New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose.

Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation.

As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight.

I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC. The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill.

The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material.

The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops.

Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.

Dr JohnsonThe Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?

Karin SmythWe are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp. Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change.

I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee. Question put, That the clause stand part of the Bill.

18|0|10|6| The Committee divided: | Question accordingly agreed to. ||0|0

Clause 59 ordered to stand part of the Bill.

The ChairDoes any Member wish to press amendment 55 to a Division?

Dr JohnsonThe Minister has reassured us that, although it has not been lifted and shifted from the original, the amendment is a duplication of another clause. Therefore, we believe the Committee—

The ChairOrder. The Member just needs to say whether she is pressing it to a Division.

Dr JohnsonNo, I am not.

Schedule 8

Transfer of HSSIB’s Functions to CQC

14:30:00

Amendment proposed56, in schedule 8, page 116, line 8, leave out subsection (9).— (Dr Caroline Johnson.)

This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.

Question put, That the amendment be made.

19|0|4|10| The Committee divided: | Question accordingly negatived. ||0|0

Schedule 8 agreed to.

Clause 60

Transfer schemes in connection with abolition of HSSIB

Question put, That the clause stand part of the Bill.

20|0|10|4| The Committee divided: | Question accordingly agreed to. ||0|0

Clause 60 ordered to stand part of the Bill.

Clause 61

Transfer schemes under section 60taxation

Question put, That the clause stand part of the Bill.

21|0|10|4| The Committee divided: | Question accordingly agreed to. ||0|0

Clause 61 ordered to stand part of the Bill.

Clause 62

Reviews and investigations of commissioning

Question proposed , That the clause stand part of the Bill.

Karin SmythClause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State.

On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48.

NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit.

This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality.

This approach will also provide important flexibilityas commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.

Dr JohnsonI have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?

Karin SmythMy understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong. Question put and agreed to. Clause 62 accordingly ordered to stand part of the Bill. Clause 63

Time limit for bringing proceedings Question proposed , That the clause stand part of the Bill.

Karin SmythThe 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help.

Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action.

The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation.

A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.

Dr JohnsonAs the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.

Karin SmythApologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?

Dr JohnsonThe Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question.

The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent.

The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?

Karin SmythPut simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention. Question put and agreed to. Clause 63 accordingly ordered to stand part of the Bill. Clause 64

Abolition of Healthwatch England Question proposed, That the clause stand part of the Bill.

The ChairWith this it will be convenient to discuss the following:

Schedule 9.

New Clause 74— Report on the abolition of Healthwatch England —

“(1) Within 12 months of the passage of this Act, the Secretary of State must lay a report before both Houses of Parliament on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs.

(2) The report must consider—

(a) the effectiveness of escalation routes for complaints,

(b) the ability to receive responses to complaints from the relevant ICB officer,

(c) accountability of ICB CEOs for delivering new functions arising from the abolition of Healthwatch;

(d) independence in the delivery of patient surveys, and

(e) ability to investigate organisations from which the ICB commissions services.

(3) The report must make recommendations about how any issues identified under subsection (2) may be mitigated.” This new clause would require the Secretary of State to publish a report within 12 months of the passage of this Act on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs. New clause 78— Healthwatch funding —

“(1) The Secretary of State, must within 12 months of the passing of this act, enact a scheme to fund Healthwatch England and local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14.

(2) The Secretary of State must consider uprating this funding with inflation for 2026/2027.” This new clause would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care in 2013/14.

The ChairI call the Minister.

Karin SmythThis is a popular clause, Ms Lewell—and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.

14:45:00

Taken together, the clause and schedule provide for the abolition of Healthwatch England, which is a step that we are not taking lightly. I want to pay tribute to everybody involved in this work. In some areas, Healthwatch has played a really important role in amplifying the experiences of patients, families and carers, and those insights have helped shape services over many years, but the system for capturing feedback has become fragmented, with multiple routes for producing large volumes of information without clear ownership or, crucially, the action and impact to make the necessary changes.

The arrangements we have divorce those listening to patients from those with the power to make change. The patient voice was left on the outside lobbying in, too far from where local commissioning and national policymaking decisions take place. As set out in the 10-year health plan, we are simplifying the landscape so that listening to patients and users is not something done at arm’s length and not something that has to be done as part of the commissioning process as a box to tick, but fundamental to the commissioning process and the work of these organisations—a core responsibility at the heart of Government and across the NHS and local authorities. That is why we are bringing patient voice in house to give it a greater profile at the national level within the reformed Department of Health and Social Care.

That will lead to a step change in how the Department considers patient experience as an ongoing part of national policymaking. We will appoint a director of patient experience within the Department, who will be responsible for overseeing a more coherent approach. That will include stronger national surveys to collect feedback, a reformed complaints process that is easier to navigate, and clearer local arrangements so that concerns are heard early and resolved quickly.

The creation of the new patient experience directorate does not need legislation. However, the requirements in the Bill for the Secretary of State to oversee and have the ability to issue guidance to ICBs and local authorities on best practice for obtaining user views will ensure that the Department plays a central role in strengthening patient voice and holding the system to account. The patient experience directorate will also ensure that the experience of diverse communities and seldom-heard groups feed into the design and delivery of services. This will in turn help improve experiences and outcomes and reduce inequalities.

I know that some across the House and the Committee are worried that the abolition of Healthwatch England could weaken the patient and user voice. I cannot stress more clearly that that is absolutely not our intent. Our intent is the exact opposite. We want to make feedback easier to give and, crucially, harder to ignore and more directly linked to improvement. Patients and users should not have to work out which organisation to tell. The Government should be accountable for listening and taking action.

I remind hon. Members that there is no shortage of independent outside scrutiny of Government and the NHS, from the Parliamentary and Health Service Ombudsman to the Patient Safety Commissioner, now sitting within the Medicines and Healthcare products Regulatory Agency, along with a wide number of voluntary, community and social enterprise sector organisations, which we will all know well from our local communities. We have not lacked recommendations; rather, as we have heard in recent debates, we have lacked the actions to fix the issues that they address. That is why this clause, to bring patient voice in house at the Department, is vital. It will ensure that patient and user insight informs policy and decision making at the highest level, where it cannot be ignored. I therefore commend the clause to the Committee.

Dr JohnsonClause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England.

Members may be familiar with the term “nothing about us without us”—the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change.

Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out research, conducted visits to inspect standards and represented communities when changes were proposed. They also helped the public with information about local services, including how to make complaints—very similar processes.

The Labour Government abolished community health councils in 2003, although a cursory trip to Hansard reveals that the Government repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do that. That is reminiscent of what we are discussing today, because abolishing Healthwatch was not in the Labour party manifesto.

In 2003, the community health councils became patient and public involvement forums, and five years later they became local involvement networks. The names and structures have changed, but the principle of patients having an independent voice remained. Healthwatch is the latest iteration. To be precise, Healthwatch England was established initially as a committee of the Care Quality Commission in 2013. It operates a hub-and-spoke model with more than 150 local healthwatches spread across local authority areas.

Healthwatches play a vital role in exposing problems in the health service. Indeed, even the King’s Speech contained a reference to Healthwatch England. According to Healthwatch England’s May 2025 report,

“nearly one in four…adults have noticed inaccuracies or missing details in their medical records”,

such as inaccurate personal details and inaccurate records of medicines, diagnoses, treatments and conditions. I note that the Minister herself has relied on Healthwatch when bringing problems facing her constituents to the House. She said:

“In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling.” —[ Official Report, 10 February 2022; Vol. 708, c. 484WH.] So Healthwatch is valuable.

I invite Members to look at the impact that Healthwatch had in 2023-24. More than 925,000 people used their local healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services. Healthwatch England helped to secure changes to Royal Mail so that NHS letters are delivered to patients on time. It also led new NHS guidance so that patients commencing cancer treatment have priority access to NHS dentists. A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care.

Recently, my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Healthwatch has influenced the future of attention deficit and hyperactivity disorder care, encouraged the uptake of cervical cancer screening and so much more. That is why the public and health experts are alarmed by the Government’s plans.

As for HSSIB, the success of Healthwatch is due to its independence, but the Government want to do away with that. Their policy paper commits to replacing Healthwatch with a new patient experience directorate, which will sit inside the Minister’s Department. Instead of having organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the Minister’s Department. How can she guarantee the independence, and the perception of independence, of the new directorate? How can she be sure the public will trust it?

I remind Members of what Councillor Dr Wendy Taylor of the Local Government Association said:

“The current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework.”

When Healthwatch conducts surveys, it often solicits information that proves problematic for the Government of the day. How can the public have confidence that the new directorate’s process will do the same? What will stop the Secretary of State deciding what questions get asked and what data gets published? From my reading of the Bill, the answer is nothing.

The Government have made it clear that, alongside the new directorate, ICBs will take over several patient voice functions. I appreciate that this strays slightly into the subject of the next group of provisions, Ms Lewell, but it is difficult to separate Healthwatch from local healthwatches. The Patients Association has warned:

“Splitting local Healthwatch between ICBs and local authorities risks creating a patchwork of accountability with no single body responsible for ensuring patients are heard”.

If responsibility to deliver those functions is shared between different parts of the health system, who becomes accountable if it is not funded? Who is accountable if people fall through the cracks? If accountability is divided, it often means that accountability is somewhat diminished. Members also need to ask whether it is financially feasible for ICBs to deliver patient voice. In its evidence, the Health Foundation wrote:

“Moving the NHS functions of local HealthWatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.”

We know that ICBs are under financial pressure because of decisions by the Labour Government; they have had to slash operating costs by 50%, and many are pencilling in cuts to frontline services. Against that backdrop, how can they afford to deliver patient voice functions? Ms Lewell, your guess is as good as mine.

We have not heard about any additional funding from the Government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2025-26, and local healthwatch £14.1 million. How much of that money will be redirected to the patient experience directorate and the ICBs?

I tabled a written question about the benefits to the public purse of abolishing Healthwatch. The Minister’s response was as follows:

“The potential savings from abolishing Healthwatch England and Local Healthwatch are dependent future policy decisions regarding the approach taken to collecting user experiences post-abolition.”

She set out an intention for “future policy decisions”, but there was, and still is, an absence of a plan. That is something we have heard again and again in relation to health, in Committee and throughout the two years that this Government have been in power: the absence of a plan for how things will be achieved. They have lofty aims, and understandable and sometimes really good goals, but no understanding of how they are going to get there.

It is not just the Opposition who are concerned; I will give some examples of Government Members who are, too. The hon. Member for Birmingham Erdington (Paulette Hamilton) said:

“One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures.” —[ Official Report , 1 June 2026; Vol. 786, c. 921.] The hon. Member for York Central (Rachael Maskell) said:

“Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners.” —[ Official Report , 9 June 2026; Vol. 787, c. 136.] The hon. Member for Blaydon and Consett said:

“I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and…with the ability to pull the levers”? —[ Official Report , 1 June 2026; Vol. 786, c. 944.] We have also heard concerns from the Health and Social Care Committee.

But the Member that the Minister may be most interested in is the right hon. Member for Makerfield (Andy Burnham). He wrote to the former Secretary of State last year saying:

“People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.” Does the Minister agree? If so, why does she want to remove the independence of patient voice? The right hon. Member for Makerfield also said:

“The independence of resident and patient voice is a necessity. Without it, we risk losing the trust of the public, the richness of lived experience, and the ability to challenge and improve the system from within, particularly during this time of significant system reform”.

My plea to the Minister is thisthink again about the importance of the independence of patient voice. People will give their views when they think they can do so independently and safely—a principle that was echoed in the debate this morning. Removing the independence does not seem necessary, and I do not understand why the Minister thinks that it will improve patient care and thereby patient safety. It is clear that Members not only on the Opposition Benches, but right across the Government Benches—in fact, potentially the new Prime Minister from next week or the week after—may think the same. I encourage the Minister to reconsider this step.

15:00:00

Dr Danny Chambers (Winchester) (LD)For over 50 years, there has been a statutory independent patient voice in the health and care system. The creation of Healthwatch was, in part, a direct response to the issues raised by the Francis inquiry into Mid Staffs. In a 2024 Healthwatch poll, almost a quarter of NHS patients said that they had experienced poor care in the past year, but 56% of them—more than half—took no action. Of that 56%, 20% said that that was because they were scared that giving negative feedback directly to NHS services would affect their ongoing treatment. Women, people living in areas of greater deprivation, disabled people and unpaid carers were significantly more likely to give the fear of retribution as a reason for not speaking up.

The Government are stripping patients of their voice in our NHS. Rather than being able to go to an independent body and express how the NHS can work better for them, patients will now be able only to give feedback to the same organisation that might have failed them. I have had experience of that in the past few weeks. My partner Emma has endometriosis, which has been an ongoing condition. She was worried that speaking to the local hospital trust specifically about the treatment she received might affect her treatment going forward.

The Government have argued that the changes will bring patient insight closer to decision making, making it much more effective at securing change. The former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), stated that patients do not need “ventriloquists”. That blatantly disregards the vital role played by Healthwatch in advocating not only for vulnerable patients who, understandably, do not feel confident navigating health services with often complex or combative systems, but for whole communities with a pre-existing distrust of the system.

We believe that removing Healthwatch leaves the health service to mark its own homework, which creates a conflict of interest. It will significantly undermine public trust, as independence is removed. Will vulnerable people who have suffered harm or poor experiences in the health and care system really have faith in a system headed by a director in the Department of Health and Social Care, which is the very organisation running the system that caused them harm in the first place? On a local level, will they have faith going to the same ICB that oversees the providers that have failed them? One need only look at the long list of maternity failings in Mid Staffs to see that internal functions can fail catastrophically. We know all too well that the NHS default is sometimes to cover up. The public knows that, too, so independence is everything.

Healthwatch has been keen in spotting and exposing challenges in the health service, such as widespread failures in the NHS referral process, yet there will be no incentive for the new system to investigate such issues, which are invisible in the main NHS performance metrics. The system does not always know what questions it needs to ask, so an independent route for unsolicited feedback is important. We also think that the provisions disadvantage hard-to-reach communities and those who may have a distrust towards the NHS and public authorities, making it harder to gain the feedback and concerns of those communities. That risks inadvertently further baking in inequalities.

More widely, clarity has not yet been provided on how those functions will be funded. The reform is coming alongside major reductions in ICB running costs. Healthwatch currently receives almost £26 million a year; that is already 60% less in real terms than the original DHSC estimate to fund the network. There is a risk that the money will be absorbed into wider budgets and never spent on the patient experience infrastructure. If people want to see the value of Healthwatch, they need look no further than the Cabinet Office briefing notes on the King’s Speech, which reference a May 2025 Healthwatch report on missing medical records to make the case for the single patient record.

Fundamentally, the Government are conflating patient voice with patient involvement in decision making. While greater patient voice in commissioning and decision making is needed, it is not a replacement for the advocacy and other functions of Healthwatch, which helps vulnerable people to navigate a complex health and care system and performs signposting functions. Splitting local healthwatch functions across ICBs and local authorities once again separates health and care and reinforces existing gaps between them. As we know, many issues span both areas and need a joined-up investigative approach. How will the new model ensure a joined-up view of people’s experiences across the NHS and social care? We urge the Minister to reconsider this decision. We have seen overwhelming support for Healthwatch across the sector, and it is becoming increasingly clear that many people in the NHS and the medical profession think that this is a huge mistake.

Healthwatch England has played a central role in escalating the findings of local healthwatch organisations and in advocating nationally. We have three examples. The first is the call to publish research highlighting inequalities in waiting times for disadvantaged groups, and for a demographic breakdown of waiting lists, which the NHS obliged with last summer. The second example arose after Healthwatch Sunderland supported a patient with a learning disability who had received accessible screening information but risked missing care because of inaccessible follow-up letters. Healthwatch England raised that gap with national bodies and highlighted inconsistencies in communication, and, as a result, the national easy-read templates were introduced across the cancer pathway, which improved accessibility and reduced risk. The third example is that Healthwatch feeds back patients’ horrific stories of corridor care—including that of a pensioner who was left in a corridor—to NHS leaders, and lobbies for increased transparency and oversight when it comes to corridor care.

I have several questions in three forms. Is the Minister genuinely sure that a director of patient experience in DHSC will be eager to advocate for patients and flag issues at a national level given that they will essentially be flagging to their bosses where work is not up to scratch? Is she sure that the level of persistence that has so often been needed to advocate for change at a national level would be forthcoming from a director employed by DHSC? What will be the mechanism for escalating local concerns that indicate national or systemic issues?

Will the Minister explain where the Government envision the new director sitting in the DHSC structure, and what the reporting lines will be? How will the Government ensure that they have the resources and sense of operational independence to investigate and raise concerns nationally? Healthwatch England has often flagged issues to MPs and to the Health and Social Care Committee as a way of applying pressure on NHS leaders and Ministers to enact change.

Joe RobertsonI am a member of the Health and Social Care Committee, and the hon. Member is absolutely right to say that Healthwatch England raises issues with us. When the Department assumes those roles and functions, I very much doubt that it will be as keen to disclose such issues to the Committee.

Dr ChambersThe hon. Gentleman must have read the next line of my speech. We are concerned that a DHSC employee appearing before that Committee will not clearly and openly state whether DHSC is failing.

New clause 78

“would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care”

in 2013-14. We do not just want to protect Healthwatch; we want to strengthen it. As I mentioned, it receives almost £26 million a year, which is spread over 153 organisations. In real terms, that is about 60% less than the £43.5 million that DHSC originally estimated would be needed to fund the network. The Healthwatch network does such amazing work—I will not go through it all again—despite being underfunded compared with those original estimates. Imagine the work it could do if it was adequately funded.

Even more worryingly, there is still no clarity on how Healthwatch’s functions will be funded once they have been transferred to the new system. Given the ongoing constraints and cuts to ICB running costs, there is a real risk that the funding for Healthwatch will simply end up being incorporated into wider ICB budgets, and money for the patient experience infrastructure could end up being cut entirely. The new clause aims to ensure that the Healthwatch network is properly funded, but it also raises the point that, if this change is to go through, funding for patient experience infrastructure must be protected. Otherwise, the Bill risks not just weakening patient experience, but removing it altogether as the funding gets swallowed by wider NHS operational demands.

Dave Robertson (Lichfield) (Lab)It is, as ever, a pleasure to see you in the Chair, Ms Lewell.

Healthwatch was established, at least in part, as a response to the Mid Staffs scandal. Mid Staffs came up three times in our evidence sessions, and the hon. Member for Winchester mentioned it just now. That scandal matters to everyone, but it has a particular resonance for my role in Parliament. Many of my constituents were harmed by the failing at Mid Staffs. I was born in that hospital, and I speak as a Staffordshire MP. None of us should ever forget what happened or allow it to be swept aside without examining it. There were a great many failings at Mid Staffs over a long period. Oversight was just not in the room when decisions were being made.

Staffordshire county council’s health and care overview and scrutiny committee clearly did not do that job. The Francis report stated:

“The arrangements for public and patient involvement, and for local government scrutiny in Stafford, were a conspicuous failure.”

The report recommended some changes to ensure that Healthwatch, which was in the process of being set up at the time, was funded properly. In that light, the framing of this debate is important and timely. Healthwatch has been going for well over a decade. It is right that we now examine its impact, as it is a significant part of patient voice within the NHS.

Despite the very best efforts of a great many hard-working staff and an army of committed volunteers across the country, the quality of local healthwatch organisations is pretty changeable. Over the past few weeks, I have spoken with right hon. and hon. Members from across the House. The feedback that I have received has ranged from, “My local healthwatch team is brilliant— I work with them really closely and they have really helped out with a huge amount; they deliver great things in my constituency” all the way to, “I have some pretty significant concerns about their impact.” In a couple of cases I heard, “What is Healthwatch? I have never heard of it.”

Helen Morgan (North Shropshire) (LD)We heard in evidence that the reason for that variability was a lack of funding. Would the hon. Gentleman support our new clause 78, which tries to deal with the lack of funding and ensure a consistent service from Healthwatch across the country?

Dave RobertsonFunding Healthwatch is really important, but to address the issue properly, we must make sure that Healthwatch is in the rooms it needs to be in. Funding needs to be part of the process that ICBs follow. I will touch on that later, so the hon. Member will hear further thoughts on the matter.

Local healthwatch organisations across all our constituencies have an important role. At the local level, they are geographically bound to counties. In constituencies like mine and that of the hon. Member for North Shropshire, those geographical areas are huge. The health disparities within my constituency, with two towns that are 4 miles apart, one with a significant mining—

Gregory Stafford (Farnham and Bordon) (Con)I hesitate to intervene on the hon. Gentleman, because he seems to be straying into the next grouping and I do not want to encourage him down that route, but now that he has raised it, I share his concern. I do not know what it is like in his area, but the ICB areas that local branches of healthwatch will be absorbed into are even larger than counties. In my area, Surrey and Sussex make up three administrative counties. That is an even larger area. The provisions are clearly not the solution to the problem that the hon. Gentleman is outlining.

Dave RobertsonIn isolation, that criticism would be legitimate, but, alongside other changes being introduced, there are ways to mitigate that problem.

I am concerned that local healthwatch branches are not truly local. The healthwatch in Staffordshire has not held an event in my constituency for a number of years. I think its last three events were just volunteer fairs to get more volunteers involved. That is not to say that there are not significant numbers of people there who work very hard to support people in their engagement with the health service, but geographic changeability is real. On a national scale, Healthwatch England has a huge role to play.

15:15:00

I will use the example of maternity services to assess the impact of Healthwatch—despite the best efforts of those involved, those services show that it is not working particularly well. After the Mid Staffordshire scandal, there were issues with a large part of the Staffs trust, but it was particularly pronounced in maternity.

Healthwatch was set up in 2013; two years later, the Morecambe Bay report came out. A lot of what that report addressed was historical and happened before 2013, but there was very little mention of things starting to change in the intervening two periods. One of the recommendations in the Morecambe Bay report was that

“The Trust should increase public and patient involvement in resolving complaints”.

The report also concluded:

“The NHS complaints system in the University Hospitals of Morecambe Bay NHS Foundation Trust failed relatives at almost every turn. Although it was not within our remit to examine the operation of the NHS complaints system nationally, both the nature of the failures and persistent comment from elsewhere lead us to suppose that this is not unique to this Trust. We believe that a fundamental review of the NHS complaints system is required, with particular reference to strengthening local resolution and improving its timeliness”.

It does not sound like patient voice was particularly close to decision makers in the situation at Morecambe Bay.

Six years later in 2021, the East Kent report stated that

“The Trust...used high-level information inappropriately as reassurance, taking comfort from the grouping that at least there were other trusts in the same boat. At times, it has used this false reassurance as a bolster against the plethora of evidence from other sources that there were very significant problems in its maternity services.”

It seems that decision makers were bound by the directorates in the NHS—by their bosses and the structures that exist to hold them to account. Healthwatch’s independence—or, in this case, remoteness—meant that decision makers were not hearing patient voice as they should have been, which had disastrous consequences for huge numbers of families.

Five years on from that, Baroness Amos’s report on maternity and neonatal care, which was published just last week, repeatedly mentions that mothers were not listened to. One recommendation in the report is for maternity services to

“Engage meaningfully with women, birthing people, families, and representative groups to inform priorities and decision-making, and champion approaches to listening to women and families that lead to visible action and change.”

The final part of that recommendation—“lead to visible action and change”—is so important. I was taken by the point that the hon. Member for Winchester made about Healthwatch publishing research. That is great and valuable, and that research will obviously be helpful, but if Healthwatch is not in the room with the commissioners and decision makers, will any of it lead to visible action and change?

I am not in any way down on the hard-working Healthwatch staff and committed volunteers. They work hard to achieve things for their communities, but they are not given the structures needed for visible action and change. Yes, changes to Healthwatch will come, which will be a challenge and come with risks, but I am impressed that, by moving the responsibility for patient voice to the room with the commissioners, so that one of their key responsibilities is to listen to patient voice, the Bill gets over the barrier of remoteness. It puts patient voice in the heart of the room and in front of the people making decisions. As we have seen for more than a decade, there are many hard-working people, and thousands of recommendations are not necessarily being acted on—as Opposition Members said in long speeches this morning. We need to get patient voice into the room with the decision makers.

Helen MorganWill the hon. Gentleman give way?

Dave RobertsonI will make some progress. There are concerns that if we roll some responsibilities into ICBs or councils, the Department needs to make sure that the issue does not get pushed to the side and that the funding does genuinely remain for patient voice. I am reassured that there will be a patient experience directorate within the Department. That will bring decision making and the patient voice into the Department while also keeping an eye on what is happening with those ICBs and ensuring that they have standards to hit.

The Department needs to ensure that it is sharing good practice and keeping oversight of local authority commissioning of social care. The CQC is starting to do that, and there are some positive indicators. There is obviously more work to do, and we need to stay on top of it because, as I said earlier, there are risks whenever there are changes to healthcare. I am reassured that bringing the patient voice into the room with decision makers is the right way to enact change.

Dr JohnsonWill the hon. Gentleman give way?

Dave RobertsonI am just about to conclude, so I will allow the hon. Lady to come back when she makes her speech shortly.

The final point I want to make is about local government. I hope the Secretary of State will issue guidance on how local government will commission adult social care services. I also hope we will get annual reporting from ICBs and local councils on how they are using the patient voice. I know that the Secretary of State will have the ability to intervene, and I would expect him to do so should those reports show that the patient voice is not being used, is not finding its way into the room or is not leading to the meaningful change that the Amos report suggests.

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

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

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

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

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

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

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

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

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

“seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.] She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied:

“Yes. I kind of think, as the debate goes on, that—with the changes to Healthwatch in particular—you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation—there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 16, Q24.] We already know from the evidence that we received, unprompted, from National Voices and the King’s Fund that the abolition of NHS England will not solve the problems that the Minister, the Government and the Department think are there, and indeed it could be done in a different way.

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

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

15:30:00

New clause 74 was tabled by the hon. Member for Rugby, and the hon. Member for Bury St Edmunds and Stowmarket spoke to it. I have a lot of sympathy for what the hon. Member for Rugby is trying to achieve here. Clearly—I hope that I am not putting words in his mouth—he tabled it because he has similar scepticism about the effectiveness of what the Government are proposing; otherwise, why review it?

There are some problems. The new clause mentions complaints but, although I fell into this trap when talking a moment ago, Healthwatch does not really deal with complaints; it raises issues and systemic failures that can be brought up through the system. Likewise, I am concerned that nothing in the new clause covers what happens once the Government have done their impact assessment. Even if the impact assessment comes back and says, “Actually, this has been a terrible idea,” the Government cannot do anything and, to be honest, once they have abolished these things it will be extraordinarily hard to pull them back. I have a lot of sympathy for the new clause, but unfortunately it will probably not achieve what the hon. Member for Rugby and I want.

Joe RobertsonIt is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone. The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making—I am sure that they do, of course—and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that.

That different purpose is thissome of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that comes with an independent organisation providing patient voice. We have heard how the Select Committee and MPs, in their free-ranging Back-Bench function, benefit from hearing that voice through an independent organisation such as Healthwatch England, because it allows them to fulfil their scrutiny function. This is not just about decision making; it is also about scrutiny of decisions once they have been made. What will the Select Committee, MPs and journalists do when they no longer have the light shed by that independent voice?

As my hon. Friend the Member for Farnham and Bordon has pointed out, representatives who are employees in the Department of Health and Social Care rightly have other overriding primary duties to the employer—the Department itself. Let us ensure that patient voice is articulated by those who do not have a primary obligation to their employer, but have an obligation to an independent organisation with functions that serve solely to amplify and project the voice of patients.

There are a number of issues with the abolition of local healthwatches, but I will save that for the next discussion. I want to make the wider point that there is a centralisation issue here too. Whether the Government like it or not, this measure will centralise powers into the Department; it will take outside powers from Healthwatch England and bring them in-house. That is nothing short of a centralising measure. The Minister needs to address the justification for that, because the more negatives there are to this decision, the more we need to understand the positives. So far, they are light indeed, or she has failed to articulate them. I think that there is a reason she has failed to articulate the positives: they simply do not exist.

I look forward to the Minister’s response. I urge her to take some more interventions, because the arguments she has given to the Committee in her speeches at the end of each discussion have tended to raise more questions than they have answered. We can only deal with that by intervening on what she says.

Karin SmythI think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell. I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously.

I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different.

The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them.

The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention.

On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.

Liz Twist (Blaydon and Consett) (Lab)I was flattered to hear my comments on Second Reading quoted by the hon. Member for Sleaford and North Hykeham, but I think she has misunderstood me. My question to the Minister was and still is about how we maintain within the new arrangements the ability to speak up on behalf of others. Could the Minister comment on that?

Karin SmythI thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important.

At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable.

I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.

Helen MorganFor the record, I tabled amendments to delete those clauses, so there was consistency of intention.

Karin SmythI am just computing that in my brain. Can I seek clarification on that?

Helen MorganI tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.

Karin SmythI understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.

15:45:00

Currently, local authorities are responsible for commissioning local healthwatches and deciding how best to deploy resources locally. This means that setting a fixed national funding level in legislation would not guarantee an increase in what the local healthwatch ultimately receives. It would remain up to local authorities to determine how much is ultimately spent on the local healthwatch, now or in future, while undertaking their new user involvement responsibilities. It is right that local authorities are in charge of determining, on a local level, how best to deploy their resources in their areas. I should be clear that although local authorities have a statutory duty to provide a local healthwatch, we will continue to provide funding to support those duties.

The Department provides approximately £3.3 million in funding each year to Healthwatch England, as a statutory committee of CQC, and we will continue to fund Healthwatch England as long it stays in place. For those reasons, I ask the hon. Member for North Shropshire not to press her new clause 78.

My hon. Friend the Member for Bury St Edmunds and Stowmarket spoke to new clause 74, which was tabled by my hon. Friend the Member for Rugby. That new clause raises some important issues around transparency, which I am passionate about and have often spoken about. The new patient experience directorate within the reformed Department of Health and Social Care is about directly informing commissioning. Indeed, NHS-commissioned patient services already sit within Government-linked structures and achieve strong participation by actively building trust. We know that for the new arrangements to work effectively, we need to continue to grow that work. At a local level, we want those who commission services to hear directly from patients and the public. That means clearer accountability, with commissioners responsible not just for what services are delivered but for listening to people, and acting on and implementing what they say.

To ensure that these new arrangements are a success, effective oversight and transparency will be critical. That is already a key consideration in establishing the patient experience directorate, and the Bill includes additional key safeguards. First, integrated care boards will be required to publish an annual statement on how they have gathered feedback and—this is crucial—what actions they have taken as a result of that feedback. That is a vital role: it will make their behaviour more transparent and public. It may also provide a link for local Members of Parliament, local people and ICBs across the patch in the same way that people use public forums, for example, at a local authority level. ICBs will be required to publish an annual statement.

At a national level, as part of the regulatory function of local authority adult social care commissioning, the CQC will also look at whether the statutory functions of local authorities are being met. Additionally, the Secretary of State will have a new power to direct ICBs on the exercise of their functions if that is felt necessary to set consistent standards in this area. Local Members of Parliament and other bodies will have a key role in raising those issues.

The existing complaints regulations allow people to make a formal complaint to providers of services or to a commissioner of services, and ultimately to the appropriate ombudsman. Healthwatch has no statutory role in relation to complaints, so the abolition of Healthwatch services will therefore not affect the complaints procedure.

Finally, following its passage, we will undertake an evaluation of the Bill to provide objective and robust evidence for both learning and accountability. The learning element will feed directly into the development of services and the creation of an evidence base, and the accountability element will support further decisions and approaches to implementing services. The new clause would therefore duplicate our wider plans and would add unnecessary complexity to the legislation without delivering any other practical benefit. The Government consider that the current approach strikes the right balance. For those reasons, I ask hon. Members not to press their new clauses and I commend clause 64 and schedule 9 to the Committee.

Question put, That the clause stand part of the Bill.

22|0|10|6| The Committee divided: | Question accordingly agreed to. ||0|0

Clause 64 ordered to stand part of the Bill.

Schedule 9 agreed to.

Clause 65

Abolition of arrangements with Local Healthwatch organisations

Question proposed, That the clause stand part of the Bill.

The ChairWith this it will be convenient to discuss schedule 10.

Karin SmythClause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities.

At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers. This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners.

As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change.

Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.

Dr JohnsonAs I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape.

There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening?

The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change?

The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not.

The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans?

The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”?

Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.

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

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

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

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

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

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

Dr Prinsleyrose —

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

16:00:00

I have a list of examples from Lib Dem colleagues from constituencies across the country that show where Healthwatch works well. My hon. Friend the Member for Torbay (Steve Darling) notes that his local healthwatch identified and investigated failures by care providers. After Healthwatch exposed the problems, the provider was put under special measures and no longer exists. Without Healthwatch, the provider would still be providing substandard care. There were even concerns about abuse. Central to exposing the issue was that Healthwatch was trusted by care workers to anonymously share their experience.

Moving on to Cromer in north Norfolk, my hon. Friend the Member for North Norfolk (Steff Aquarone) got in touch with me to note that in 2023 the Conservative-led county council decided to close the Benjamin Court reablement centre with no proper public consultation. Healthwatch Norfolk stepped in to carry out an extensive engagement process with the local community and found overwhelming support for and need for the centre. It also exposed a lack of communication from the county council and ICB as a common thread during the closure process. Without the intervention of Healthwatch and without—as I will obviously say—campaigning by local Lib Dems, the local community would have had no route to meaningfully share its desire for the centre to remain open, and it would likely have been shut. We are hopeful that at least some form of NHS services or care services will return to Benjamin Court.

Finally, my hon. Friend the Member for Stratford-on-Avon (Manuela Perteghella) notes that the surveys and data of Warwickshire Healthwatch have helped to reveal that her constituency is a dental desert. That problem is now being addressed by the ICB, which is trying to deal with it.

Healthwatch organisations shape services as well as report problems. As the Minister pointed out, they do not have a statutory complaint process role but they can alert to systemic problems within the local system. Without Healthwatch, the ICB and county council in Norfolk would have continued to ignore local residents by simply refusing to ask the question that they did not want the answer to: “Does the local community need this service?” Healthwatch was valuable due to its ability to go out and ask questions that the ICB did not want the answers to. In Torbay, care workers made it clear that the independence of Healthwatch made them feel comfortable sharing their concerns about the failing care provider. We must ask: would they have felt comfortable doing that internally, into the system that was commissioning that provider?

I also remind hon. Members—as the shadow Minister, the hon. Member for Sleaford and North Hykeham, has already—of our potential future Prime Minister’s support for his local healthwatch. In November, the right hon. Member for Makerfield praised his local healthwatch organisations for their impartiality, deep relationships with communities and role in bringing lived experience into system improvement. The Liberal Democrats agree with him wholeheartedly on those points.

I return to a point I made earlier in the debate. Local healthwatch responsibilities are set to be split between the ICB and the local authority, looking at the social care and the health elements separately. Although local authorities will be funded to continue the social care element of local healthwatch, it is not clear that ICBs will be able to. That gives us two concerns: first, that there will not be sufficient resourcing for service-shaping on the NHS side, from the ICB; secondly, that such work will become increasingly divorced from the shaping of social care services.

Dr JohnsonIs there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?

Helen MorganThe hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.

Edward ArgarClause 65 and schedule 10 focus on local healthwatch arrangements. As I said when speaking to the previous group of amendments, Healthwatch is respected and trusted at a national level, and that is even more the case at a local level. I fear that the Government seek to remove something that works, that is effective and that ensures a strong patient voice in the system.

It simply does not work to have integrated care boards take on those responsibilities, as they will be marking their own homework rather than being the independent patient voice. It is a little like the discussion the Committee had during the previous grouping on HSSIB, in which it turned out that the CQC will be able to investigate itself, but the chief executive of the CQC would decide whether any protected disclosures could be published during that investigation. That measure brings things entirely within the system and removes the independent voice, which is exactly what this clause also does.

The ICB is the voice of the NHS system, not the voice of the patient. We need the grit in the oyster that is provided by an independent voice talking to the ICB. Being in the room with an ICB will not mean that the patient voice is heard more loudly or clearly, or that it will be acted on—it is probably more likely to mean that it is not. As an example from my constituency, the ICB did conduct a consultation exercise on the proposed closure of St Mary’s birth centre in Melton Mowbray, the response to which was overwhelming: the patient voice said that they did not want that to happen. That response was fed into the ICB, but the ICB did what I fear it planned to do all along and closed the centre. Given that that voice in the room came from a consultation exercise led by the ICB, it seemingly did not make a jot of difference to the outcome or decision, or to whether the patient was heard.

On the impact of local authority scrutiny panels, the NHS ICB in Melton previously recognised the need for increased GP provision in the town due to the increasing size of the town and the long waiting times, but just recently decided to reverse that position and say that it did not see the need for that. Members of the scrutiny committee, across all parties, were absolutely clear that they disagreed with that decision, but did that get listened to or make a jot of difference to the ICB? No—the ICB did what it was going to do anyway and changed its mind.

My concern is that we will see less grit in the oyster and patient voice, and more managerialism in the NHS ICB system. We heard from the hon. Member for North Shropshire and the shadow Minister about the challenges there would be, even were that patient voice to happen. Given the Government’s 50% cuts to ICB budgets, which are already impacting frontline services, ICBs will not be able to take on additional responsibilities without the funding that they need. That is quite apart from the principle that they should not be marking their own homework. I fear that “system knows best” will become the default.

We have also heard about the geographical challenges. Given that mergers and acquisitions are getting even bigger, ICBs are moving further and further away from what was conceived: for them to have the same geographical footprint as the upper-tier local authority providing social care, to ensure that the two organisations spoke to each other and were better integrated. Removing the representative from the local authority that provides that healthcare from the board, even if they are replaced with a mayor, does not bring about the reconnection with social care provision that is so central. Removing the voice of general practice or primary care from the ICBs again moves that independent challenge away from the system.

I fear that this is a fragmentation of those links at a local level and the weakening, if not silencing, of a patient voice that can challenge publicly and ensure that what patients need to have said is genuinely said. Being in the room does not mean that that voice is heard or acted on, as shown from the examples I have spoken about: there is a consultation exercise, the view is reflected on, and the ICB does what it was going to do anyway and does not change its position. I have genuine concerns about the loss of an independent patient voice in a local context.

The Minister will correct me if I am wrong, but I think she made the point in her opening remarks that we have lacked not recommendations and suggestions for changes but action to fix the issue. But it is not for Healthwatch to take action to fix the issue; it is for the ICBs and the NHS to act on those recommendations. We are proposing to give the bits of the system that have failed to take action and fix the issue not just the responsibility that they already have but the responsibility for reflecting patient voice. The one bit that is working—where patients’ voices are heard—is the bit that we are getting rid of. We are not seeking to fix the bits that have real pressure and genuine levers to compel an ICB to act on those recommendations when they are made independently, rather than simply marking its own homework.

As with my reflections on clause 64, I genuinely fear that in this weakening of patient voice, particularly at a local level, the patient will be the loser because the system will continue to do what it wishes to do. It will do its consultations, and it may have a director of patient experience at an ICB level, but they will be working for the ICB; they will not be there as an independent voice to challenge the ICB—including publicly—on what it is doing.

I hope that the Minister reflects further on the real diminution, if not the neutering, of patient voice that comes with some of these arrangements. As always, I look forward to her reflections when she winds up.

Gregory StaffordI want to address this clause because I believe that the Government are making a significant mistake by abolishing Healthwatch England, as they have just done with the group of amendments, and local healthwatch organisations. The Government have sought to reassure the Committee that the functions currently carried out by Healthwatch will continue; however, that is not the question before us. The question is whether those functions can continue with the same degree of independence, credibility and public confidence once they are absorbed into the organisations that they currently scrutinise.

Having listened carefully to the witnesses who appeared before the Committee, and having reflected on the debate on Second Reading, I do not believe that the Government have demonstrated that they care. Once again, the Government’s case rests largely on the recommendations of Dr Penny Dash. Dr Dash argued that patient engagement should sit much closer to those responsible for planning and delivering services, that providers and commissioners gather and respond to patient experience themselves, that integrated care boards already possess engagement functions capable of undertaking that work, and that the variation between local healthwatch organisations means that the current statutory model is no longer justified.

Those are interesting arguments, but they were examined by this Committee and, in my view, were not sustained by the evidence that we subsequently heard. Indeed, what struck me throughout the oral evidence sessions was not simply that witnesses disagreed with Dr Dash’s conclusions but that they challenged the central assumptions on which they depend. Dr Dash’s recommendations assume that independence is desirable but not essential. The overwhelming weight of evidence presented to this Committee suggests precisely the opposite.

That distinction matters, because this debate is not fundamentally about patient experience. No member of this Committee disputes that patients should influence the design and delivery of services; Healthwatch already exists to help to achieve precisely that. The issue before us is different: it is whether those speaking on behalf of patients should remain institutionally independent of the organisations whose decisions they are expected to scrutinise. Throughout our proceedings, I have become increasingly convinced that that is the question that Ministers have not answered adequately.

16:15:00

The concern has not come solely from Opposition Benches. On Second Reading, the hon. Member for Hornsey and Friern Barnet (Catherine West) intervened on the Secretary of State:

“Healthwatch Haringey plays an enormously important role in being a champion for the ecosystem within a locality. The Local Government Association is very concerned about some of the discussions.”

That intervention deserves attention, because it did not come from an Opposition Member seeking to frustrate the Bill; it came from a Member on the Government Benches, recognising the contribution made by Healthwatch in her own community and the concerns expressed by local government about the proposals before us. The Secretary of State did not dispute her assessment of Healthwatch’s value. Instead, he argued that the Bill sought

“to bring the voice of patients closer to the people who plan and deliver services.” —[ Official Report , 1 June 2026; Vol. 786, c. 887.]

The Minister today has done something similar. With respect, again that answers a different question. Bringing patient voices closer to decision makers is not the same as ensuring that those voices remain independent of the decision makers. Integration and independence are not synonymous. Indeed, the evidence we have heard suggests that independence is precisely what gives Healthwatch its authority. That distinction is not just theoretical, but reflected in the evidence submitted by those who work in the health and care system itself.

Healthwatch Surrey, which covers part of my constituency, including the town of Haslemere, has provided statements from NHS leaders and from Surrey county council. Those are not organisations resistant to partnership working; they are organisations that work with Healthwatch every day. The chief executive of NHS Surrey and Sussex told me that Healthwatch’s

“independent role in gathering this insight and acting as a voice for the community is essential in ensuring that the needs of all residents are heard—especially those who may otherwise go unheard or are at risk of health inequalities.”

The chair of NHS Surrey and Sussex stated:

“I would wish for an independent service to enable resident and patient voices to be heard to remain in place going forward.”

The chief nursing officer described Healthwatch simply as “a third eye”. Councillor Tim Oliver, leader of Surrey county council, explained:

“Healthwatch has operated as an impartial champion...built a trusted brand within local communities where individuals can feel ‘safe’ in sharing their experiences and concerns...Their independence has been central to this.”

He went further, observing that healthwatches are

“trusted because they are outside the system”.

Such evidence is particularly important because it comes from the organisations that will inherit those responsibilities should the Bill proceed. Far from arguing that independence is unnecessary, they describe it as essential to the effectiveness of the existing arrangements. Surrey county council also highlighted another practical reality, that

“many individuals do not feel confident using these formal mechanisms.”

That is precisely why Parliament has repeatedly concluded that an independent patient advocate is required.

Independent bodies exist because some people are unwilling to raise concerns directly with the institutions about which they are concerned. That is not a criticism of those institutions; it is simply a recognition of human behaviour. The evidence from Surrey therefore reinforces what many of the witnesses subsequently told this Committee. Trust is not created simply because responsibilities are transferred from one organisation to another; trust depends on independence.

Professor David Croisdale-Appleby, the chair of Healthwatch England, reminded the Committee that that is not a new constitutional principle. He said:

“we have had 52 years of independent organisations representing the patient voice, as well as that of the carer.”

That is not simply an historical observation; it reflects Parliament’s long-standing judgment that patients should have access to an advocate who is institutionally separate from those providing and commissioning care.

Professor Croisdale-Appleby also explained why Healthwatch cannot be understood simply as another engagement function. He told us:

“it is about independence and holding organisations to account...we are not only the ears of the patient and the carer; at times, we hold feet to the flames over whether something sensible is being done. We do not give up on this; we pursue it down the rabbit hole.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]

I found that one of the most important pieces of evidence heard during our proceedings. It defines the distinction between engagement and accountability. Engagement teams collect views; Healthwatch collects evidence, investigates concerns, challenges organisations, follows up recommendations and persists until action has been taken. Those are fundamentally different responsibilities.

Indeed, Professor Croisdale-Appleby’s evidence exposes what I regard as the principal weakness in the Government’s case. If Healthwatch exists to hold organisations to account, how can that responsibility be transferred to the very organisations being held to account? That is not a political question but a structural one. How does an integrated care board investigate itself independently? How does it scrutinise its own decisions? How does it, in Professor Croisdale-Appleby’s words, hold feet to the flames when the feet are its own?

That question was put to Ministers on Second Reading. The hon. Member for Bicester and Woodstock (Calum Miller) asked the Secretary of State:

“can he reassure the House that bringing the scrutiny of local voices up to the level of the Secretary of State will not diminish the independence of the local healthwatch organisations that…do so much to promote the patient voice and to hold the NHS to account for its services?” —[ Official Report , 1 June 2026; Vol. 786, c. 888.]

That was a perfectly reasonable question, but the Secretary of State did not explain how independence will be preserved. Instead, he returned to the argument that patient voices will be brought closer to those planning and delivering services. Again, that is a different proposition. Closer does not mean more independent, and nor does it necessarily mean more effective.

The evidence presented to this Committee points consistently in the opposite direction. Witness after witness argued that Healthwatch’s effectiveness derives precisely from the fact that it sits outside the organisations whose decisions it scrutinises. That institutional separation is not an administrative inconvenience, but the foundation upon which public confidence has been built. If that independence is removed, the burden falls on the Government to explain how the same confidence, the same willingness to come forward and the same capacity to challenge will be maintained. Having listened carefully to the evidence and the Minister’s comments today, I do not believe that explanation has yet been provided.

The question of independence was reinforced by Sarah Tilsed, speaking on behalf of the Patients Association. Her evidence was notable because it came from an organisation whose sole concern is the interests of patients, rather than the preservation of any particular institutional structure. She told the Committee:

“we need a truly independent patient voice”—

not simply a patient voice, but a truly independent voice. She went on to warn:

“Abolishing healthwatches creates a fragmentation of patient engagement responsibilities across ICBs and local authorities.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]

The Government have presented these proposals as a simplification of the landscape. One of the country’s leading patient organisations has described them rather differently. It suggested that responsibility would become fragmented, rather than simplified. That is a material difference of opinion, and one that Ministers have not adequately addressed.

Perhaps the most significant aspect of Ms Tilsed’s evidence concerned public confidence. She told the Committee:

“patients trust independent organisations. I feel that that trust might be lost in local communities.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]

That observation goes to the heart of this clause. Trust cannot simply be transferred from one statutory body to another, and nor can it be created by legislation. It is earned over time through experience.

Many of the people Healthwatch represents have had poor experiences of health and care services. Some have experienced unsafe care, and some have struggled for months—sometimes years—to have their concerns recognised. For those individuals, approaching an independent organisation is qualitatively different from approaching the organisation about which they wish to complain. The Government assume that patient engagement will continue because the statutory function will continue, but the witnesses asked a different question: will patients continue to come forward if they no longer believe the organisation hearing their concerns is independent of the system that they are challenging? That is a practical question about behaviour.

The Committee has heard evidence suggesting that independence is itself one of the principal reasons that patients are willing to engage. That concern was echoed on Second Reading: the hon. Member for Strangford (Jim Shannon) warned that abolishing independent patient bodies risked weakening the patient voice. In the oral evidence to this Committee, I found it striking how often witnesses representing very different organisations returned to precisely the same issue: not bureaucracy, organisational charts or governance arrangements, but independence. That consistency deserves considerable weight.

Professor Croisdale-Appleby challenged another important assumption underpinning Dr Dash’s recommendations. Dr Dash argued that patient engagement functions could largely be absorbed into NHS organisations. Professor Croisdale-Appleby explained why meaningful engagement is considerably more demanding than that description suggests. He told the Committee that Healthwatch

“has been very successful in reaching out to those communities often referred to as ‘difficult to reach’…where we all know the health inequalities are often the deepest.”

He then explained how that work is undertaken, saying that

“there is quite often an investment of some six months for one of our people to go into a particular community…and win the confidence of the people so that they actually talk to us about the problems. I have to ask how that depth and focus is to be replicated under the arrangements suggested in the Bill.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]

It is not a rhetorical question, but it has remained unanswered.

Building trust with communities experiencing the greatest health inequalities cannot be achieved through an organisational redesign alone; it requires sustained engagement and relationships built over time. More importantly, it requires confidence that those listening are independent of the institution whose performance is being discussed. Communities that already distrust public institutions are unlikely to become more willing to engage simply because the engagement function has been transferred into those institutions.

The Government have not explained how those relationships will be maintained, nor have they explained how the expertise accumulated by local healthwatch organisations over many years will be preserved. The Committee is being asked to assume that a statutory function can simply be relocated without affecting the way it is discharged. The evidence clearly suggests otherwise.

The Government have relied heavily on another element of Dr Dash’s review—namely, that the performance of local healthwatch organisations is too variable to justify retaining the present statutory model. At first sight, that seems to be a reasonable criticism. If there is significant inconsistency across England, reform is an entirely legitimate subject for discussion.

Indeed, Professor Croisdale-Appleby accepted that there is variation across the 153 local healthwatch organisations. He did not seek to deny it, but he challenged the Government’s explanation for why that variation exists. He told the Committee:

“One of the reasons there is a difference or variation among the 153 is that the amount of funding is very different. Some of them get 10 times the funding of others”.

That evidence is significant because it changes the diagnosis. The Government appear to argue that variation demonstrates a flaw in the Healthwatch model itself. Professor Croisdale-Appleby suggested something rather different: that much of the variation is the predictable consequence of unequal investment. He went on to say that

“if the funding were more equitable, some of that variation would disappear”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 48, Q78.]

That is, in my view, one of the most important pieces of evidence heard by the Committee. If inconsistency is principally the product of funding disparities rather than organisational design, the logical response is to address the funding disparities. It is not to abolish the organisation altogether.

Professor Croisdale-Appleby drew another important distinction. He told us:

“What it does not allow…is a change in the quality of the way in which the research is done.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 48, Q78.]

That deserves careful attention. Differences in organisational capacity do not necessarily imply differences in professional standards. A smaller organisation with fewer resources may produce fewer reports than a larger one. That is not the same as suggesting that its work is less rigorous. The evidence therefore points towards a funding issue rather than a structural failure.

That conclusion is reinforced by the evidence submitted by Healthwatch Surrey. The chief nursing officer described Healthwatch as a “third eye”. The chair of NHS Surrey and Sussex said:

“I would wish for an independent service to enable resident and patient voices to be heard to remain in place going forward.”

The chief executive described Healthwatch’s independent role as “essential”. Surrey county council explained that Healthwatch is

“trusted because they are outside the system.”

Taken together, those statements are striking. They come not from campaign organisations or from political parties, but from organisations working within the health and care system itself. Far from arguing that independence has become unnecessary, they argue that it remains fundamental to the effectiveness of patient representation.

That brings us back to the Government’s central proposition. Ministers ask us to conclude that because there is variation between local healthwatch organisations, the independent model should be abolished. The evidence heard by the Committee points to a different conclusion. Where funding is unequal, funding should be made fairer. Where consistency can be improved, consistency should be improved. Where good practice can be shared more effectively, it should be shared. Those are the arguments for reform. They are not, on the evidence we heard, arguments for abolition.

Indeed, the abolition of Healthwatch does not answer the question posed by Professor Croisdale-Appleby—it does not explain how long-established relationships with “seldom-heard communities” can be replicated. It does not explain how institutional trust will be preserved, or how an independent voice becomes stronger by becoming part of the system it is expected to scrutinise. On those central questions, I respectfully suggest that the Committee has heard considerably more evidence than it has heard answers.

16:30:00

One further aspect of Professor Croisdale-Appleby’s evidence deserves attention. Throughout our debates, much has been said about ensuring that patients are heard, but Healthwatch does considerably more than just listen. Professor Croisdale-Appleby reminded the Committee of the scale of its work, saying:

“We have produced over 20,000 reports”.

That is an extraordinary body of evidence built over many years from the lived experience of patients and carers across England.

More importantly, Healthwatch does not simply publish reports before moving on to the next issue. As Professor Croisdale-Appleby went on to explain:

“When we produce reports…we always follow up on those recommendations and ask, ‘Are they being implemented? Are they being listened to?’ Each year, we produce a report that says, ‘What change has occurred as a result of the recommendations that we make?’” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]

That is the language of accountability. It is not simply consultation and it is not merely engagement; it is independent scrutiny followed by persistent follow-up until change has either occurred or been shown not to have occurred. That is a very different function from just gathering patient feedback.

I come back to the central questionwho performs that role if Healthwatch disappears? Will integrated care boards publish reports criticising their own decisions? Will they systematically monitor whether recommendations directed at them have been implemented? Will they publicly report on the effectiveness of their own response? The Government have said that the function will continue, but the witnesses clearly stated that the effectiveness of that function depends on its institutional independence.

The Committee also heard important evidence from Sir Ciarán Devane, whose evidence was particularly valuable because he did not approach the question from the perspective that no change should ever be made. Indeed, he accepted that the reform of patient engagement arrangements may be appropriate. Yet even he identified independence as something that must not be lost. He told us:

“This function has been slightly outside and independent, playing back into decisions; we have to ensure that the level of independence remains somehow in how this is constructed”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40, Q67.]

That is a significant concessiona witness prepared to contemplate structural reform who nevertheless regarded independence as indispensable.

Sir Ciarán continued by saying that we have to

“make sure that what was good about healthwatches is preserved”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40-41, Q67.]

I agree entirely. Ultimately, that is the question before the Committee: does the Bill preserve what was good about Healthwatch? Or, as I contend is more likely, does it remove the very characteristic that has enabled Healthwatch to command public confidence for more than a decade?

Sir Ciarán identified another practical concern, warning that

“there is a risk because of that pressure.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 41, Q67.]

The pressure to which he referred was the operational and financial pressure that already faces integrated care boards. That brings me to one of the unanswered practical questions arising from the Government’s proposals. Throughout our consideration of the Bill, Ministers have spoken about reducing bureaucracy, simplifying structures and improving efficiency. Integrated care boards are expected to operate within substantially reduced running costs yet, at precisely the same time, they are expected to assume the statutory responsibility that is currently exercised by independent healthwatch organisations.

When questioned about that change, Sir Ciarán accepted that the responsibilities represented

“an additional duty”

and acknowledged that

“if there is no extra money coming…it will be pressured.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40, Q67.]

That observation seems self-evident. If organisations are expected simultaneously to reduce expenditure while assuming additional statutory responsibilities, something must inevitably give.

The Committee has not been told how the new responsibility will be resourced. Will additional funding accompany the duties? Will specialist staff transfer? Will the expertise and local relationships built over many years be maintained? Or are we simply expected to assume that patient representation can somehow improve while independent organisations disappear and resources remain constrained? The evidence has not answered those questions.

There is also a broader constitutional principle at stake. Across public life, we recognise that effective scrutiny requires institutional independence. As I mentioned when we were speaking about HSSIB, the Government are scrutinised by independent regulators, public expenditure is examined by the National Audit Office, and citizens may complain to independent organisations. Parliament has long recognised that patients deserve the same protection. As Professor Croisdale-Appleby reminded us,

“we have had 52 years of independent organisations representing the patient voice”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]

Successive Governments have reorganised the NHS many times, sometimes for the better and sometimes not, but they have consistently preserved an independent patient voice. This Bill breaks with that principle. The burden of proof therefore rests with the Government, and I do not believe that they have discharged that burden.

What struck me both on Second Reading and during the Committee’s evidence sessions is that Ministers and witnesses have been answering very different questions. Ministers have spoken about integration and organisational efficiency; witnesses have spoken about independence, trust and accountability. That evidence has been remarkably consistent. Professor Croisdale-Appleby told us that Healthwatch exists to hold “feet to the flames” and to pursue concerns “down the rabbit hole”. Sarah Tilsed warned that

“patients trust independent organisations. I feel that that trust might be lost in local communities.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]

Sir Ciarán Devane told us that we have to

“make sure that what was good about healthwatches is preserved”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40-41, Q67.]

And the chief executive of NHS Surrey and Sussex described Healthwatch’s independent role as “essential”.

Those witnesses came from different organisations and different perspectives, but they reached the same conclusion. None argued that Healthwatch should remain unchanged. They argued that where there are weaknesses, they should be reformed, where there are inconsistencies, they should be addressed, and where the funding is unequal, it should be made fairer. What they did not argue for was the abolition of independence. That is why I cannot support this clause.

The Government have relied heavily on one review. The Committee has heard from those who work with patients, represent patients and speak for patients, and their message has been clear: “Preserve independence.” If Ministers believe that Healthwatch can be improved, please improve it. If they believe consistency can be strengthened, strengthen it. But let us not abolish the only statutory body whose sole purpose is to represent patients independently of those who commission and provide NHS services, because once that independence is lost, it cannot be recreated. For those reasons, I hope that the Minister will reconsider.

Joe RobertsonThe Government’s proposal to abolish the independent voice of patients is a mistake. It is a backward step, and I have seen no compelling reason why it should happen. Apparently, the voice of patients is going to be realised through integrated care boards and local authorities themselves, but that is not an independent patient voice. The very point of independence is that that voice is represented through an organisation that has no other function—no other skin in the game other than to represent that voice. It is remarkable that the Government are taking this step.

I suspect the Minister will say—she has already given a number of reasons—that this is happening in order to bring the voice of patients closer to those who make decisions, but that is not the function of Healthwatch. If she wants to achieve those things, she can achieve them while maintaining Healthwatch as an independent patient voice.

That independent voice ensures not only better decision making, but more effective scrutiny of decisions that have been made, and it does it by ensuring there is no blending or conflict of interest within a certain organisation—the decision maker. It does it by ensuring that light is cast on the critique, the scrutiny and the voice of patients, and that that process takes place outside the closed doors of, in this case, the integrated care board, not behind them. I suspect that the Minister will say that the system is not working, because there are too many good reports by Healthwatch that sit on a shelf and have not been implemented. I would far prefer for us all to be able to see reports that have not been implemented sitting on a shelf and try to do something about them than for the patient voice to be heard behind closed doors and not acted upon. That is the inevitable conclusion from this merger—this abolition of the independent patient voice.

I want to talk about my experience on the Isle of Wight of the important work that our local healthwatch does. It assists me in my role as a parliamentarian and representative of the people, which is to scrutinise the decision-making of my local integrated care board and others, by providing the objective and unfiltered voice of patients through data, statistics and records, all of which will be lost within the ICB when this abolition takes place.

Guess who is often on the sharp end, or who is often critiqued by the evidence provided by Healthwatch? It is the ICB itself. Therefore, it is no wonder that Professor Croisdale-Appleby, the chair of Healthwatch England, agreed with the characterisation that this looks like the ICBs or other bodies marking their own homework. They will get to decide which part of the patient voice is acted upon, and which part is ignored, without the public gaze or scrutiny that is provided by an independent report that decision makers, parliamentarians, local councillors and the independent media can also use.

I will give a particular example from the Isle of Wight. Not so long ago, the integrated care board for Hampshire and the Isle of Wight proposed to reduce funding for Mountbatten hospice on the island and to redistribute that money to the mainland—it was, in my view, outrageous. The integrated care board had all the information available at its fingertips to realise that that was a bad proposal, and it had all the patient voices and views that it could possibly come across to realise that it was a mistake. It did not first consult representatives, such as me, my neighbour the hon. Member for Isle of Wight West (Richard Quigley) or local councillors, before making its proposal.

It was then Healthwatch’s data on the views and voices of patients, which had already been gathered, that helped the hon. Member, local councillors and me to make an argument against the proposal, directly to the ICB, in the media and to councillors at county hall. Without the tools that Healthwatch provided, it would have been so much harder to make that case. The ICB backed down on that proposal, but, if all that infrastructure, and all the information that Healthwatch independently provided, had sat behind closed doors within the ICB, we would not have had the opportunity to make our case and reverse the decision. That is one of the many thousands of real-life examples across the country where the affected patient voice was aired and properly used to reverse a bad decision, and it is an ability that will be lost.

Another issue is the fact that the centralisation of powers will inevitably water down the patient voice. There are over 150 local healthwatch branches, but there are not 150 integrated care boards. In the case of the Isle of Wight—I use that as an example because it is my own patch, but it will be the same situation up and down the country—we have our own Healthwatch Isle of Wight, which represents the unique insight and views of patients on the island. If those powers go to the integrated care board, that will cover Hampshire and the Isle of Wight, a population nearly 10 times as big. Our unique patient voice will be watered down into the patient voice of Hampshire; while the Hampshire patient voice is equally valid, that will nevertheless reduce the unique insights of smaller populations all over the country by including them in something bigger.

Particularly unique to my constituency and Isle of Wight West is health travel—that is, the reality of having to cross the Solent on a ferry to access so many health services. That is something that Healthwatch Isle of Wight uniquely understands through its direct consultation and work with island patients. Indeed, the people who work for our local healthwatch and its trustees are islanders. They do not just get it because they hear it; they get it because they live it. If that entire function is taken up to the Hampshire and Isle of Wight level, that unique insight will be lost. The ICB may give some regard to the cost of ferry travel and the implications of the disruption caused by having to travel on a ferry in order to access a hospital service that is not available on the Island, but its decision making will be much devalued in weight if it does not have the unique, independent patient voice coming from the Isle of Wight via our Healthwatch.

16:45:00

We have too often seen the ICB making decisions without due regard for the fact that while the journey from, for example, Ryde to a hospital in Portsmouth may be three or four miles as the crow flies, and may in theory be covered by public transport via a ferry and a bus, the disruption of having to make that journey for, in some cases, reasonably routine procedures is unique to an island community. It does not bear equivalence to travelling three, four or five miles without a stretch of water in the way.

I am using my own patch as an example, and it is fairly unique, but there are many areas across the country, particularly coastal and rural ones, with their own unique challenges. At the moment, those are well-represented through small, independent local healthwatches. That uniqueness will be lost, not only because of the lack of independence of the patient voice that will result from merging healthwatches with ICBs, but because the patient voice will be merged with others, since ICBs cover far wider areas. Given the values that Labour says it stands by and gets elected on—patient choice, patient voice, improving healthcare outcomes—it surprises me that a Labour Government want to abolish that independent patient voice. No matter how much they want to make space for that voice within an ICB, they cannot argue that that voice is independent once it becomes part and parcel of the ICB.

Karin SmythAgain, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape—well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do.

I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure.

I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”—that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience? Who are they?” It constantly surprises me, as it did when I worked inside the system. These are not remote people. We know who they are and what is wrong with them. We know how remote they are from the system. That goes to the heart of why the taxpayer is so alienated in this country from public services and their poor functioning. That is what the Government want to change.

It is not a matter of ICBs adding a new function; the Opposition have fundamentally misunderstood that. It is about rewiring these organisations to do something very different. Their function as strategic commissioners is to understand and to use all the data and evidence, including direct voice. We can argue about how that direct voice is taken in, but that is fundamentally what a commissioner is—I say that, having been a commissioner. It is not being done well, and that is why we are changing the legislation. Under previous legislation, ICBs had multiple functions. We are changing that to force them to be commissioners, but it is not an add-on; it is fundamental to the commissioning process. It is a complete rewiring of the organisation to listen to patient voice, patient experience and the reality of health inequalities.

In my constituency, I am afraid have not seen examples of the independent voice really speaking on behalf of the people I serve—some of whom have the worst health inequalities in the country, largely as a result of the tobacco industry and its legacy—whereas their experiences and their health outcomes are very well known and should drive the necessary changes. That is why we are driving all the changes in the 10-year health plan: to meet the needs of communities. We will continue to have this debate, but I wanted to make that absolutely clear.

We assume that the independent voice is always clear, but it is not. We have heard that it is variable and fragmented. That is not the fault of anyone trying to provide it, but that is where it is. The system is supposed to listen and improve services, and it does not. Things need to be changed in order to achieve that, and that is what we intend to do. The changes will be supported by scrutiny, transparency and oversight arrangements. The alternative, which is maintaining a separate structure with limited levers to drive change, has not delivered, and it cannot continue to try.

We are not removing patient and user voice; we are embedding it at the heart of the new system. ICBs will be expected to carry out proactive, inclusive engagement, particularly with so-called seldom-heard groups, including carers, those who do not have access to digital platforms, those less proficient with technology and people for whom English is a second language. Crucially, ICBs will be accountable for demonstrating reach and impact, not simply how many reports or engagement exercises they have done. Impact is what we will be looking at.

As I have said, this is about moving from a model where voices can be collected but overlooked to one where they must be heard and acted upon. The new patient experience director in the Department will work closely with local systems to identify national themes and significant concerns, ensuring that patient experience informs policy and improvement at the national level. To answer a previous question, the Secretary of State will have the power to issue directions to ICBs and local authorities if they are failing to exercise that function.

As I have said in debates on previous groups, I understand that it is difficult when we are debating the abolition of something outwith the wider framework of the 10-year health plan, the Dash review, the patient experience directorate in the Department and changes to the national quality board. It is incumbent on the Government to make that architecture clear and to build confidence and trust. That is what we intend to do, and that is how this body will be taken forward.

All comments have been noted. There is a fundamental difference of approach. We are making those bodies fundamentally different and rewiring them to do something different. I understand the bumpy road—I have been part of that, with community health councils and links to Healthwatch, and it has been a long one. I think we will keep returning to this theme. Those organisations have not been changed to do what they are supposed to do, and that is the ambition of this Government. Question put, That the clause stand part of the Bill.

23|0|9|6| The Committee divided: | Question accordingly agreed to. ||0|0

Clause 65 ordered to stand part of the Bill.

Schedule 10 agreed to.

16:56:00

Sitting suspended.

17:10:00

On resuming—

Clause 66

Civil contingenciescategory 1 responders

Question proposed, That the clause stand part of the Bill.

Karin SmythAs the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response.

Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee. Question put and agreed to. Clause 66 accordingly ordered to stand part of the Bill. Clause 67

Minor and consequential amendments Question proposed, That the clause stand part of the Bill.

The ChairWith this it will be convenient to discuss the following:

Government amendments 20 to 24 and 83.

Schedule 11.

Karin SmythThese are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act.

Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others—primarily the Secretary of State and integrated care boards—and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67 to the Committee. Question put and agreed to. Clause 67 accordingly ordered to stand part of the Bill. Schedule 11

Minor and consequential amendments Amendments made20, in schedule 11, page 140, line 16, at end insert—

“91A The Armed Forces Act 2006 is amended as follows.” This amendment and amendments 21 and 22 remove a reference to NHS England from section 343AZB of the Armed Forces Act 2006 (to be inserted by the Armed Forces Bill). Amendment 21, in schedule 11, page 140, line 17, leave out

“of the Armed Forces Act 2006”. See explanatory statement for amendment 20. Amendment 22, in schedule 11, page 140, line 18, at end insert—

“92A In section 343AZB (inserted by the Armed Forces Act 2026), in subsection (5)(a) omit sub-paragraph (i).” See explanatory statement for amendment 20. Amendment 23, in schedule 11, page 144, line 5, leave out paragraph 118. This removes an unnecessary consequential amendment to section 12E of the NHS Act 2006 (that section is replaced in its entirety by clause 10 of the Bill). Amendment 24, in schedule 11, page 148, line 9, leave out paragraph 139. This removes an unnecessary consequential amendment to a heading that is replaced by clause 11. Amendment 83, in schedule 11, page 191, line 35, at end insert— “Children’s Wellbeing and Schools Act 2026 400 In Schedule 1 to the Children’s Wellbeing and Schools Act 2026 (relevant authorities)—

(a) omit paragraph 9;

(b) in paragraph 12, omit ‘section 25 of’.”— (Karin Smyth.) This is a consequential amendment to Schedule 1 to the Children’s Wellbeing and Schools Act 2026, which would remove a reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Schedule 11, as amended, agreed to. New Clause 20

Arrangements between NHS bodies and local authorities

“(1) Section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities) is amended as follows.

(2) In subsection (6), for the words from ‘consultation’ to the end substitute ‘the making of arrangements by virtue of this section’.

(3) Omit subsections (7A) to (7L).

(4) In subsection (8), at the appropriate place insert—

‘“local authority” includes—

(a) a combined authority,

(b) a combined county authority, and

(c) the Greater London Authority;’.”— (Karin Smyth.) This enables combined authorities, combined county authorities and the Greater London Authority to enter into arrangements with NHS bodies under section 75 of the NHS Act 2006 in relation to any of their functions, replacing the current different and more limited provision about combined authorities and combined county authorities. Brought up, read the First and Second time, and added to the Bill. New Clause 21

Dispensing medical practitioners etc

“(1) The National Health Service Act 2006 is amended as follows.

(2) In section 132 (persons authorised to provide pharmaceutical services)—

(a) for subsection (1) substitute—

‘(1) Except as may be provided for by or under regulations, no arrangements may be made by an integrated care board with a person providing primary medical services under Part 4 to provide pharmaceutical services.’;

(b) in subsection (3), for ‘medical practitioners’ substitute ‘persons providing primary medical services under Part 4’;

(c) in subsection (4)—

(i) for paragraph (a) substitute—

‘(a) as to grounds on which an integrated care board may, or must, refuse to grant an application for inclusion in a list referred to in subsection (3),’;

(ii) in paragraph (aa) omit ‘of medical practitioners’;

(iii) in paragraph (b), for ‘NHS England by a medical practitioner’ substitute ‘an integrated care board by a person’;

(iv) omit paragraph (c).

(3) In section 134 (pilot schemes), in subsection (8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.

(4) In Schedule 12 (LPS schemes), in paragraph 1(8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.”— (Karin Smyth.) This updates the legislation about the provision of pharmaceutical services by medical practitioners to conform with current law and practice whereby commissioning arrangements are generally made with the practice rather than individual doctors. It also removes a reference to dental practitioners that is not needed. Brought up, read the First and Second time, and added to the Bill. New Clause 22

Inadequate provision of pharmaceutical services

“(1) Section 133 of the National Health Service Act 2006 (inadequate provision of pharmaceutical services) is amended as follows.

(2) For subsection (1) substitute—

‘(1) Subsection (2) applies if the Secretary of State is satisfied that a situation or event has caused or is likely to cause a disruption resulting in the inadequate provision of pharmaceutical services in England or in an area within England.’

(3) In subsection (2)—

(a) after ‘Secretary of State’ insert ‘may by direction’;

(b) for paragraph (a) (but not the ‘and’ at the end) substitute—

‘(a) require an integrated care board to make other arrangements,’;

(c) in paragraph (b) omit ‘may’.

(4) After subsection (2) insert—

‘(3) A direction under subsection (2) must specify the period for which it has effect.

(4) The period must not be more than 6 months.

(5) But the Secretary of State may by further direction extend the period for which a direction under subsection (2) has effect by up to 6 months at a time.

(6) The Secretary of State must publish any directions under this section.’”— (Karin Smyth.) The amendments made by this clause (among other things) relax the legal test for making alternative provision to address the inadequate provision of pharmaceutical services owing to a disruption of services. Brought up, read the First and Second time, and added to the Bill. New Clause 23

Pharmaceutical servicesappeals etc

“Schedule ( Pharmaceutical services: appeals etc ) makes provision about the destination of appeals, and jurisdiction to determine certain matters, currently governed by Part 7 of the National Health Service Act 2006 (pharmaceutical services and local pharmaceutical services).”— (Karin Smyth.) The clause introduces a Schedule which amends provisions about certain appeals etc to the First-tier Tribunal. Those appeals will be transferred to an NHS body determined by regulations. It is expected that initially this will be NHS Resolution. Brought up, read the First and Second time, and added to the Bill. New Clause 91

Regulationsreference to agreements and standards

“(1) The Medicines and Medical Devices Act 2021 is amended as follows.

(2) In section 2 (power to make regulations about human medicines), after subsection (4) insert—

‘(4A) Regulations under subsection (1) making provision in reliance on section 3, 4, 5 or 7 may refer to international agreements or standards relating to human medicines, including agreements or standards as they have effect from time to time.’

(3) In section 16 (manufacture, marketing and supply), after subsection (2) insert—

‘(3) Provision made in reliance on subsection (1)(a) may refer to United Kingdom standards that— (a) relate to the marketing, putting into service or other supply of medical devices, and

(b) are specified in a list published by the Secretary of State from time to time.

(4) Regulations made under section 15(1) that contain provision made in reliance on subsection (1)(a) about relevant requirements (or exceptions from them) may include provision in relation to a medical device where—

(a) the device complies with regulatory requirements applicable somewhere outside the United Kingdom which is specified in regulations, and

(b) a description of the device and the regulatory requirements applicable to it are contained in a list published by the Secretary of State from time to time.

(5) In this section “United Kingdom standard” means a standard that is—

(a) set by the British Standards Institution, or

(b) primarily developed for use in the United Kingdom, or part of the United Kingdom.’”— (Karin Smyth.) This new clause would amend the Medicines and Medical Devices Act 2021 to (a) enable regulations to refer to both international agreements and standards and standards developed in the United Kingdom and (b) enable the Secretary of State to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom. Brought up, and read the First time.

Karin SmythI beg to move, That the clause be read a Second time.

The ChairWith this it will be convenient to discuss the following:

Government new clause 92— Medical Devices Regulations 2002mutual recognition agreements . Government new clause 93— Consultation about medicines and medical devices regulations . Government new clause 94— Medicines and medical devices regulations: parliamentary procedure . Government new clause 95— Medical devices etc: parliamentary procedure for certain fees regulations . Government amendments 80 to 82.

New clause 67— Secretary of State directions relating to early access to medicines —

“(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the implementation of a scheme providing early access to medicines to people with life-threatening or seriously debilitating conditions.

(2) The bodies are—

(a) integrated care board,

(b) NHS Trusts,

(c) NHS Foundation Trusts,

(d) NHS Advanced Foundation Trusts, and

(e) other health and social care bodies.” This new clause would give the Secretary of State power to direct integrated care boards, NHS Trusts, NHS Foundation Trusts, and NHS Advanced Foundation Trusts to implement a scheme to provide early access to medicines to people with life-threatening or seriously debilitating conditions. New clause 68— Review of the Early Access to Medicines Scheme —

“(1) The Secretary of State must, within six months of the passing of this Act, commission a review of the regime for early and accelerated access to medicines in England and Wales. (2) The review conducted under subsection (1) must consider—

(a) the effectiveness of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP),

(b) the effectiveness of the early access outside of the Early Access to Medicines Scheme (EAMS) and Innovative Licensing and Access Pathway (ILAP), and

(c) equality of access across England and Wales, with the aim of reducing geographical inequalities between different NHS trusts.

(3) The Secretary of State must lay a copy of the report and recommendations of the review before both House of Parliament.” This new clause would require the Secretary of State to commission a review of regime for early and accelerated access to medicines.

Karin SmythI will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises.

These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly.

New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time.

Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry.

The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales.

The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service.

New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time.

New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function.

Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force.

In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.

Dr JohnsonNew clause 91 would amend the Medicines and Medical Devices Act to enable regulations

“to refer to both international agreements and standards and standards developed in the United Kingdom”

and enable the Secretary of State

“to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.”

New clause 92 would amend the definition of “mutual recognition agreement” so that

“agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.”

New clause 93

“amends the duty to consult in relation to regulations about human medicines and medical devices.” That means that instead of a public consultation, it

“gives the option of consulting such persons as the relevant authority considers appropriate”.

I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody.

New clause 94

“changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.”

That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes.

Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.

Karin SmythI thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue. Question put and agreed to. New clause 91 accordingly read a Second time, and added to the Bill. New Clause 92

Medical Devices Regulations 2002mutual recognition agreements

“(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows.

(2) For regulation 1A (Schedules) substitute— ‘ 1A Schedule Schedule 2A has effect.’

(3) In regulation 2 (interpretation), in paragraph (1)—

(a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’;

(b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’.

(4) Omit Schedule 2 (mutual recognition agreements).”— (Karin Smyth.) This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations. Brought up, read the First and Second time, and added to the Bill. New Clause 93

Consultation about medicines and medical devices regulations

‘(1) Section 45 of the Medicines and Medical Devices Act 2021 (consultation) is amended as follows.

(2) In subsection (1), for “a provision of Part 1, 2, 3 or 4” substitute “Part 1 or 3”.

(3) After subsection (1) insert—

“(1ZA) Before making regulations under Part 2 or 4 the relevant authority must—

(a) carry out a public consultation, or

(b) consult such persons as it considers appropriate.”

(4) In subsection (3), at the beginning insert “Where a public consultation is carried out”.

(5) In subsection (4), in the words before paragraph (a), for “subsection (1)” substitute “subsection (1ZA)”.’— (Karin Smyth.) This amends the duty to consult in relation to regulations about human medicines and medical devices. It gives the option of consulting such persons as the relevant authority considers appropriate instead of a public consultation. Brought up, read the First and Second time, and added to the Bill. New Clause 94

Medicines and medical devices regulationsparliamentary procedure

‘In section 47 of the Medicines and Medical Devices Act 2021 (regulations: procedure), for subsection (3) substitute—

“(3) Regulations under Part 1 are subject to the draft affirmative procedure.

(3A) Regulations under Part 2—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on section 6(1)(a) (fees);

(ii) provision amending the meaning of ‘appropriate practitioner’ or ‘approved country health professional’ for the purposes of Part 12 of the Human Medicines Regulations 2012 (see regulation 214 of those regulations);

(iii) provision amending any of the following provisions of the Human Medicines Regulations 2012—

• regulations 217C(3) or 217CA(3) (original pack dispensing for products containing relevant substances: definition of ‘relevant substance’),

• Schedule 13 (prescription only medicines for which community practitioner nurse prescribers are appropriate practitioners),

• Schedule 15 (requirements for specific products subject to general sale),

• Schedule 16 (patient group directions and vaccine group directions),

• Schedule 17 (exemption for sale, supply or administration by certain persons),

• Schedule 18 (substances that may not be sold or supplied by a pharmacist without a prescription in reliance on emergency provisions),

• Schedule 19 (medicinal products for parenteral administration in an emergency), or

• Schedule 21 (medicinal products at high dilutions); (iv) provision amending regulation 250 of the Human Medicines Regulations 2012 (restrictions on persons to be supplied with medicinal products: exceptions) for the purpose of changing the products to which any exception from time to time provided for by that regulation applies;

(v) provision that is consequential on provision of a description mentioned in any of sub-paragraphs (ii) to (iv);

(b) are subject to the made affirmative procedure if they—

(i) contain only provision that is made in reliance on section 7 (emergencies),

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health, and

(iii) are not within paragraph (a);

(c) are subject to the draft affirmative procedure if they are not within sub-paragraphs (a) or (b).

(3B) Regulations under Part 3—

(a) are subject to the negative procedure if they contain only provision made in reliance on section 12(1)(a) (fees), and

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).

(3C) Regulations under Part 4—

(a) are subject to the negative procedure if they contain only provision of one or more of the following descriptions—

(i) provision made in reliance on—

• section 17(1)(a) (fees), or

• paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);

(ii) provision amending or revoking regulation 1ZA of the Medical Devices Regulations 2002 (expiry of certain provisions) or consequential on such provision;

(b) are subject to the made affirmative procedure if they—

(i) contain only provision made in reliance on section 18 (emergencies), and

(ii) contain a declaration that the person making them considers that they need to be made urgently to protect the public from an imminent risk of serious harm to health;

(c) are subject to the draft affirmative procedure if they are not within paragraph (a) or (b).”’ —(Karin Smyth.) This changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure. The changes all relate to regulations about medicines and medical devices (although the procedural provisions relating to certain other matters are restated in the amendment). Brought up, read the First and Second time, and added to the Bill. New Clause 95

Medical devices etcparliamentary procedure for certain fees regulations

‘In Schedule 7 to the European Union (Withdrawal) Act 2018 (regulations), in paragraph 12—

(a) in sub-paragraph (1) for “relate to altering the amount of a fee or charge to reflect changes in the value of money” substitute “fall within sub-paragraph (1A)”.

(b) after sub-paragraph (1) insert—

“(1A) Provision falls within this sub-paragraph if it relates to—

(a) altering the amount of a fee or charge to reflect changes in the value of money,

(b) altering the amount of a fee or charge to be charged in connection with the exercise of a function which a public authority has by virtue of provision made under section 8C in connection with the EU medical devices Regulations, or

(c) altering the amount of a fee or charge to be charged under the Blood Safety and Quality Regulations 2005 (S.I. 2005/50).

(1B) In sub-paragraph (1A)(b) ‘the EU medical devices Regulations’ means—

(a) Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC, or

(b) Regulation (EU) 2017/746 of the European Parliament and of the Council of 5 April 2017 on in vitro diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU,

as they have effect from time to time by virtue of Article 5(4) of the Windsor Framework.”’ —(Karin Smyth.) This allows regulations altering certain fees in relation to medical devices etc to be made subject to the negative resolution procedure. At the moment those regulations are subject to the affirmative resolution procedure. Brought up, read the First and Second time, and added to the Bill. New Clause 1

National Maternity Commissioner

“(1) The Secretary of State must, within six months of the passing of this Act, appoint a National Maternity Commissioner, situated within the Department of Health and Social Care.

(2) The functions of the National Maternity Commissioner are to—

(a) oversee NHS maternity services;

(b) act as an independent voice for women and families;

(c) ensure lessons are learned from identified failures and that the recommendations of maternity reviews are acted upon;

(d) promote consistency, safety and accountability across NHS maternity services; and

(e) advise the Secretary of State on matters relating to the safety, quality and provision of maternity services in England.

(3) The person appointed as Commissioner must—

(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role; (b) have first-hand experience of working in maternity services, so far as reasonably possible; and

(c) not be a sitting Member of Parliament.”— (Helen Morgan.) This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise of maternity services, and not a political appointment. Brought up, and read the First time.

Helen MorganI beg to move, That the clause be read a Second time.

The ChairWith this it will be convenient to discuss new clause 13— Maternity Safety —

“(1) The Secretary of State must ensure that every NHS maternity unit is rated ‘good’ or ‘outstanding’ by the CQC.

(2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes—

(a) 24/7 consultant obstetrician cover on every labour ward,

(b) one-to-one midwifery care,

(c) a Director of Midwifery in every maternity service,

(d) ringfenced maternity service development funding, and

(e) a dedicated neonatal workforce plan.

(3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.” This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.

17:30:00

Helen MorganNew clause 1, which I tabled, would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise in maternity services, and not a political appointment.

It is important to start by saying that I tabled the new clause before we had the report from Donna Ockenden on the Nottingham review, and last week’s report from Baroness Amos on her national review, both of which recommended the appointment of a maternity commissioner. Obviously, since then, the Secretary of State has announced that he will appoint a maternity commissioner. None the less, I will state the arguments for having one, and if the Minister can give us some assurances today, I will not press the new clause to a vote.

Just to set the scene, which I think we all know too well, maternity services in England have suffered a series of high-profile scandals. The cost of political neglect has been paid by families in terms of trauma, injury and lost lives. We have known for a long time that maternity services in this country have been failing. Numerous recommendations have been made over that period, but they have not been effectively acted on in a consistent way, and Baroness Amos’s inquiry finally confirms that.

It is important to say that the vast majority of births take place safely, successfully and happily. However, where things go wrong, having a baby safely has become a postcode lottery. Women are being routinely silenced, and staff who raise the alarm on unsafe care or systemic discrimination have been put off or crushed by a culture of fear. We therefore need to make England the safest country in the world to have a baby.

The Liberal Democrats have been campaigning on that for a long time, and following the Ockenden and Amos reviews it genuinely feels that there is now the will and focus to deal with the problem once and for all. This issue has been going on for far too long. We thank the Secretary of State for hearing our campaign and Baroness Amos’s calls for a national maternity commissioner to oversee national standards and drive change. We also pay tribute to campaigners such as Louise Thompson and the former MP for Stafford, Theo Clarke; without their advocacy, and without so many women sharing their stories, we would not be moving forward.

It is important to say that one individual—one maternity commissioner—will not solve all the issues in maternity by themselves, but they can help drive change and address recurrent issues, whether those are cultural or about safe staffing. They can hold Ministers to account, help restore public confidence in NHS maternity service and ensure that accountability exists. But I want to be clear that the buck should always stop with the Secretary of State; they hold the power and the purse strings, and this role cannot be used by Ministers as a way to shirk that responsibility.

I hope the Minister will clarify a few key points. First, can she reassure us that the commissioner will be independent and not a political appointee? It is essential that this individual feels confident to hold the Government to account and have those difficult conversations. That is far less likely if they are a political appointee.

Secondly, women have made it clear that for them to be reassured that this change will happen and happen meaningfully, they need a clear timetable for when the maternity commissioner will be in place and operating. Understandably, the Secretary of State has not been able to provide that yet, given the need for this Bill to pass through Parliament and for the statutory role to be on the books, and given the time it will take his maternity taskforce to define what it wants the role to look like and for the appropriate legislation to be written and put in place. However, we hope we can get a firm commitment to a timetable from the Minister today or, if not today, then on Report.

We think the commissioner should be involved in the establishment of the taskforce, because it is important that it does not develop a plan that they are required to implement, despite it being something they personally would not have approved. I therefore hope the commissioner will be in place very quickly, even if only on a temporary basis, so that they are working to get the taskforce plan into place.

We heard from the Secretary of State that the commissioner will co-chair the taskforce alongside him. That seems to be the right move, and I welcome it, but, as I said, it is important that they have some role in shaping its action plan, so that they can feel responsibility for it and be fully behind its implementation. Will the Minister commit to introducing a temporary maternity commissioner so that that can happen? Finally, we have heard reports that the taskforce is not meeting very regularly. I hope the Minister can reassure me that it is now meeting much more regularly and getting that plan into place as quickly as possible, and that the Secretary of State is fully on board in driving forward the commissioner’s role as soon as possible.

New clause 13, which is also in my name, is about putting a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a good or outstanding rating from the CQC. I will not repeat some of the points I have just outlined about failing maternity services, but the first quarter of 2026 saw the worst ever recorded rate for maternity injuries. Four years ago, the Ockenden review into the Shrewsbury and Telford hospital NHS trust, which is in my area, found that over 200 babies had died unnecessarily in Shropshire. Yet, despite several immediate and essential actions being put in place, a subsequent CQC review found that the majority of maternity units in this country did not achieve a good rating for safety—they were inadequate in some way. That is just not acceptable.

Our package of measures includes the maternity commissioner, which the Government are obviously progressing with, and we are very pleased about that. However, we also need investment in the service to ensure that that maternity commissioner has the resources they need to make the changes required. We therefore call for one-to-one midwifery care for every woman in labour; a consultant on every labour ward 24 hours a day, seven days a week; a director of midwifery—a senior, experienced midwife—in every maternity service to ensure that more junior midwives on that ward are suitably supervised; the restoration of ringfenced service development funding; and a dedicated neonatal workforce plan.

New clause 13 also requires an annual report to be laid before the House on the “effectiveness of the scheme”. That would allow Parliament to track progress and hold the Government’s feet to the fire on it. Baroness Amos has also called for regular reporting to Parliament to maintain accountability, albeit through the maternity commissioner.

There seems to be consensus, here and across the NHS, on the need for meaningful and decisive action on maternity. There is a great deal of overlap between our plan and the recommendations Baroness Amos has made, and I hope the Minister will be able to take some of these points on board and incorporate them into the Bill.

Dr JohnsonAs the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner.

New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012 and 2013. I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words.

The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity.

My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election.

I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.

Karin SmythI am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause.

Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families.

That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action. As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are committed to putting the role on a “statutory basis” as soon as possible.

I am afraid I cannot give the hon. Member for North Shropshire a more detailed timetable at the moment, because we are currently looking at options to legislate at pace, including potentially through this Bill, subject to discussions through the usual channels, while also—this is crucial—giving the taskforce the opportunity to shape the scope of the role. That was one of Baroness Amos’s urgent actions, and we accept it as a crucial first step in overseeing systemic improvements to care and outcomes and earning back the trust of women and families.

The maternity and neonatal commissioner will champion the voices of families and drive forward that necessary change. The Secretary of State will remain accountable to Parliament for maternity services. The role will be discussed urgently with the taskforce and will have a relentless focus on driving those improvements, which will include co-chairing the taskforce.

As the Committee knows, these are complex matters. The Government, having accepted the Baroness Amos’s recommendation, intend to legislate as soon as practicable. Our immediate priority is to work quickly through the taskforce to define the scope and responsibilities of the role. I know that the hon. Member for North Shropshire will not press the new clause, but I commit to keeping in touch with her and other hon. Members as this work progresses.

Dr JohnsonWe talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?

Karin SmythI am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made.

On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.

17:45:00

However, we recognise the importance of driving improvements in maternity and neonatal care so that ratings can improve over time. We acknowledge that we must reset maternity and neonatal services, which is why we commissioned the national investigation and have introduced a maternity commissioner. It is also why we are investing £10.6 million to fund 1,000 additional temporary roles for newly qualified midwives to join the NHS.

Baroness Amos made specific recommendations relating to the maternity and neonatal workforce, including the introduction of a modern service framework for those services to set out consistent safety, workforce and operational standards. That will be considered in detail by the taskforce personally chaired by the Secretary of State, which will oversee the development of an action plan by the end of the year. The plan will translate Baroness Amos’s recommendations into action, along with those of Donna Ockenden from the investigation into Nottingham, and drive systemic and sustained improvements across maternity and neonatal care.

We will also shortly publish a 10-year workforce plan, which will put the NHS workforce on a sustainable footing so that it can deliver the service model set out in the 10-year health plan. The Government think that the focus should now be on developing the action plan. Now is not the time to legislate for a new approach, so I hope that the hon. Member for North Shropshire will withdraw the new clause.

Helen MorganI thank the Minister for her response. Given the commitments that she has made, I do not intend to press the new clauses, but I hope she will be able to come back to us on Report with some more concrete progress. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 3

Assessment of risks posed by contracts with non-UK based suppliers

“(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.

(2) In conducting an assessment under this section the Secretary of State must—

(a) pay particular regard to contracts which provide technology companies with access to confidential patient data;

(b) consult national security experts on the risks posed to UK sovereignty by such contracts;

(c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK; (d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and

(e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations.

(3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.”— (Dr Chambers.) This new clause would require the Government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK. Brought up, and read the First time.

Dr ChambersI beg to move, That the clause be read a Second time.

The ChairWith this it will be convenient to discuss the following:

New clause 4— Duty on the Secretary of State to prioritise domestic suppliers —

“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— ‘1CD Duty to prioritise domestic suppliers (1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom.

(2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist.

(3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with—

(a) patient groups,

(b) national security experts, and

(c) staff unions,

on the proposed contract and lay a report on such a consultation before Parliament.

(4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for its agreement is negatived by either House of Parliament.

(5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.’” This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers. New clause 5— NHS Digital Sovereignty Strategy —

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (‘an NHS Digital Sovereignty Strategy’) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by—

(a) assessing, managing and mitigating risks—

(i) associated with foreign interference,

(ii) arising from reliance on foreign-supplied technologies, and

(b) preventing over-reliance on foreign providers by building domestic capacity.

(2) For the purposes of this section, a ‘relevant information system’ is an information system with access to NHS patient data.

(3) An NHS Digital Sovereignty Strategy published under this section must—

(a) include risks associated with—

(i) hardware,

(ii) software,

(iii) supply chains, and

(iv) procurement processes;

(b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;

(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies;

(d) recommend steps to support and develop sufficient domestic capability where it does not currently exist;

(e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.” This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies. New clause 9— Retendering of contract for the NHS Federated Data Platform —

“The Secretary of State must, before February 2027, commence a competitive retendering for the contract to provide the NHS Federated Data Platform.”

New clause 10— NHS contracting for IT or data services —

“(1) The Secretary of State must, within six months of the passing of this Act, by regulations establish a governance framework for the contracting of any IT or data services by the Department of Health and Social Care or any NHS organisation.

(2) The framework established under subsection (1) must include the following provisions—

(a) a party may not bid for any contract for services where such services have previously been provided by the party on a free trial basis;

(b) the automatic extension of contracts should be subject to audit by the National Audit Office;

(c) contract terms must include provision for the department or NHS organisation to take ownership of any bespoke system built or developed by the contractor during the delivery of the contract;

(d) the department or NHS organisation must, at the end of the contract period (or following any extensions) conduct a competitive retendering process; and (e) where a retendering process takes place under subsection (2)(d), the contractor may not assist in the preparation of the contract specification.

(3) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.”

New clause 43— Data obligations —

“A contract given in relation to the provision of NHS services must include an obligation to provide data under the Freedom of Information Act 2000 in relation to that contract and to the patients served.” This new clause would oblige those receiving contracts to provide NHS services to make available FOI data in relation to the patients covered by the contract and the contract itself.

Dr ChambersNew clauses 3 to 5 are related to the publication of risk assessments of contracts between NHS organisations and suppliers based outside the UK. They would place a duty on the Secretary of State to prioritise domestic, UK-based suppliers in the case of technology systems and contracts involving the handling of NHS patient data, and place restrictions on the signing of such contracts with non-UK-based suppliers. New clause 5 would require the Government to publish an NHS digital sovereignty strategy setting out how they intend to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

We had a Westminster Hall debate on this subject recently. The lack of transparency in how some contracts are awarded is one of the central concerns about Palantir’s involvement with the NHS. We are particularly concerned about the national security considerations of offshoring the whole of our nation’s health data to any foreign company, which makes us vulnerable to political and economic changes in other countries, but especially to companies of questionable integrity in an increasingly authoritarian jurisdiction with little respect for privacy and sovereignty. We should all be worried that our health data has been so closely linked with such an organisation, which has shown itself all too eager to work closely with Donald Trump’s Administration. We know that his Immigration and Customs Enforcement agency has been using health data to identify people’s immigration status, and there is a lot of concern that people are not coming forward for medical treatment as a result. Doctors and patients have already voted with their feet and shown that they do not trust Palantir and its system for this very reason, which is also a key reason for the limited uptake of the federated data platform so far.

As such, we have tabled various new clauses to try to address those concerns, to ensure that they do not plague the single patient record, which we absolutely support and want to help the Government to deliver, along with any other vital technology or data system. New clause 3 would ensure that a risk assessment is conducted of all non-UK tech and data suppliers, with particular regard for national security. It is centrally important that doctors and patients trust the systems that hold their health data and that, as a country, we trust them to be safe and secure. We should not trust rogue actors with our nation’s health information. New clause 5 deals with how we mitigate that risk. It would require the Government to publish an NHS digital sovereignty strategy, setting out how they intend to address the risks of foreign interference and reliance on foreign technologies.

Our potential answer to both those questions lies in new clause 4, which would prioritise domestic suppliers that handle sensitive or confidential NHS data. We recognise that that will not always be possible, but where domestic capability does not exist and it is therefore necessary to work with foreign suppliers, to ensure the transparency and effective oversight of a contract with a foreign supplier, it must be brought before Parliament. Should a contract be signed with a non-UK supplier, it would also be subject to consultation with patient groups, national security experts and staff unions to make sure that the system is onside. If it is not, uptake of it will be stunted, as we have seen with the federated data platform.

Gregory StaffordObviously, I have sympathy for what the hon. Member is trying to achieve—ensuring that our data systems are free from potential hacking by either state or non-state actors is very important—but I cannot see anything in new clause 4 about the size of contracts. Does his suggestion relate to any contract, however small, that was given to a non-UK-based company? It is not clear what he means by a non-United Kingdom company. Is that one that is headquartered here, one that is listed on our stock exchange, or one that has a CEO who is a British citizen? I am not quite sure what he means by a UK-based company, but if we can define an outside-based one, is he saying that any contract of any size given to such a company will have to come to Parliament?

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

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

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

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

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

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

Dr JohnsonI rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however.

New clause 3 says:

“Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.”

That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be cumbersome and completely unnecessary to include all of those.

Even with the tech companies themselves, there is a risk for small contracts for small pieces of tech to create a huge amount of bureaucracy. I am not sure that it would specifically improve data quality or data protection. It is reasonable that the Minister would consider risk assessments, and I hope that she would automatically consider them before contracts that are particularly sensitive or contain patient data, but I am not sure that the new clause works.

Moving on to new clauses 4 and 5, the hon. Member talked about Palantir. It may even have been his intention for these new clauses to target one specific American firm, but the actual impact would erect costly barriers to trade. The NHS contracts IT functions to firms based in other countries when the business case is strong. It uses Microsoft, an American company that offers software, cloud services and Outlook for emails; Oracle for standardising and automating financial processes; Sectra, a Swedish company, for transferring medical images and reports; and Dedalus, an Italian company, for migrating services to the cloud. To echo the point made by the hon. Member for Bury St Edmunds and Stowmarket, should the NHS prioritise a British company over an international company if the service has better functionality and a lower cost and is safe?

The hon. Member for Winchester spoke about the vibrant life sciences and tech sector in this country, but if we close off our markets to those from overseas, will others not do the same? Would he want those life sciences companies to be unable to export? There is a barrier to free trade here.

18:00:00

Dr ChambersThis is not about closing off markets or shutting off the potential to use foreign companies if they are most appropriate. It is about prioritising and investing in UK technology and our economy to solve some of our domestic problems while also providing security. Saying that we are closing off domestic markets is misunderstanding the thrust of the new clause.

Dr JohnsonI think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe.

New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.

Edward ArgarMy questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister.

New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be?

I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.

Karin SmythI am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work.

I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience.

I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control.

We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins.

A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier.

Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually.

As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary.

Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.

I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose.

The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses.

Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.

Dr ChambersI appreciate the Minister’s response and the comments of other Members, which were insightful as usual.

When we discussed whether carers could access parts of the single patient record, Members made very good points about privacy and historical health issues that a patient might not want a carer to know about. Those are very sensible concerns, but someone watching these proceedings or looking back over the record would think that there had been a lot more agonising over whether someone caring for a patient could access relevant information than over the potential systemic misuse of health information facilitated by private companies. A lot of people are worried about that when it comes to procurement, trust and sovereignty.

I thank the Minister for her comments on new clause 3. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 4

Duty on the Secretary of State to prioritise domestic suppliers

“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— ‘1CD Duty to prioritise domestic suppliers (1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom.

(2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist.

(3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with—

(a) patient groups,

(b) national security experts, and

(c) staff unions, on the proposed contract and lay a report on such a consultation before Parliament.

(4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for its agreement is negatived by either House of Parliament.

(5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.’”— (Dr Chambers.) This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers. Brought up, and read the First time. Question put, That the clause be read a Second time.

24|0|2|8| The Committee divided: | Question accordingly negatived. ||0|0

New Clause 5

NHS Digital Sovereignty Strategy

“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (‘an NHS Digital Sovereignty Strategy’) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by—

(a) assessing, managing and mitigating risks—

(i) associated with foreign interference,

(ii) arising from reliance on foreign-supplied technologies, and

(b) preventing over-reliance on foreign providers by building domestic capacity.

(2) For the purposes of this section, a ‘relevant information system’ is an information system with access to NHS patient data.

(3) An NHS Digital Sovereignty Strategy published under this section must—

(a) include risks associated with—

(i) hardware,

(ii) software,

(iii) supply chains, and

(iv) procurement processes;

(b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;

(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies;

(d) recommend steps to support and develop sufficient domestic capability where it does not currently exist;

(e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.”— (Dr Chambers.)

This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

25|0|2|8| The Committee divided: | Question accordingly negatived. ||0|0

Ordered, That further consideration be now adjourned.— (Emma Foody.)

18:14:00

Adjourned till Thursday 9 July at half-past Eleven o’clock.

Written evidence reported to the House

HB110 Alzheimer’s Society

HB111 British Dental Association (BDA)

HB112 Iron Mountain

HB113 Adam Cooper, Independent Researcher and Healthcare Campaigner (further submission)

HB114 National Care Association (NCA)

HB115 The NHS Alliance (supplementary)

HB116 Cystic Fibrosis Trust

HB117 Carers UK (supplementary)

HB118 Shockwave Medical, part of Johnson & Johnson MedTech

HB119 Coalition for Responsible Digital Health (CoRDH)

HB120 Pernicious Anaemia Society (PAS) and the B-12Alliance (joint submission)

HB121 National AIDS Trust

HB122 Parkinson’s UK