Public Bill Committee: Health Bill (Twelfth sitting)

The Committee consisted of the following Members:

Chairs† Sir 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

(Morning)

[Sir Roger Gale in the Chair ]

Health Bill

09:25:00

The ChairGood morning, ladies and gentlemen. Electronic devices switched off, please, and no teas or coffee in the Committee Room. Members may remove their jackets if they wish to do so and, exceptionally, if any Members wish to remove ties, because of the weather I am prepared to permit that as well.

Clause 58

NICE recommendationsdecisions about time for compliance

Helen Morgan (North Shropshire) (LD)I beg to move amendment 78, in clause 58, page 43, line 40, at end insert—

“1. (8B) Regulations under subsection (8A) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.

2. (8D) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.” The amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.

The ChairWith this it will be convenient to discuss clause stand part.

Helen MorganThe amendment was tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) on behalf of the approximately 1.2 million people in England who live with myalgic encephalomyelitis, because five years after the introduction of National Institute for Health and Care Excellence guideline NG206, little has changed. Service provision according to NG206 remains patchy and poor, with many patients having traumatic experiences. The amendment would require a period to be set in which integrated care boards and other health bodies must comply with the guideline, and the Secretary of State must publish an annual statement on compliance with NG206 across the NHS in England.

The introduction of the guideline after sustained campaigning represented a major reform after years in which ME was treated as a psychiatric condition and patients were pushed to follow graduated exercise therapy. Often, GET had disastrous consequences, precipitating serious deteriorations that patients never recovered from. Credit is due to the hon. Member for Washington and Gateshead South (Mrs Hodgson), the current Minister for Public Health and Prevention, for her determination when in opposition to bring about the change.

In a written answer published last week, the Minister for Public Health and Prevention confirmed that all ICBs have a statutory obligation to ensure sufficient care provision for their population, but the experience of those with ME is that that obligation is far from being fulfilled. In some ICBs, no services for ME are commissioned; in others, the provider has a history of providing services that reflect not NG206, but the old and condemned approach of GET. Some services are provided out of psychiatry departments, which is a huge red flag for those with ME, and information on the quality of services is patchy. Results from a big survey of more than 5,000 people with ME or long covid in late 2025 painted a bleak picture: more than half said that they had been disbelieved by an NHS healthcare official, one in three had been made to feel that their ME was their own fault, and almost two in five had had an encounter with a clinician that was traumatic or traumatising.

Five years after its introduction, NG206 is far from being complied with, and so members of the ME community—approximately 1.2 million people, as I said—are desperately asking that something be done to address the situation. The amendment represents a route that offers hope for many long-neglected and mistreated people. I do not intend to press the amendment to a vote, but I hope that the Minister will be able to reassure us about improving the consistency of provision for people with ME.

Moving to the clause generally, we broadly support the intention, but think that more safeguards need to be built into the principle, given the powers that are being handed to the Secretary of State. The clause makes provision for the period for compliance with a NICE recommendation, but gives no detail of how that will work in practice or how often the Secretary of State will change the standard three-month rule that NICE requires. No ceiling is put on the compliance period, no criteria govern when the period may be extended, and there is no duty to consult or set out reasoning.

What will the process be when the Secretary of State intervenes in the period of time for compliance with a NICE recommendation? We thought that there would be some mix of evidence requirements, consultation, statement of reasons, impact assessment and some kind of parliamentary scrutiny. The Secretary of State should at least have to set out their reasoning why the new power has been used. The value of the current requirement is almost entirely due to the compliance period being short and fixed. The three-month rule gives a positive NICE recommendation practical force. A power to lengthen or vary that period without constraint weakens the requirement in substance while leaving it formally intact. The right is not removed but its timing is made discretionary. For a patient awaiting treatment, that does not amount to the same thing.

A variation power is not new. Since the introduction of the budget impact test in 2017, NHS England has been able to apply to NICE to extend the funding period for medicines with a budget impact above a defined threshold, but, importantly, that period is criteria-based, triggered by a defined financial threshold, subject to a defined process and time-limited in effect. We are not overtly opposed to the power in principle, but more safeguards should be built into the criteria for its application. I would be grateful for some guidance from the Minister on that.

Dr Caroline Johnson (Sleaford and North Hykeham) (Con)I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals.

In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website.

The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short term.

The requirement would also limit clinical judgment. A patient may have a particular set of symptoms or conditions or be on a particular set of medications that mean that the doctor or clinician looking after them needs to vary from the guidance. NICE intends the guidance to be just that, guidance, not law, but if guidance becomes law, the doctor or clinician will not be able to vary from it. My concern is that the amendment would be overly restrictive. Although it is well-intentioned, and it is a good idea to ensure that guidance is followed where possible, it would be too rigid. I therefore do not support the amendment, while continuing to support the aim of better treatment.

Clause 58 amends the Health and Social Care Act 2012 by inserting a new section 237(8A), which states:

“Provision made under subsection (8)(b) may include provision about the period within which a recommendation is to be complied with (including provision for the period to be determined by NICE or the Secretary of State).”

At the moment, NICE technology appraisals check the value of a product, whether a drug or a technology, then NICE makes a recommendation. It is then supposed to be the case that within 90 days or three months, ICBs ensure that those technologies are available, but we know that in the real world it can take longer—sometimes 12 to 24 months—for some things to become available. That could be because technology needs to be bought or training needs to take place.

I understand why there could be variation and why the Government may want to consider varying the period, but it is not clear why they need to do so in legislation, because it is possible now to vary the period on an individual basis. For example, the Government imposed a five-year limit rather than a 90-day limit for the introduction of hybrid closed loop systems for diabetes, because that is a technology that requires proper training and they were never going to be rolled out in such a short period. The other product that notably has a longer time is tirzepatide, which is more commonly known as Mounjaro. I suspect that that is down to cost, but I am not certain.

Why do the Government want to change the 90 days? The patient’s right to treatment with a NICE-approved product within 90 days will become a right to getting the product when the Secretary of State says so. That is not really a right at all, because it does not give patients any comfort and may mean that products are received later. The Government have put this power into the Bill, so they clearly intend to use it. Given that they have the power to vary on an individual basis, why do they need the power to vary on a blanket basis? Do they intend to extend the 90-day limit across the board? If so, by how much? There is no ceiling. The Committee received written evidence from Henry Burkitt from Oxygen Strategy, who made the point that there is no ceiling, no maximum time, no duty to consult and no necessity for the Secretary of State or NICE to give reasons why a delay has occurred.

The life sciences industry talks about how it wants products to be rolled out. When it is investing and doing research in this country, it wants to see new products rolled out as quickly as possible once they have been approved, and the clause is a sign that roll-out might be delayed. I understand that the Government might want to be able to vary on certain products, but they already can; why do they want to vary on a more general basis? It is presumably to slow down roll-outs, but by how much?

Gregory Stafford (Farnham and Bordon) (Con)On a point of order, Sir Roger. I am a parliamentary patron and champion of Action on ME. I feel I ought to put that on the record, as we have an amendment on ME.

The ChairThank you. That is a matter of record. Any other takers? No.

The Minister for Secondary Care (Karin Smyth)Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State.

NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment.

That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals.

I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which.

To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures.

I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it.

To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations.

The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that.

Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.

Helen MorganI thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Clause 58 ordered to stand part of the Bill. Clause 59

Transfer of HSSIB’s functions to CQC Question proposed, That the clause stand part of the Bill.

The ChairWith this it will be convenient to discuss 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.”

Karin SmythClause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission.

Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services.

With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it embeds a comprehensive investigatory framework with an established statutory regulator.

The CQC will be one organisation with separate functions—a regulatory function and an investigative function—to preserve the integrity of each. Within the CQC, HSSIB will continue to operate as a discrete unit and retain its independence from providers, allowing it to identify learnings and take a no-blame approach.

Janet Daby (Lewisham East) (Lab)The Minister will recall that in evidence, Dr Rosie Benneyworth, interim chief executive officer of HSSIB, spoke about the vital work of the organisation, especially with regard to investigations where vulnerable staff and workers do not feel confident about coming forward for fear of reprisal. HSSIB did great work in that area, and I am wondering whether the CQC will carry it on and take on board that learning.

09:45:00

Karin SmythI thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.

Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)What we are talking about is not so much the safety of staff when they come forward, but the safety of patients, and whether we genuinely believe that the proposed modification to the arrangement will improve patient safety. That is the underlying point. Although the safety of staff is important, it is the safety of patients that we must bear in mind.

Karin SmythOf course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change.

My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body.

The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system.

We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions. Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated.

The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform.

Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that.

The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition.

The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process.

Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition.

Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost.

Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.

Dr JohnsonThese clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician.

When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues.

Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error.

One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble.

That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it.

At the time that HSSIB was established, there was consensus about it. The General Medical Council said:

“We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.”

The British Medical Association told Parliament:

“We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.”

Similarly, NHS Providers told Parliament:

“NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.”

Indeed, the Minister for Secondary Care herself is on the record as having said:

“HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.” –– [ Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.] I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do.

In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC.

Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that

“a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”,

and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that.

The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that

“the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”

10:00:00

I was at the Adjournment debate on patient safety yesterday evening, in which my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) highlighted that 1,400 recommendations have been issued across the last few years from 30 public inquiries across England and Wales, but HSSIB has issued only 56 recommendations, and does so cost-effectively: its budget is much lower than the budget for an individual public inquiry. If HSSIB accounts for less than 3% of all recommendations issued in the last 30 years and its investigations are cost-effective, what are the Government trying to achieve by folding it into the CQC? It just does not make sense. The recommendations given have been specific, relatively low in number, targeted and effective; why would we not want that?

Another question ishow will this work in practice? The Minister told the House that combining the functions of HSSIB and the CQC will be

“to the benefit of both.” —[ Official Report , 1 June 2026; Vol. 786, c. 958.]

The impact assessment speaks of

“a more strategic approach to the commissioning of safety investigations”

and “economies of scale savings”, so it sounds as though the benefit may be financial and not operational, but I think we have demonstrated that that does not really make sense either. The impact assessment also makes it clear that the national quality board will provide

“clear direction to the new investigation unit”.

Considering that the national quality board is tied directly to the NHS, how does direction from the NQB square with the independence of the new investigation unit? On top of that, as the Minister will be aware, the impact assessment says that the topics of “the vast majority” of investigations are expected to be directed by the Secretary of State. Again, that will have an effect on independence. There is currently a power to direct, but it has been seldom used, whereas the Government seemingly intend to use it more frequently.

The other question is more fundamentalif HSSIB is rolled into the CQC, what happens if the HSSIB unit finds a problem with healthcare that is caused by the CQC failing to properly regulate or properly inspect? In the Committee’s first oral evidence session, I asked the chief executive of HSSIB how that would work in practice. She said:

“If we were a directorate in the CQC, as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also concern about our ability to make effective recommendations to the CQC if we are a directorate within it.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 23, Q38.]

There is a serious risk of a chilling effect if the Committee just waves these clauses through. The impact assessment indicates that Ministers want to preserve HSSIB’s safe space, but I do not see how that is feasible. In its submission the King’s Fund wrote:

“The transfer of the functions of HSSIB into the Care Quality Commission (CQC) also raises questions around people being able to trust the system and come forward with their concerns and issues.”

How sure will people be that they are responding in a safe space? How willing will they be to speak when they know that in the same breath they are also reporting to the regulator?

Dr Danny Chambers (Winchester) (LD)This subject is of particular interest to me. For quite a few years I was a trustee of a charity that supported evidence-based medicine and quality improvement. The hon. Lady talked about a no-blame culture. We now tend to use the term “just culture” but it is the same kind of thing: we must have a safe space for people to come forward, like in the airline industry. We want to encourage reporting not only of mistakes but of near misses so that improvements can be delivered without tragic incidents having to take place. If we are to create a culture in which people will come forward to admit even potential mistakes and near misses, they cannot in any way fear punitive punishment under regulations. Does the hon. Lady agree that folding HSSIB into the CQC will make it difficult to create a culture in which people feel confident enough to want to come forward with and overtly discuss mistakes and errors?

Dr JohnsonThe hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear.

Dr Benneyworth made it clear to the Committee that

“we are still working in a culture of fear” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.] and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that

“people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”. —[ Official Report , 1 June 2026; Vol. 786, c. 915.]

Gregory StaffordAs my hon. Friend said earlier, the problem comes when this new body within the CQC has to investigate the CQC. In the oral evidence session, I asked Dr Dash what would happen if the problem was CQC, and she gave what is probably the most extraordinary answer out of the many extraordinary answers she gave. It is worth repeating:

“Well, we then have to deal with that as a problem. That is the same as saying, ‘What happens if the problem is this organisation or that one?’…What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.] She did not answer my question at all. In fact, she entirely sidestepped it. How can we have confidence in the Government’s proposal if the architect of the procedure cannot answer the most basic questions about the investigatory framework?

Dr JohnsonMy hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer.

It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”—according to the impact assessment—of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State.

The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the Government have produced, but I do not think it is enough.

We have also tabled some amendments, including new clause 42, which would ensure that there is some operational independence in the choice of investigation by requiring the Secretary of State to adequately fund and resource patient safety investigations, including some of those initiated by this unit within the CQC.

Amendment 55 is a probing amendment. We noticed that much of the legislation has been lifted and shifted from the previous Act, but some things are missing, including national security grounds. We want to understand why that ground has not been included in the Bill. Very occasionally, health events have national security connotations—the Salisbury chemical weapons attack, for example. In such circumstances, restrictions on investigatory capabilities could be necessary. I do not know—I was just interested in why the Government have chosen deliberately to remove that particular clause.

Amendment 56 would allow

“the Commission to recoup charges in excess of the costs incurred in providing assistance.”

The HSSIB programme is world-leading. People look at it from across the globe, and some have asked for training or information on it, for which we have been able not just to recoup costs but actually charge. I do not understand why the Government have removed that provision, because it is an opportunity for them to get extra money without taking it off people in taxes. Do the Government want HSSIB to lose its international standing, or do they want British taxpayers to subsidise training for foreign health services? It is not clear. I would be grateful if the Minister explained that.

We need to come back to what the hon. Member for Bury St Edmunds and Stowmarket said at the beginning: what is the purpose? The purpose is patient safety.

Sojan Joseph (Ashford) (Lab)The point about patient safety is absolutely important, as every Bill Committee member would agree. The number of patient safety incidents has been going up for the last 10 years. Between 2015 and 2022, there was a 62% increase in patient safety incidents in this country, and since the creation of HSSIB, the number of incidents has again gone up. Does the hon. Member agree that the CQC, which has access to all patient records and all documentation in any healthcare settings in real time, would be able to monitor the improvement and progress that each provider is making following the learning from each incident? That would be important and helpful, as the HSSIB has limited ability to look into documentation and clinical notes.

Dr JohnsonI thank the hon. Gentleman for that intervention, but I think this comes to part of the problem. When producing a list of faults—of things that are wrong with the service—and saying, “We need to improve the culture; it needs to be better”, we need to ask, “Okay, but how? What will be the deliverable, measurable way of doing that? How will we go about improving things?” For example, let us say that there is a problem with patients with aortic dissection, so how will we prevent that? The benefit of HSSIB is that it produces a plan, the plan is implemented and patients are safer. Part of this is about the delivery plan.

As for the other part, the hon. Member talked about monitoring progress, but that is not the job of HSSIB. If a mistake or an event happens, it is investigated by HSSIB—HSSIB produces a set of investigations based on understanding how and why it happened, because of the safe space—and then those recommendations are put forward to the Government. The Government then, ideally, implement those changes. The Minister is there to ensure that those are implemented. It will be her job to ensure, having decided which recommendations are to be implemented, that that is done fully and properly. It is a separate function. The CQC is a regulator, HSSIB is an investigator, and the Minister is there to ensure that things are delivered properly.

Going back to patient safety, at the end of my interview, I essentially told the panel, “I cannot tell you that anything is 100% safe”. The assurances that can be provided are that the staff and equipment are available, that training is available for people to do the job, and that processes are in place to identify shortcomings and learn from them, so that they are not repeated. That is key: to find the learning and spread it more widely. As the hon. Gentleman said, implementation is a challenge. It is possible to implement this on an individual basis or to implement a lesson in a unit that has had an error or mistake. Spreading it more widely, so that this is heard in every unit across the country, is more challenging. Fundamentally, I do not think I have heard anything from any of the Ministers, and I do not think it is in the Dash report either, to explain why the Government believe that rolling HSSIB into the CQC with all the problems that it might cause—the risk of it suing itself over whether the safe space is available or not—makes patients any safer.

10:15:00

Decluttering a landscape does not make patients any safer. Rolling HSSIB into the CQC does not make anything safer. In fact, one of the fundamental things I do not understand about this is that the Government say, “Don’t worry, it’s okay—we’re basically recreating HSSIB within the CQC,” in which case they have not decluttered the landscape; they have just hidden it and sort of pushed it out of the way within the CQC. They have not removed it. Either they have decluttered the landscape and removed it, or they have not. It does not seem clear which the Government think they have done. I would be grateful if, when the Minister wraps up her comments, she could explain why she thinks this move will improve patient safety for us all across the NHS.

Helen MorganI declare an interest as a member of the all-party parliamentary group on patient safety, which is opposed to the changes to HSSIB proposed in the Bill. Over the last couple of weeks, we have been reminded why we need an appropriate safety landscape when things go wrong. We have had the Donna Ockenden review into Nottingham maternity services. We have had Baroness Amos’s national review into the picture following a range of maternity scandals across the country. Yesterday evening, I attended the debate on the regulations to compensate victims of the infected blood scandal. Safety is at the top of all our minds at the moment, as it should always be.

Something that has come across very strongly from Members of all parties, on both sides of the House, is that culture is critical to ensuring that those types of issues—the huge scandals—never happen again. Indeed, smaller scandals must never happen again, because people need to be free. Staff in particular need to have the confidence that, if they report concerns about the way they operate, they will be safe to do so without jeopardising the rest of their career, and that those concerns will be acted on and the lessons learned. Everybody here wants to achieve that. I do not think anybody is arguing about the fundamental principle that, when there are concerns, they need to be raised in a safe place and that the lessons from those concerns need to be learned.

That is why I share the lack of understanding of the shadow Minister, the hon. Member for Sleaford and North Hykeham, about why rolling HSSIB into the CQC will change that culture, because the CQC is a regulatory body and HSSIB is an investigatory one. Their missions are fundamentally different. Putting them together compromises the independent investigation element in a way that is very difficult to overcome. We were told in the evidence to the Bill Committee by HSSIB’s chief executive that it is often told, “We tell you this; we wouldn’t tell a regulatory body.” It is clear that this perception of safety is critical to the way in which people interact with HSSIB.

We also heard in evidence to the Committee that the CQC warned that, as it stands, the Bill could leave it fighting against itself in the High Court. We could get a scenario where the regulatory arm of the CQC sought access to HSSIB’s confidential investigation reports, while HSSIB, the investigative branch, tried to keep them secret to protect its independence. That is not a situation anyone wants to end up in, and I am sure that is not the intention of this clause.

I think the shadow Minister has already made this point, so I will not labour it, but it is also important that the investigatory body must be able to examine the regulatory frameworks, commissioning decisions and oversight arrangements without institutional conflict. When I look back, for example, at the scandal that unfolded at Shrewsbury and Telford hospital NHS Trust over the maternity failings, I see that the CQC had given that trust a good rating during the course of all those terrible things going wrong. The CQC’s process clearly failed in that situation. It is difficult to imagine an arm of the CQC turning around in that scenario and saying that the CQC got its own assessment wrong. If it had tried to do that, it is difficult to imagine how that might have played out and that people might have had confidence in raising that problem.

I am also concerned about this because, as the Minister has alluded to, the CQC has faced significant criticism and publicly admitted that it has failed to carry out its functions to the best of its abilities over recent years. Although I welcome the Minister’s assurance that the transfer would happen only once the CQC was in a better place, the CQC might—again—be part of the problem in some instances, and HSSIB must be able to point to that where appropriate.

Lib Dem amendment 5 attempts to introduce the principle that, if this must happen, there needs to be a firewall in the CQC to keep HSSIB operationally independent. To achieve that, the amendment proposes to insert into the process a committee that is operationally independent of—with a majority of people who are not on—the CQC. Opposition new clause 42 seeks to do the same thing. I would be open to any suggestions that the Minister might make to reassure us that HSSIB will continue to be operationally independent, for all the good reasons that hon. Members have outlined.

Gregory StaffordBefore I address the clauses, I say for the record that 21 years ago this morning, 52 people were murdered and 784 injured by Islamist terrorists in London. I pay tribute to all the medical professionals who treated those people in such difficult circumstances.

I will speak to clauses 59 to 63 together because they all concern one of the most significant structural changes proposed in the Bill: the abolition of the Health Services Safety Investigations Body as an independent statutory organisation, and the transfer of its functions to the Care Quality Commission. At first glance, that may appear a relatively modest machinery-of-government change. The Minister argues that HSSIB’s functions will continue, its statutory safe-space protections will remain and operational independence will somehow be preserved. However, when one examines the evidence presented to the Committee, and that given to the Health and Social Care Committee, of which I am a member, it becomes increasingly difficult to identify the problem that this merger is intended to solve. Instead, what emerges is a remarkable degree of consensus among those with the greatest expertise in patient safety that this proposal carries significant risks while offering little measurable benefit.

The question before us is therefore not whether HSSIB’s statutory functions can be transferred to another organisation, but whether Parliament should abolish an institution that it deliberately created to be independent. That distinction matters. Across public life, we recognise that effective scrutiny depends on institutional independence. Government expenditure is examined independently by the National Audit Office, citizens complain to independent ombudsmen rather than to the organisations about which they are complaining, air accidents are investigated independently by the Civil Aviation Authority, and rail accidents are investigated independently of the regulator. In each case, Parliament has recognised that organisations charged with investigating failures should not also be responsible for regulating, inspecting or enforcing against those they investigate. Healthcare should be no different.

Indeed, if anything, healthcare should demand an even greater degree of independence. Learning from failure depends on the confidence of patients, clinicians and families that they can speak openly and without fear that the information that they provide will later be used for regulatory or enforcement purposes. That is precisely why HSSIB was created. Its purpose was never to attribute blame but to understand why systems fail, identify the underlying causes of patient harm and ensure that lessons are learned before similar tragedies occur again. That philosophy represented a deliberate shift away from a culture of blame and towards one of learning. It was modelled consciously on the air accidents investigation branch, whose success over many decades has demonstrated that independent, no-blame investigations produce better safety outcomes than investigations driven primarily by enforcement.

It is therefore difficult to understand why the Government now seek to move away from the model that other safety-critical industries continue to regard as fundamental. Clause 59 would abolish that independent body and transfer its functions to the Care Quality Commission. In doing so, it would bring together two organisations with fundamentally different statutory purposes, different powers and, perhaps most importantly, different cultures. HSSIB investigates and the CQC regulates. One exists to ask why the system failed; the other exists to ask whether the organisation complied with required standards—those are not the same questions. Nor do HSSIB and CQC require the same relationship with those from whom evidence is obtained. An investigation depends on trust; a regulator depends on compliance. An investigator encourages candour; a regulator necessarily retains enforcement powers. The different roles are not a weakness of the system; they are precisely why Parliament chose to establish separate organisations.

I would be grateful, therefore, if the Minister could explain what assessment has been made of the impact on public confidence of the investigator and the regulator becoming part of the same statutory organisation. More specifically, what assessment has been made of the likely effect on clinicians’ willingness to speak openly if the organisation receiving confidential evidence also contains the regulator responsible for inspecting and enforcing standards? That concern has been expressed not only by the Opposition, but repeatedly by independent experts—and indeed, we just heard the hon. Member for Lewisham East asking similar questions.

Even the Care Quality Commission has expressed reservations. Evidence that it submitted to the Health and Social Care Committee earlier this year acknowledged that a lack of clarity remains regarding the respective roles of HSSIB and the CQC. Rather than resolving that uncertainty, the proposed merger risks deepening it. The CQC warned that preserving an effective separation between its investigatory and regulatory functions would be essential if confidence in HSSIB’s safe space were to be maintained, and it recognised the genuine risk of perceived conflicts of interest if those functions become blurred. I think that should give the Committee pause for thought. When the organisation receiving the additional responsibilities is itself warning about the difficulty of maintaining the boundaries, we should listen very carefully. If the CQC believes that the risks exist before the merger has even taken place, what confidence can Ministers offer that those risks will somehow disappear afterwards? Similarly, the all-party parliamentary group on patient safety, of which I am a member, has expressed concern that HSSIB should remain institutionally independent so that its evidence-based recommendations can continue to command confidence across the health system.

Such concerns, as I said, are not confined to Parliament, nor are they confined to one political party. They are shared by patient safety organisations, healthcare professionals and those directly involved in investigating serious incidents. During our oral evidence sessions, I put a straightforward question to Dr Penny Dash. I observed that I could find almost no one apart from her and the Department who believed that moving HSSIB into the CQC was the right course of action. That was not intended as some sort of rhetorical flourish; it reflected the evidence before us. Former Secretaries of State, patient safety experts, independent investigators and numerous professional organisations have all questioned the proposal.

Despite the breadth of concern, the Government have not produced compelling evidence that HSSIB, as presently constituted, is failing. Nor have they demonstrated that the separation between investigation and regulation is itself creating harm. Instead, Ministers have repeatedly assured us that HSSIB’s operational independence will remain, that safe space protections will remain and that independent investigations will remain. If that is indeed the Government’s position, an obvious question follows: if HSSIB will continue to operate independently, if its investigations will continue to be conducted independently and if its statutory protections will remain intact, why is it necessary to abolish the independent organisation at all?

That question goes to the heart of clauses 59 to 63, and throughout the evidence presented to the Committee, I have heard no convincing answer. The Government ask Parliament to believe that everything that makes HSSIB valuable will continue unchanged, but at the same time, they ask Parliament to dismantle the very institutional structure deliberately designed to protect those characteristics. That is not merely an administrative contradiction, but a constitutional one. If institutional independence genuinely matters, it should be preserved. If institutional independence does not matter, Ministers should explain why Parliament was wrong to establish it in the first place.

That question of necessity leads directly to the Government’s principal justifications for clauses 59 to 63, the Dash review. The Government have repeatedly relied on that review as the intellectual basis for abolishing HSSIB as the independent body, yet when one examines the report and the evidence given by its author to this Committee, the case becomes increasingly difficult to sustain.

Without doubt, the review identifies a genuine problemit concludes that the patient safety landscape has become crowded and in places confusing. Dr Dash told the Committee that she had identified more than 150 organisations operating across the wider patient safety landscape, and that clinicians were spending considerable time responding to different organisations, requesting information, completing forms and participating in overlapping reviews. She said that the system had become “busy and confusing”, and that that was distracting clinicians from improving the quality of care.

10:30:00

Nobody disputes that unnecessary bureaucracy should be reduced, or that duplication should be removed where it genuinely exists. Nor, I think, would anyone argue against simplifying an over-complex landscape, if doing so allowed frontline clinicians to spend more time caring for patients. The question, however, is whether HSSIB is the problem—and when one examines the evidence, the Government have not demonstrated that it is. Indeed, HSSIB represents only a tiny proportion of that landscape. In its first 30 months of operation, it produced just 38 recommendations. Its annual budget is around £6 million. By comparison, more than £160 million is spent each year across patient safety activities. The overwhelming majority of recommendations within the system do not originate from HSSIB at all, but from regulators, public inquiries, royal colleges, NHS England and many other organisations.

I ask the Minister againif the concern is excessive bureaucracy across more than 150 organisations, why have the Government chosen to abolish one of the smallest, most focused and arguably most cost-effective organisations within that landscape? How does removing one body, responsible for just a handful of carefully targeted, systematic investigations, simplify the wider system in any meaningful way? Where is the evidence that HSSIB is responsible for the duplication identified in the Dash review?

These are important questions because, during her evidence, Dr Dash repeatedly referred to simplification and alignment. She explained that:

“The point of bringing it into the CQC…is that we are trying to simplify this landscape…The hope…is that by bringing HSSIB into the CQC, you can align the work of the two.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]

But alignment is not, in itself, an argument for abolition. Many organisations work alongside one another, but that does not mean they should be merged. Indeed, through public administration, we deliberately maintain institutional separation precisely because organisations fulfil different constitutional functions: investigators are different from regulators, auditors from departments, and ombudsmen from the bodies about which complaints are made. That separation is not duplication—it is a safeguard.

As my hon. Friend the Member for Harwich and North Essex said, the Dash review gets some basic facts wrong. It claims that HSSIB could not retain maternity investigations because the Health and Care Act 2022 made no provision for them. In his words, that is

“wrong in fact and law.” —[ Official Report , 6 July 2026; Vol. 789, c. 143.]

The problem was not powers; it was safe space protections. Why have Ministers accepted that assertion and many others that are simply untrue?

The review then claims that HSSIB has extended beyond its remit by “making…systemic recommendations”. My hon. Friend called that “complete nonsense”; HSSIB was created to do exactly that. Like the AAIB, the marine accident investigation branch and the rail accident investigation branch, it exists to identify system failures and recommend change. That was Parliament’s intent from the outset. My hon. Friend speaks with particular authority because he chaired the Select Committee that proposed HSSIB and the Committee that scrutinised the legislation. Why are Ministers relying on a review that misstates both the law and Parliament’s intent?

Most concerning is recommendation 3 in that report—as my hon. Friend calls it, the “fundamental flaw in Dash”—which proposes that most safety investigations remain with provider organisations. Yet, as the hon. Member for North Shropshire has pointed out, Ockenden and Amos exposed the weaknesses of trusts investigating themselves. Families do not trust organisations to mark their own homework, and neither do clinicians and patient safety groups. Amos was clear: when families lose confidence in a local investigation, they should have access to an independent one. If not HSSIB, then who? That is the question Ministers have yet to answer.

During our evidence session, my hon. Friend the Member for Sleaford and North Hykeham asked Dr Dash directly about the obvious conflict created by merging HSSIB into CQC. Dr Dash’s response was strikingly brief. She said,

“I do not see a conflict. I think they are complementary”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q3.]

With respect to Dr Dash, that assertion does not answer the concern. Two organisations may be complementary; that does not mean they should become one. The police and the Crown Prosecution Service are complementary, as are the National Audit Office and the Treasury, and the air accidents investigation branch and the Civil Aviation Authority, yet Parliament deliberately keeps those institutions separate, because each performs a fundamentally different role.

I therefore put a series of questions directly to Dr Dash during our evidence session. I reminded her that the King’s Fund, Nuffield Trust and the Health Foundation appeared before the Health and Social Care Committee, and all three advised against bringing HSSIB into the CQC. I observed that no one apart from her and the Department thought it was a good idea, and I think that observation remains true today. Concerns have been raised by former Health Secretaries, patient safety organisations, the professional bodies, people working within HSSIB, academics specialising in patient safety and even the Care Quality Commission. That breadth of concern must give Ministers pause.

I then asked Dr Dash what I believe is the central question before this Committee:

“if…the safe space element would be retained and HSSIB would operate as an independent organisation, how can you square the fact that it would remain independent and yet be part of the CQC? If it does remain independent, what is the need to bring it into the CQC?” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]

I have reflected carefully on her answer. She returned once again to simplification. She spoke about aligning work and reducing duplication, but did not explain why abolishing the independent statutory body was necessary if, as the Government repeatedly assure us, operational independence, safe space protections and investigative independence will all remain exactly as before.

That contradiction runs throughout the Government’s case. On the one hand, Ministers tell us that nothing of substance will change. On the other, they ask Parliament to dismantle the very institutional framework that Parliament itself established only a few years ago. Those two positions cannot comfortably co-exist. If institutional independence is essential to maintaining confidence, it should remain institutional. If institutional independence is unnecessary, Ministers should explain why Parliament was right to legislate for it in the first place. The Government cannot simultaneously argue that HSSIB’s independence is indispensable while abolishing the independent institution itself.

Nor is this simply an academic debate about organisational charts. This goes directly to confidence. Patients, families and clinicians do not read statutory drafting before deciding whether to speak openly. They judge organisations by what they are. Today, HSSIB is clearly understood to be an independent safety investigator, but if this Bill became law tomorrow, it would sit within the Care Quality Commission—the body responsible for regulating, inspecting and assessing providers.

However carefully the internal governance arrangements are drafted, public perception will inevitably change. Once confidence in independence is weakened, rebuilding it may take many years, which is why I remain unconvinced that the Government have demonstrated either the necessity or the proportionality of these clauses. They have identified a real challenge across the wider patient safety landscape, but they have yet to demonstrate that abolishing one of the few internationally respected independent safety investigation bodies is the appropriate solution.

If the Government’s argument is one of administrative efficiency, the evidence we have heard from those who have spent years improving patient safety demonstrates why efficiency cannot come at the expense of independence. Perhaps no witness was better placed to address that than my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt). As the longest-serving Health Secretary in recent history and the Minister who championed a new approach to patient safety following a number of tragic failures in the NHS, he reminded the Committee why HSSIB was established in the first place. He told us that

“the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned.”

That comparison is fundamental. The Government present this merger as though it were merely an organisational restructuring, but it is not. It represents a departure from a principle that has underpinned accident investigation in every major safety-critical industry for decades. Those functions are deliberately separated because investigators must earn the confidence of those whose evidence they seek. The objective is not to establish blame, to prosecute or even primarily to determine liability; it is to understand why the system failed so that the same tragedy does not occur again.

My right hon. Friend explained exactly why the model was adopted for healthcare. He said:

“The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn.”

That sentence captures the entire philosophy behind HSSIB. Safe space is not a procedural convenience; it is the mechanism through which investigators obtain the evidence that would otherwise remain hidden. People speak honestly because they trust the institution. They trust that investigators are there to understand, not to punish. That trust cannot simply be written into legislation.; it has to be actually earned. It must be protected, for once it is lost, it is extraordinarily difficult to rebuild.

My right hon. Friend went on to a very clear conclusion:

“I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 29-30, Q52.]

That is a remarkable piece of evidence. The architect of this approach to patient safety is telling us that the feature of HSSIB that has proved most successful is the very feature that these clauses place at risk. He is not arguing that safe space will disappear overnight; he is making a more subtle and, I would suggest, more important point. Safe space depends upon confidence, confidence depends upon independence, and independence depends not only upon statutory wording, but upon institutional identity. Patients, clinicians and families know today that HSSIB is separate from the regulator. However carefully Ministers draft governance arrangements, that perception will inevitably change.

The Government repeatedly assure us that operational independence will remain, but operational independence is not the same as institutional independence. Indeed, that distinction was brought into sharp focus during our evidence sessions. Dr Rosie Benneyworth, the chief executive of HSSIB, explained why safe space matters in practical terms rather than in legal theory. She said:

“Safe space…means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs.”

She went on to describe the reality within today’s NHS:

“We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns…we are still working in a culture of fear.”

That evidence should concern every one of us on the Committee. The success of HSSIB was never based on an assumption that the NHS already possessed an open speaking-up culture—quite the opposite. It was created precisely because too many staff still fear the consequences of speaking openly.

Dr Benneyworth continued by explaining that the HSSIB’s independence gives confidence not only to staff, but to patients. She said:

“This enables staff working in the service and patients to talk to us freely…Patients sometimes worry that they will be treated differently…This enables patients to talk to us in the knowledge that they will not be named.”

Perhaps most tellingly of all, she described the trust that HSSIB has spent years building. She said:

“We are now in a stage where we are growing that trust…When we launch an investigation, organisations right across the country say, ‘Please come and see what’s happening here.’…I worry that that might be impacted by the changes ahead.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]

Those are not the words of an organisation resisting change for its own sake. They are the considered concerns of the organisation that Parliament established specifically to investigate patient safety without fear or favour.

The Government argue that statutory protections will remain. I do not doubt the sincerity of Ministers in making that commitment, but we cannot legislate for trust. Legislation cannot compel confidence, and it cannot guarantee that a frightened junior doctor, an agency nurse or a bereaved family member will feel the exactly the same about approaching an investigator housed within the regulator as they do about approaching an entirely independent statutory body. It is not a legal question; it is a human one.

Dr Benneyworth recognised that if Parliament proceeds with the proposal as outlined in these clauses, the legislation must go further than it currently does. She told us that there needed to be

“much more clarity about governance…to protect independence”

and that

“it is vital that there is a legal duty for the CQC to protect safe space.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 26, Q44.]

Even the organisation being abolished is telling Parliament that the safeguards in the Bill are insufficient.

I therefore return to the central question. If the Government’s objective is to improve patient safety, why jeopardise one of the very few organisations that has successfully built trust among clinicians, patients and families? Why weaken confidence in the one institution specifically designed to investigate systematic failure, independent of regulation and enforcement? Why abandon a model that aviation, rail and every other major safety-critical industry continues to regard as essential? Those questions remain unanswered.

Dr Dash sought to challenge the comparison with aviation. She accepted that she was aware that the air accidents investigation branch and the Civil Aviation Authority are two separate organisations. She argued, however, that healthcare was somehow different. She told the Committee:

“the more I have looked into it, the more I think there are limits to that analogy.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 9, Q11.]

She suggested that aviation investigations were more focused on identifying specific technical failures such as a faulty component, and that healthcare safety issues were broader questions about the quality of care.

With respect, I do not think that argument addresses the fundamental point. The lesson from the aviation industry is not whether a safety failure involves a bolt on an aircraft, a medication error in a hospital or a failure in a clinical pathway. The lesson is about how high-risk systems learn. The principle is that those investigating failures must be trusted by those who provide the evidence, and that principle does not depend on whether that failure occurred at 30,000 feet or at the bedside. Indeed, the more complex the system, the more important that independence becomes.

Modern healthcare, as I think we all know, is one of the most complex systems in society. When something goes wrong, the cause is rarely a single individual’s mistake; it is usually a combination of pressures, incentives, processes, communication failures and organisational decisions. That is precisely why HSSIB exists. Its purpose is not to determine who should be blamed, but to understand why the system allowed harm to occur. That distinction is fundamental.

10:45:00

Joe Robertson (Isle of Wight East) (Con)My hon. Friend is making a comprehensive speech and getting to the nub of all the relevant points. He talks about the system failing; to me, that is the absolute nub. The CQC is absolutely part of the system and of the establishment. If anyone is put off from making a complaint to the CQC when they think the CQC may be to blame, how on earth can the functions currently exercised by HSSIB continue in any effective way?

Gregory StaffordMy hon. Friend makes several key points, and he is absolutely right: what problem are the Government trying to solve here? If we believe in independence, believe in an investigatory body and believe it is working well—and it demonstrably is working well—why on earth would we change it? That goes to a further point: these clauses not only potentially provide for a transfer of HSSIB into CQC but add risk and failure in that procedure.

My hon. Friend asks how we can be confident that the system is going to work if a patient or a clinician does not want to put their head above the parapet because they are frightened that there will be regulatory consequence. That is a fundamental problem with the Government’s proposal. As I have said several times in this speech, we have not had the answer to that and no answer seems to be forthcoming. I may touch on that in a bit more detail in a moment.

My right hon. Friend the Member for Godalming and Ash was clear on this topic when he gave evidence to the Committee:

“My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 29, Q52.] That is the problem that HSSIB was created to address and why I struggle with the Government’s argument. If the problem is that the NHS does not learn lessons effectively, the answer should be to strengthen the organisation designed specifically to help it to learn, not to weaken the independence of that organisation. My right hon. Friend the Member for Godalming and Ash identified the precise part of the system that remains broken. He said:

“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.] That is the crucial point. The Government’s justification for the merger appears to be based on a concern that there are too many recommendations, too many reviews and too much duplication, but the evidence of my right hon. Friend highlights a different problem. The issue is not that we do not know what needs to change but that we too often fail to act on what we already know. The answer to that problem is not fewer independent investigations but stronger accountability for implementing recommendations. Indeed, my right hon. Friend made that point powerfully in his evidence. He explained that

“What there needs to be is a formal system with a legal obligation on the Government.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q53.] He warned that too often recommendations disappear into what he described as “agree in principle”, which allows organisations to acknowledge a problem without committing to a timetable for fixing it.

The Government are proposing structural change because recommendations are not always acted on, but the problem is not the existence of HSSIB; it is the absence of sufficient accountability when recommendations are made. The Government appear to be addressing the wrong failure. There is another important point from my right hon. Friend’s evidence. He explained that one of the long-term purposes of HSSIB was to reduce the need for expensive public inquiries. He told the Committee that

“Ideally, when something goes wrong, what you want is for there to be an investigation and for lessons to be learned, so that grieving families can say, ‘Well, at least we are confident that this wouldn’t happen again.’”

However, because families often lack confidence that lessons will actually be learned, they understandably seek public inquiries. My right hon. Friend explained:

“families still think the only way they can get real change is through a public inquiry” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 32, Q56.] That is an important warning. If confidence in HSSIB is reduced, the unintended consequence may be more public inquiries, not fewer—more cost, more delay and, most importantly, more time before lessons are learned and acted on. That is the opposite of what the Government say they want to achieve.

The Government’s second argument is that safe space can be protected through legislation. I accept that Ministers intend to preserve those protections; however, the evidence we have heard demonstrates that the issue is not simply one of statutory wording but of culture and confidence. My right hon. Friend the Member for Godalming and Ash gave a particularly important example: he explained that the CQC plays a vital role because it rates healthcare organisations. Hospitals and GP practices care deeply about whether they are rated “outstanding”, “good”, “requires improvement” or “inadequate”. His concern was this:

“If a staff member is talking openly to HSSIB about a failure of governance in their organisation, and that is the same organisation that could decide whether they get stripped of their ‘outstanding’ rating and downgraded to ‘good’ or ‘requires improvement’, my concern is that some people may worry and say, ‘Maybe I shouldn’t be open, because this could affect my hospital’s rating.’” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 33-34, Q59.] That is the practical problem: the Government’s argument relies on the assumption that staff will distinguish perfectly between different parts of the same organisation, but the concern is that a frontline clinician may not see those internal distinctions. They may simply see that the investigator and the regulator now sit under the same roof. When people are deciding whether to disclose something that may have consequences for themselves, their colleagues or their organisation, perception matters. As my right hon. Friend said,

“we have to be really careful that people still have confidence in the safe space function if this merger goes ahead.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 34, Q59.] A similar point was made by Professor Carl Macrae from the University of Nottingham. While giving evidence to the Health and Social Care Committee, he said that it is difficult to conceive how legislation alone could overcome the fundamental conflict created by merging an independent safety investigation body with a regulator, given that the two organisations perform inherently different functions.

The Government’s case depends on trust surviving that merger, but the evidence tells us that trust is precisely what is at risk. Dr Benneyworth made a similar point from HSSIB’s perspective. She told this Committee: “There needs to be much more clarity about governance and how that will work in the legislation to protect independence.”

She went further and suggested that if the Government proceed, there would need to be much stronger safeguards, including

“a legal duty on the CQC to protect the safe space.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 26, Q44.] That evidence is significant because it is not a witness arguing that change is impossible; it is the organisation at the centre of this proposal telling this Committee that the legislation, as drafted, does not provide sufficient reassurance.

The Government’s response cannot simply be that they intend to be careful. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that the integration would be approached with “enormous care”, but we have to ask what that actually means in legal terms. Where are the enforceable safeguards? What prevents a gradual erosion of independence once HSSIB is part of the regulator? History tells us that institutional safeguards matter precisely because they protect against future changes in culture, leadership or priorities. A body can begin with the best of intentions, but still drift over time—that is why Parliament creates independent institutions in the first place. It is not because Ministers are untrustworthy; it is because good governance recognises that structures matter. In this case, the structure matters enormously.

Those concerns become even more significant when we consider the legal framework around protected information and the practical operation of safe space. The Government’s argument appears to rest on the belief that if the right protections are written into legislation, the independence of HSSIB can be preserved, but the evidence we have heard suggests that the challenge is much more fundamental. The question is not simply whether information is legally protected but whether staff, patients and families will continue to believe that it is protected. That distinction matters.

During our evidence session, Dr Benneyworth highlighted a very specific concern about the drafting of the legislation. She explained that, at present, the clauses related to connected individuals could create uncertainty about who in the CQC might have access to protected material. She said:

“The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.” — [ Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.] That is the crucial point: the success of HSSIB depends on confidence that information provided in confidence will remain within the investigation process. If there is uncertainty about whether information could move elsewhere in the organisation, the very existence of that uncertainty risks undermining safe space.

Dr Benneyworth went further. She explained:

“There needs to be a legal duty on the CQC to protect the safe space.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 25, Q41.] That is a remarkable admission. The organisation whose functions are being transferred to the CQC is telling Parliament that the Bill, as drafted, does not provide that sufficient certainty. The Government’s response cannot simply be that everyone involved will act in good faith. Good governance requires more than good intentions; it requires a structure that protects independence, regardless of who happens to lead an organisation in future, who is Secretary of State or who is in government. That is why Parliament creates these independent bodies in the first place.

There is also a practical issue that cannot be dismissed. Dr Benneyworth explained that HSSIB is unique because it can investigate every part of the healthcare system, including national bodies. She told the Committee:

“At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 23, Q38.] That includes looking at how national systems operate, how regulators function and how different parts of the health service interact. That independence is important, because sometimes the problem is not the provider delivering care; sometimes the problem is the system around it.

A regulator may look at whether an organisation has complied with standards; an independent investigator may ask a different question: why did the system make it possible for failure to happen? The questions are complementary, but not interchangeable. Dr Benneyworth made precisely that point when discussing national failures. She explained that some problems cannot be solved by regulating an individual organisation, because the underlying issue sits elsewhere in the system. She said that is not something that can be changed by a regulator—a fundamental distinction. Regulation can identify whether standards have been met and independent investigation can identify whether the system itself needs to change. Both functions are necessary, but combining them risks weakening both.

Those concerns sit within a wider challenge on candour in healthcare. The statutory duty of candour was introduced following the Francis inquiry into the failures of the Mid Staffordshire health trust. The duty’s purpose was straightforward: when something goes wrong, patients and families should receive an honest explanation. Despite that legal duty, however, evidence remains of a defensive culture within parts of healthcare. Legal advice can sometimes encourage organisations to think first about liability, rather than about learning. Administrators can understandably become concerned about litigation risk—and where fear dominates, openness suffers. That is precisely why the safe space matters.

HSSIB was created to provide an environment where the priority is not defending an organisation, but understanding what happened. If we weaken confidence in that environment, we risk making the wider culture of candour even harder to achieve. The irony, of course, is that the Government argue that the merger will strengthen patient safety, and yet the evidence suggests that it could weaken one of the most important ingredients of patient safety: openness.

I also want to express concerns shared with me directly by people working within HSSIB. During a meeting with some of my constituents who work in the organisation, individuals involved in patient safety investigations raised significant concerns about the proposed move. They believe that bringing HSSIB into the CQC represents a backward step for patient safety. They also expressed concern that the rationale for the merger has shifted. Initially, the argument appeared to focus on streamlining and reducing duplication; increasingly, however, it appears to be about reducing the number of safety recommendations being made. That misunderstands the problem. As I have pointed out before, the challenge is not the existence of recommendations but ensuring that those recommendations lead to action. Indeed, I was informed that HSSIB has already been developing a recommendations monitoring system, specifically designed to improve implementation and oversight. In other words, the organisation is already working to address the very issue now being used as justification for restructuring it. That brings me back to the evidence given by my right hon. Friend the Member for Godalming and Ash. He identified what I believe to be the central weakness in the Government’s argument:

“the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 30, Q52.] That is the point that Ministers need to answer. If recommendations are not being implemented, strengthen implementation; if accountability is weak, strengthen accountability; and if learning is not embedded, create mechanisms to ensure that learning happens—but do not weaken the independence of a body responsible for identifying those lessons. The risk is that the Government solve the wrong problem. They will remove the independence of the investigator, while leaving untouched the failure to act on what investigators discover.

After considering the evidence presented to this Committee, the evidence that we heard in the Select Committee and my conversations with my constituents and others, I remain unable to support clauses 59 to 63. That is not because I oppose reform or believe that the patient safety landscape cannot improve—of course it can. The NHS must continue to learn, adapt and improve, but improvement requires honesty about what is working and what is not. The evidence suggests that HSSIB’s independent investigative model is one of the things that is working and that failure lies elsewhere. It lies in whether recommendations are being implemented, whether organisations learn quickly enough and whether staff feel safe enough to speak up. The answer to those problems is not to remove independence, but to strengthen it.

The creation of HSSIB represented a recognition by Parliament that healthcare needed the same principles of independent safety investigation that serve aviation, rail and other high-risk industry so well. Those principles exist for a reason: when something goes wrong, society needs an organisation that people trust to ask what happened, why it happened and what must change to prevent it from happening again. That organisation must be separate from those responsible for regulating the system. It must be able to investigate without fear or favour. It must command the confidence of patients, families and healthcare professionals.

The Government say that the protections will remain, but the evidence we have heard overwhelmingly demonstrates that confidence in those protections is precisely what is at risk. Once institutional independence is removed, it simply cannot be recreated through internal guidance or assurances. The structure matters, the culture matters and the trust matters.

For those reasons, I urge the Minister to reconsider clauses 59 to 63. If the Government believe that improvements can be made to co-ordination, accountability or implementation, discussions on that should absolutely continue and the Opposition would welcome them. However, the clauses go much further. They remove the independent status, which is so important. Given the enormous human and financial cost of avoidable harm in healthcare, Parliament should be extremely cautious before weakening one of the few mechanisms specifically designed to prevent it.

11:00:00

Edward Argar (Melton and Syston) (Con)I am particularly keen to speak on clauses 59 to 63, because HSSIB was a key part of the Health and Care Act 2022, which I took through as a Minister. At that time, I was grateful for not only the fearless and tough questioning from the now Minister, who was on the Opposition Benches, but for her support. She said:

“HSSIB is a really important new body” –– [ Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564.] She also said that it is a

“new and important body, which we are all desperate to ensure works well.” –– [ Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 566.] It is fair to say that it does work well, as my hon. Friend the Member for Farnham and Bordon set out clearly in his detailed remarks. The thread running through his remarks, which is particularly important in this context, was trust. People who have had something go wrong and have reported a problem need to trust that it will be looked at independently and dispassionately.

I fear that what is proposed here results from a deeply misguided decision, which has at the heart of its logic a fundamental flaw. As the hon. Member for North Shropshire set out, the decision fails to recognise that HSSIB’s role is fundamentally different from the role of CQC. It is an independent investigator; it is not a regulator or an enforcer, yet that somehow seems to be conflated in what the Government are trying to do here. They have simply failed to make a logical case for the change.

The hon. Member for Bury St Edmunds and Stowmarket, who I always listen to with great interest on these matters, highlighted that patient safety should be at the heart of this legislation. That is absolutely right, but patient safety goes hand in hand with the confidence of those working in the system to speak out and put forward evidence that will improve patient safety. It is not an either/or; one is complementary to the other. It is important that this safe space remains, because that provides the conditions in which patient safety can be improved.

In her evidence during the first session of this Committee, Dr Dash stated that she found more than 150 organisations operating in this space when she undertook her review. However, in Hansard , she went on to say:

“I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q2.] Only six out of 150? That does not ring true. That is not a tidying-up of the landscape but a very narrow focus. When the Minister comes to her concluding remarks, can she answer who specifically determined those six organisations for Dr Dash and told her to look only at those, ignoring the other 144-plus organisations? We all know that what a review comes up with is, to a large degree, determined by the scope set for it. By picking a mere six out of 150-plus organisations, I fear there is a risk that the scope has effectively, to a degree, stacked the outcome of what would be looked at and what would be concluded.

Before addressing specific concerns about the approach being adopted with the abolition of HSSIB, I want to highlight a real challenge with—even if one accepted the premise, which I do not—where it is proposed the functions are transferred to, as my hon. Friend the Member for Farnham and Bordon set out.

Dr Dash said in her evidence that the CQC

“still has a way to go, and we all need to acknowledge that.”

She went on to say:

“I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 4, Q2.] We are talking about moving an effective organisation into another organisation which, quite apart from whether the merger is appropriate given their different remits, is—by the review author’s own admission in evidence—basically not in a fit state to receive those new functions. I think that has been tacitly acknowledged by the Minister in saying it will only be done at an appropriate time, when the CQC is ready. Therefore, why make those changes at all? At the moment, it does not look like the CQC will be ready, at least in the near future, based on the evidence we have heard.

Dr JohnsonMy right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.

Edward ArgarMy hon. Friend the shadow Minister is right to highlight, for want of a better way of putting it, the cumulative challenges that will potentially be piled on the CQC, on top of the pre-existing challenges with how that organisation is functioning.

I read with great care the Adjournment debate that took place last night in the Chamber, which has been referred to by a number of hon. Members, in the name of my hon. Friend the Member for Harwich and North Essex, and I pay tribute to him for his work in this space. I worked closely with him in the context of the passage of the Health and Care Act 2022, and I know that the issue of patient safety is fundamental to what he seeks to improve and achieve in this House. I agree with him: I fear the Dash review simply fails to make the case for those changes. Also, as hon. Members have set out, it sadly appears to contain a number of errors and assumptions that are inaccurate, which I will turn to in a moment.

The fundamental challenge is to establish a way for people to feel confident and trusting in challenging a culture of denial and blame. We have seen this most recently in the context of maternity failings and scandals. The need for that safe space, and for an organisation able to challenge the institutions, is very clear, and I fear that this change actually weakens the ability to do that. Dr Dash’s review, I fear, fails to fully recognise just how important the safe space concept is—not just in how it is drafted and framed legally but, as my hon. Friend the Member for Farnham and Bordon said, in how it is perceived by those who need to use it. The CQC, of course, has a legal duty to act on information it receives, but that risks being conflated here.

I saw this illustrated last night, for example, in the Adjournment debate, in a comment made by the Minister’s colleague, the Under-Secretary of State for Health and Social Care, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), when she was responding to my hon. Friend the Member for Harwich and North Essex. She was talking about the criteria for disclosing protected information outside the investigative function. She said:

“Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail.”

This is the key point. She went on to say:

“As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space.”

And this is the crux of it:

“That person is likely to be the CQC’s chief executive officer.” —[ Official Report , 6 July 2026; Vol. 789, c. 147.] That is an inherent conflict. If the person who is the head of the regulatory body is making the decision on whether information should be disclosed by HSSIB in its folded-in form, that will do nothing to inspire confidence in disclosure and the safe space provisions. I fear that drives a coach and horses through some of the arguments being made that there are sufficient safeguards within this merger to ensure HSSIB can continue as it has done thus far.

The crux of some of Dr Dash’s arguments appears to be that there are, as the Minister also alluded to, too many recommendations being made and that it is a complex landscape. Yet HSSIB, as my hon. Friend the Member for Harwich and North Essex set out yesterday, has made 56. He went on to say that the 30 or so public inquiries and other investigations have delivered 1,400, so it simply does not follow that HSSIB is the problem in that complex landscape.

What was made very clear by, again, my hon. Friend the Member for Farnham and Bordon is that, of course, the concern is not the recommendations. It is not the organisation making the recommendations that is responsible for the fact that they are not implemented. It is the NHS itself, its inertia, its unwillingness and the Department’s unwillingness to take them forward in a coherent fashion—to drive the recommendations through and monitor whether they have been delivered on by the NHS.

Dr JohnsonOn pages 8 and 9 of the Dash review, Dr Dash talks about this. She states:

“Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.”

She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.

Edward ArgarI do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its

“scope of work beyond the original remit.”

It goes on to say:

“HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.”

I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation.

Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states:

“Most investigations into safety incidents should continue to be managed within provider organisations”.

That is the real challenge here. HSSIB’s independence is what allows it to range across the piece—to have issues raised with it and look at individual organisations. The challenge so often is that the provider organisations are marking their own homework and are simply not getting to the truth, or being as candid with those who have made the complaint as they have a right to expect.

Helen MorganI wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?

Edward ArgarThe hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.

11:15:00

I will just make two further comments. First, in terms of cost, I recognise that the Under-Secretary of State for Health and Social Care set out that this is not about cost last night in the Adjournment debate. At £6.3 million per year, I have to say that that is a tiny amount in the context of overall NHS spending. It is a large amount of money, but it is a tiny amount in the context of the NHS budget. That is money that does an incredibly good job for a relatively small budget as organisations in the NHS space go. I challenge anyone to come up with another organisation within the health and social care space with a budget of £6 million or so that does as much good and has the potential to do as much good when it comes to improving patient safety.

If the argument for this is not about money—if it is about simplifying a complex landscape and having fewer recommendations so that they are implemented—it is, again, the answer to a question that has not been asked. Clause 59 does not do that; it simply shifts HSSIB from A to B. In doing so, it does not save money. It will not necessarily reduce recommendations, of which HSSIB contributes only a small number anyway. What it will do is have a huge cost in terms of public trust and the ability of the organisation to get that open disclosure to be able to drive patient safety.

I gently say to the Minister that I hope that she will take away the strength of the feeling of members of the Committee. I hope that she will reconsider whether this move should be scrapped and whether we should be making these changes. When we should be strengthening measures to protect and enhance patient safety, I rather fear that the clause will do the opposite and risk weakening the provisions that are currently in place.

I know that the Minister is a diligent and thoughtful Minister who knows her brief very well, so I hope that she will reflect on the points made in Committee and reconsider the clauses.

Joe RobertsonIt is a pleasure to serve under your chairmanship, Sir Roger. The issues relating to clause 59, principally the abolition of HSSIB, have been well articulated, not least by my colleagues on this side. I wish to add some of my own views too.

The debate has been framed as a transfer of the functions of HSSIB to the CQC, and indeed that is the title of the clause. The Minister has certainly articulated her arguments in that way. Effectively, it is the abolition of HSSIB. In fact, clause 59(1) plainly says:

“The Health Services Safety Investigations Body is abolished.”

Its functions may be transferred, but that is quite a significant change, and I do not want that to be lost within the context of this debate. At the heart of it is this idea around investigatory and regulatory functions. While the argument remains technical—and it is of course easier for the Government and indeed Dr Dash to make the arguments to abolish HSSIB in the abstract—when we talk about the real-life implications and how real people react to different circumstances, it is plainly very significant and negative.

That is particularly true when it comes to investigating where things went wrong and when the system is at least in question and could be at fault. When there are things that need airing that people are afraid to air, confidence in the new framework is essential. Regardless of the systems, processes or protocols that the Government may wish to put in place to ensure that the safe space concept continues to exist, who on earth, if they are worried about making disclosures, will be satisfied and confident that those in the CQC, who may themselves be at fault, will not learn about a disclosure to the arm of the CQC that is empowered and entrusted with investigating the problem? An independent organisation, which HSSIB currently is, provides not just technical confidence but genuine confidence that people can speak freely on matters that may well be extremely unhelpful to their employer or the CQC—the national regulator itself.

As the hon. Member for North Shropshire noted about the Shrewsbury and Telford situation, it developed while the CQC gave a good rating. It may be that the CQC was fair in doing that, but it does not look good in the eyes of the public, and it will be a consideration for individuals seeking to make disclosures to an investigation. What will the public think?

Gregory StaffordAs I said throughout my speech, I am against this proposal whatever the nature of the CQC. However, does it strike my hon. Friend, as it strikes me, that the problems of moving the functions of HSSIB into the CQC are compounded given that the CQC, as he alluded to, is not functioning well and does not have the confidence of patients and clinicians?

Joe RobertsonMy hon. Friend leads me to a point I was going to make later, but I will make it now. He is absolutely right: the CQC has not had a lot of good press and does not instil a high degree of confidence in professionals and the public. That is a very real issue. The Minister and, I think, Dr Dash have said that the transfer of powers from HSSIB to the CQC will not happen until it is in a better place, and that is all very well, but these changes are intended to last for a long time—indefinitely, presumably. To merely wait until an organisation is in a better place to transfer those powers, and to expect that organisation to remain in a better place in perpetuity, is wishful thinking.

The CQC has had leadership issues. We all hope and I am sure that the leadership will be in a better place in the near future, but if an organisation can be in such a bad place because of a failure of leadership, those circumstances can return in the future. Of course, it might be leadership failings within the regulator that HSSIB is asked to investigate. Again, if its functions are delivered by a regulatory organisation with leadership failings, there will be no confidence whatever that a truly independent and meaningful investigation can take place.

Let us not forget that the public are somewhat jaded by investigations, inquiries and reports—justifiably so. They clearly have a valuable function, but their function is far more valuable if there is confidence in them. If a powerful organisation such as the CQC—the regulator—can effectively mark its own homework, that does nothing to help the reputation of investigations and inquiries with the public. I suspect that the problem with them in the public’s mind is that it always looks a little bit like the establishment is looking at itself and coming up with an argument it can then justify. There is a perception that that does not lead to meaningful change. With this Bill, we will create an environment where that perception is even stronger.

Edward ArgarMy hon. Friend is rightly highlighting the importance of independence, and trust in the independence, of the organisations investigating failures and making recommendations. Does he agree that that is only half of it? Those organisations are not at fault when recommendations are not implemented, so the other half of this is that the NHS and the system need to act on those recommendations when they are made.

Joe RobertsonIt is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it—an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.

Dr JohnsonMy hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or—

The ChairOrder.

11:25:00

The Chair adjourned the Committee without Question put (Standing Order No. 88).

Adjourned till this day at Two o’clock.