Public Bill Committee: Health Bill (Fourteenth sitting)

The Committee consisted of the following Members:

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

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

Brackenridge, Sureena (Wolverhampton North East) (Lab)

† Chambers, Dr Danny (Winchester) (LD)

† Daby, Janet (Lewisham East) (Lab)

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

† Irons, Natasha (Croydon East) (Lab)

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

† Joseph, Sojan (Ashford) (Lab)

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

† Morgan, Helen (North Shropshire) (LD)

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

† Robertson, Dave (Lichfield) (Lab)

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

† Smyth, Karin (Minister for Secondary Care)

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

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

White, Jo (Bassetlaw) (Lab)

Sanjana Balakrishnan, Rob Cope, Committee Clerks

† attended the Committee

Public Bill Committee

Thursday 9 July 2026

(Morning)

[Dr Rupa Huq in the Chair ]

Health Bill

11:30:00

The ChairBefore we begin, I remind hon. Members to switch electronic devices to silent. Tea and coffee are not allowed during the sitting, but there is loads of water—silver is fizzy, blue is flat. I am happy to give a blanket permission for people to take off their jackets. Officially, you are meant to ask me individually, but given the heatwave, take them off if you like.

New Clause 6

Health Data Charter

“(1) The Secretary of State must, within six months of the passing of this Act, establish an independent body (to be known as the "Sovereign Health Data Trust”) for the purpose of creating a Health Data Charter.

(2) The membership of the Trust should include—

(a) people with a diverse range of backgrounds; and

(b) health data experts, clinicians and patient representatives.

(3) The Charter must—

(a) set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS;

(b) include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data;

(c) ensure patients have control of their data, including providing relevant opt-outs;

(d) provide that all health data is held anonymously and accessed through a trusted research environment;

(e) set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS;

(f) be designed in such a way as to render it interoperable with the European Health Data Space in technical terms, including through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles within the NHS.

(4) The Sovereign Health Data Trust will—

(a) hold continuous oversight of all health data and oversee the trusted research environment;

(b) have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit;

(c) ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available;

(d) publish detailed minutes of all meetings discussing potential uses of health data; and (e) ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.”— (Helen Morgan.) Brought up, and read the First time .

Helen Morgan (North Shropshire) (LD)I beg to move, That the clause be read a Second time.

It is a pleasure to serve with you in the Chair, Dr Huq. The new clause would require the creation of a health data charter, and includes measures to protect data so as to ensure privacy and reasonable usage.

Patients should be in control of their data. As we have discussed in previous sittings, we do not think that the Bill goes far enough to provide reassurances in that regard. Everyone agrees with the need for the single patient record, but there is genuine risk—one that I do not think anyone in this room wants—that it could be derailed over very understandable and reasonable data privacy concerns. Sufficient guardrails and transparency are key, especially for secondary uses of health data. As we have discussed on many occasions, trust is essential for the system to succeed.

That is why we have tabled this new clause on a health data charter that would set out guiding principles for data sharing across the national health service, including for the single patient record. It would be led by data experts, as well as, importantly, clinicians and patient representatives. Ensuring that the voices of doctors and patients are heard is central to building trust and the widespread use of any data-sharing systems or technologies.

Gregory Stafford (Farnham and Bordon) (Con)It is a pleasure to serve under your chairmanship again, Dr Huq.

New clause 6 raises an important question on how we govern health data, which one of the greatest assets of the NHS. The development of the single patient record platform and database, and the wider use of the linked NHS data, present enormous opportunities.

When used responsibly, healthcare data can support much more personalised care, improve NHS planning, accelerate medical research, enable earlier diagnoses and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, those benefits can be realised only if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy.

NHS health data is currently overseen by NHS England, following the merger of NHS Digital into that organisation. With the Government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it is right that we consider future governance arrangements. In principle, I agree that an independent body may be needed to ensure and maintain the security, integrity and responsible stewardship of NHS data. There is definitely scope for an independent body to oversee the management and regulation of the public’s health data. That proposal places patient privacy at its heart, and would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymisation and trusted research environments, allowing valuable research to take place while reducing the risk of inappropriate disclosure. We have discussed inappropriate disclosure by a malign actor, or even inadvertent disclosure, during debate on other clauses.

The Liberal Democrat new clause also seeks to address a concern that has attracted significant public attention: where commercial organisations derive substantial value from NHS data, the NHS itself should share in that benefit. Although we did not support a number of Liberal Democrat proposals because of the inadvertent implications of their drafting, I still have sympathy with the overall thrust of what they were trying to achieve. There is a strong argument that the value generated from the data contributed by NHS patients should help to support future patient care and research.

Transparency is another important feature. Publishing data-sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help to strengthen public confidence. The proposed trust would bring those principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data.

Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research. To reassure the Committee that the framework would not create a block or dampener, or insert inertia into the system, will the hon. Member for North Shropshire tell us what evidence she found when drafting the new clause? If we are going to do something like this, the oversight should be proportionate, and it should complement, rather than duplicate or frustrate, any existing regulatory responsibilities.

Ultimately, the new clause has potential benefits. It would establish a clear social contract for NHS health data, which would hopefully protect privacy, support research and innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of a very valuable national asset. In terms of what it could be used for, that data is probably second to none in the world, but I am concerned about adding extra bureaucracy and inertia to the system, when we want a vibrant life-sciences industry that is able to use the data for the benefit of British citizens and patients. What does the hon. Member for North Shropshire think would happen in that case?

Joe Robertson (Isle of Wight East) (Con)It is a pleasure to serve with you in the Chair, Dr Huq.

My hon. Friend the Member for Farnham and Bordon has set out the arguments clearly; I will just add some of my own views. As he stated, the single patient record provides a unique and special opportunity to improve efficiency across the whole health and social care space and to empower patients, but it faces significant challenges. As I said in an earlier sitting, perhaps one of the biggest challenges is ensuring that it means something in practice. In a previous debate, the Minister helpfully clarified that the data currently held on a great variety of databases and electronic record-keeping systems in the NHS will remain on those wide and disparate recording systems. It seems that the advantages will be realised only if those systems are able to speak together and are fully interoperable. I know from a previous time in my career that, in reality, many such systems are not interoperable or are only part-interoperable, and that, even where they do speak to one another, the data is collected and recorded in different ways. Simple things—someone’s name, their age or the principal field of the issue for which they are presenting to a clinician—are recorded, but because the systems are not standardised, that data cannot be transferred between them easily.

The advantages of the single patient record will be realised only when all those systems are unified in some form, but the Bill does not address that directly. I am not necessarily suggesting that it should, but I do not see the Government acknowledging anywhere that systems are contracted and provided by private providers through procurement processes at a local level, and asking, “How do we knit that all together?” It seems that somebody somewhere will have to produce some gateway software or system to allow the single patient record to be accessed. If every other existing system needs to be able to feed into that, the public sector will have a huge role, and the private sector will sit behind it to try to deliver that. It seems a huge project that could be fraught with difficulty, it could take many years before the single patient record is established, regardless of when the Bill is passed—although I am sure it will be passed fairly soon.

New clause 6 seeks to address another significant issue with the single patient record: security and the control of data. The single patient record, if fully realised, will make it easier for data to be accessed and shared. Its very purpose is to ensure that systems and services are more integrated and data flows more freely, to avoid the ridiculous situations in which a GP fills out a patient note but cannot share it with a secondary care provider, so must print it out for the patient, or attach a PDF to an email, so that somebody at the other end can input it to their database.

One issue with making it easier to share data—including personal data of the most intimate kind—is that once it has been accessed by bad-faith operators, it is easier for them to run riot and cause an awful lot of damage. It is also much easier for wider access to be shared accidentally, because the whole system is lubricated by the single patient record. I therefore understand the reason for the health data charter as a cure for potential ills.

New clause 6(3)(b) states that the charter must

“include the primary goal of protecting people’s privacy and their data from exploitation”.

That is a fantastic goal that we all support, but I do not necessarily agree that the measure will achieve that. It is an added layer of bureaucracy. My hon. Friend the Member for Farnham and Bordon asked a rhetorical question about the bureaucracy and effectiveness. I endorse that question and hope that the hon. Member for North Shropshire will answer it.

I am minded not to support the proposal, though I agree with what it tries to achieve. If the Minister does not support the new clause, will she explain how its aim of protecting people’s privacy will be delivered by the Bill? There seems to be great scope for the undermining and abuse of privacy, not just deliberately by bad faith actors, but inadvertently.

A second issue aim of the charter is the balance between the security of personal data and the recognition of the value of anonymised data gathered by the NHS for research and development. Fully anonymised data that cannot be unpicked through reverse engineering is of huge value, both commercially and for the public good. Commercial value and the public good are not necessarily opposed to each other; in fact, they often come together. The NHS should be able to exploit the value of that anonymised data—“exploit” is probably seen as a negative word—for the public good. How do we balance that with people’s right to privacy?

Again, there is the possibility of inadvertently using for a wider public good data that was intended to be anonymised but in which people can be identified. The charter tries to get to the heart of that issue as well, which I welcome. Indeed, new clause 6(4)(a) states that the sovereign health data trust will

“hold continuous oversight of all health data and oversee the trusted research environment”.

The Minister may not agree with the new clause, but how will the Government’s proposals balance the security of an individual’s personal data while exploiting, for the public good, the value of the huge depth of anonymised data that the NHS holds and will hold? It could be used to drive so much innovative research and development, for the benefit of health delivery not only in this country, but across the world. Such a valuable commodity has commercial value that could deliver financial benefit to the NHS. I think we all agree that we have not yet exploited that area to the fullest. There is an opportunity to do so with the single patient record—if it is done properly, with all the necessary safeguards.

11:45:00

Dr Caroline Johnson (Sleaford and North Hykeham) (Con)As my hon. Friend the Member for Isle of Wight East just said, new clause 6 seeks in essence to ensure that we have good data security and control, with which I agree. Trust is important, data security is important and supporting research with anonymised data is a good thing to do.

What would the new clause do? First, it would establish an independent body known as a sovereign health data trust. In essence, that is a group of people who have been put together. The new clause does not say how big the group would be—I do not know whether the hon. Member for North Shropshire had its size in mind—but it describes a group of people with

“a diverse range of backgrounds…and…health data experts, clinicians and patient representatives.”

Are the first group intended to be laypeople, rather than experts? What does the hon. Lady mean by a “diverse range of backgrounds”? Does that relate to protected characteristics, or is she looking for a farmer from Northumberland and a lawyer from Islington, because they have different backgrounds? It is not entirely clear what she means, so I would be grateful if she clarified that. Additionally, however big that group is, who would decide how it is composed and by what criteria? Who would be responsible?

The sovereign health data trust would be charged with creating a health data charter. That leads me to my second question: what is a health data charter? In essence, a health data charter—as defined in the new clause—must “set out the fundamental principles and responsibilities for assessing whether a data sharing partnership is in the interest of the public and the NHS”,

and, as my hon. Friend the for Isle of Wight East said,

“include the primary goal of protecting people’s privacy and their data from exploitation, while promoting trust in data systems and the handling of health data”.

That is important, because we have heard in the media several examples of data being put up for sale or leaked, and the problems caused by that.

The charter must also

“ensure patients have control of their data, including providing relevant opt-outs”.

I am glad to see that bit about relevant opt-outs. We have talked about the importance of the record being shared not as a whole, but in pieces. Things such as obstetric or sexual health ought perhaps to be consented to separately. Patient control of the data is important. How would the hon. Member for North Shropshire deal with safeguarding issues in the control of data, particularly in relation to children?

The new clause sets out that the charter must

“provide that all health data is held anonymously and accessed through a trusted research environment”—

which seems reasonable—and must

“set out ways to retain and protect the value of health data in England, including providing measures to invest a share of the income generated from new medicines or treatments developed with that health data to be invested back into the NHS”.

Earlier this week, the hon. Member for Lichfield and I discussed the important value of the NHS data—I think he said that it was the most valuable dataset in the world, and he might well be right. I was a bit confused by that part of the new clause, because we talked earlier this week about the Health Services Safety Investigations Body being able to sell time and training and share expertise, including with private sector organisations overseas. The Government changed that in the Bill, so that they would only be able to retain costs and not make any money for the Treasury. When we put amendment 56 to a vote, the Liberal Democrats abstained. I do not know what the difference is between using NHS data for research and the HSSIB using their expertise for training overseas organisations. I would be grateful to understand that.

The charter must be

“designed in such a way to render it interoperable with the European Health Data Space”.

The European Health Data Space regulations were introduced in March 2025. We are in a transition period, and they will be implemented in 2027 and 2029. It should be interoperable in technical terms

“through the promotion of Findable, Accessible, Interoperable and Reusable (FAIR) data principles”.

What is the European Health Data Space? Essentially, it is a single patient record for Europe. Its instructions say member states may—I underline the word may—offer

“an opt-out option for the cross-border exchange of electronic health data under EHDS.”

I do not understand the Liberal Democrats’ argument for that, because they have made a strong argument throughout Committee stage that data needs to be shared carefully. They advanced some clauses that will ensure that data is held in the United Kingdom and that we use British tech where possible. New clause 6 would make us interoperable with the European system and presumably move us towards European systems.

Gregory StaffordI do not mean this as a cheeky point, but is it not the case that clearly, as with everything, the Liberal Democrats think that the European Union can do no wrong? They do not see the same problems of data that they have expressed in other clauses because they want to rejoin the European Union. Therefore, they conceive that it can have no possible harm to British subjects.

Dr JohnsonIndeed. When reading it, it is ironic to me that they seem comfortable with data being shared across the EU but not across our own country. It did not make complete sense to me, but the hon. Lady for North Shropshire may be able to tell us more about that in her summing up.

What else will the sovereign health data trust group do? It will have

“continuous oversight of all health data and oversee the trusted research environment”.

Having oversight over “all health data” is quite a big job. Again, what sort of resources does the hon. Lady think that will entail, and what does she have in mind in terms of the cost and bureaucracy of that? It would also

“have power to recall or restrict an organisation’s access to data if it has reason to believe that the data is not being used for public or patient benefit.”

What is the threshold for that? A lot of these organisations will be working in a commercial environment; if they receive a letter, potentially from a competitor, saying there is a concern, does that meet the threshold? What would the threshold be?

Having decided that the data might not be used for public benefit, what investigatory powers does the hon. Lady envisage the trust having to establish whether that is the case or not? What if it does receive some concerning correspondence, it does the investigation under the investigatory powers that it has been given, it decides that it does not think it is being used for public or patient benefit, and it restricts the organisation’s ability to access data? That will potentially have a significant financial penalty and it may affect patients’ access to healthcare, too. What right of appeal would the organisation have? Who would they appeal to and how would it work? On the wording, commercial activity may well benefit patients, which is sometimes forgotten.

The next thing the data trust will have to do is

“ensure that all data sharing arrangements with a non-NHS organisation are transparent, with all health data contracts entered into by a public body made publicly available”.

I would like some more detail about that. Would that include anonymously provided data? What effect would that have on the research environment and the integrity of research done under commercial arrangements? What about the costs? Would any costs be shared and what effect would that have on future commercial negotiations when the Government are trying to get the next organisation to look at the data? What level of detail made publicly available in the contract would need to be provided?

The trust would need to publish minutes of their meetings, which seems reasonable. It would need to

“ensure all health data collection and sharing initiatives are preceded by public consultation, involvement and awareness.” Do the Liberal Democrats really intend for all data collection to go through public consultation? If, as we talked about regarding corridor care, the Government wanted to know how many people are waiting more than 24 hours in A&E, would they have to do a public consultation to collect that data? It seems overly bureaucratic.

Gregory StaffordIs that not part of the problem with the wording of the new clause? It is not clear, from the new clause, what is NHS data and what is the patient’s data, and who owns which bit of it. The problem with the drafting of the new clause is that it appears to cover every single piece of data held by the NHS, whether it directly relates to a patient or not. Additionally, if the Government were to collect any other sort of data, even if on an aggregate basis, it would come under this. That would be totally unworkable and put an enormous burden of bureaucracy on the health service.

Dr JohnsonMy hon. Friend is, as ever, correct. I would be interested in whether the hon. Member for North Shropshire has made any estimates of personnel time or cost that the proposal would entail.

In summary, the new clause would create an unelected committee removing democratic control. Essentially, it is asking a committee of unelected individuals to write and implement policy, which is the job of the Minister. That should be under ministerial control.

Joe RobertsonDoes my hon. Friend agree that there is an overarching issue here of public confidence in the safety of their data? That is not about one company or another; it is about ensuring that robust safeguards are in place for everyone and for every provider of a data and record-keeping system. If the public do not have confidence, they will understandably withdraw consent for their data being held. That will undermine the single patient record and the whole way in which health can be delivered efficiently in the best interests of patients.

Dr JohnsonI agree. I am sure that the purpose behind the new clause is to ensure that data is safe, but it removes democratic accountability from the process of developing the policy, which may reduce the public’s confidence in it. I agree with its underlying principles, but much of it is cumbersome and, as yet, undefined, so it is important that we get more detail and specificity.

The Minister for Secondary Care (Karin Smyth)It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function.

There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information.

The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients.

Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.

00:00:00

Helen MorganHon. and right hon. Members on the Committee will understand that we are talking about a single patient record that we do not understand much about yet, because most of the detail will come later. This new clause is attempting to establish what guardrails we would like to see for the protection of patient data when the single patient record is brought into existence

There are very genuine concerns about people’s health conditions becoming individually identifiable. If there is an individual in a single postcode with a rare condition, anonymising the data can essentially never happen. That is a genuine concern that people have. I hope that, when we get to Report stage, the Government will be able to give us a little more detail on what safeguards they intend to put in place over the use of that data. To that end, I do not intend to press this new clause to a vote, but I hope that the Government will take into account the concerns we have expressed about building trust and protecting data privacy, and will give us further reassurance at a later stage. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 11

Directors of public health

“After section 7B of the National Health Service Act 2006 insert—

‘ 7BA Directors of public health Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.’”— (Dr Caroline Johnson.) Brought up, and read the First time.

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

The ChairWith this it will be convenient to discuss new clause 24— Directors of public health: requirements and functions —

“After section (73C) of the National Health Service Act 2006 insert—

‘ 73D Directors of public health: requirements and functions Directors of public health must—

(a) be an officer of the local authority and shall have responsibility for its public health functions,

(b) be an NHS consultant in public health responsible for giving independent professional public health advice and for promoting public debate on health matters,

(c) be a corporation sole and NHS body for working with others to initiate measures to improve the health of the people,

(d) be an officer of the Crown responsible for such functions as the Secretary of State may specify,

(e) as an officer of the Crown have power to draw the attention of the Chief Medical Officer and the Attorney General to events within the area of the local authority creating circumstances in which it might be appropriate to bring proceedings in the name of the Crown for public health purposes,

(f) be an officer of the National Health Service responsible for promoting the provision of services which are outcome-focused, are provided following a proper needs assessment and pay attention to the promotion of health and the prevention of illness,

(g) as an officer of the NHS, have power either personally (in the case of a body which primarily serves the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body which primarily serves the population of several local authorities) or through a collective arrangement established by the Chief Medical Officer (in the case of a body with a national remit) to appoint, or approve arrangements for the body to appoint, a consultant in public health to serve on the governing body of any NHS body (other than an NHS body which is a local authority), any NHS Foundation Trust, any of the bodies established under this Act or any of the bodies established under the Health & Social Care Act 2012 or any other legislation relating to the governance of the NHS (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally).

(h) as an officer of the NHS and of the local authority, have power either personally (in the case of a body which primarily serves all or part of the population of the local authority which appointed the DPH) or through joint arrangements with other Directors of Public Health (in the case of a body such as a joint board or combined authority which primarily serves the population of several local authorities) to appoint a consultant in public health to attend any local authority meeting and to advise the meeting whilst it is in session on matters affecting the health of the people (for the avoidance of doubt the consultant so appointed may be, but need not be, the Director of Public Health personally and a different consultant may be appointed for different meetings). (i) be contractually required, subject to law, to carry out the functions in subsections (b) to (h) herewith as an independent health professional treating a population as a patient and pursuing the improvement of its health and to be contractually entitled not to be subject to any detriment by the local authority or by the Crown for so doing.’”

Dr JohnsonI want to briefly discuss these new clauses because I think that they are important, particularly because they were tabled by the hon. Member for Worthing West (Dr Cooper), who is an expert in the field. New clauses 11 and 24 relate to directors of public health. We know from the Government that prevention, and therefore public health, is extremely important. New clause 11 says:

“Each integrated care board must, for the purposes of exercising any public health functions directed by the Secretary of State, appoint a lead director of public health.”

New clause 24 sets out the requirements and functions of directors of public health—what such an individual will do.

Currently, every local authority must have a director of public health, which is set out in statute. They focus on three areas: health protection, health improvement and healthcare public health. They take the evidence in relation to their population, produce a vision, develop aims, deliver those aims and then produce a report annually to say how they are getting on with that process. The National Health Service Act 2006 says that that must be done across an upper tier or unitary local authority area, and that directors of public health must provide advice about public health to any ICBs that overlap with their area. ICBs also have a legal duty to seek advice on protecting public health when they are exercising their functions.

I think that we all agree across the Committee that public health is important, but I do have some questions. Unfortunately, the hon. Member for Worthing West is not a member of the Committee, so she is not able to respond to any questions today. We have talked in this Committee about the representation of local authorities on ICBs and the fact that Government cuts of 50% have led to a merging of ICBs in a somewhat haphazard fashion, which means that there can be a clash between different areas.

I guess that my question for the Minister would be thisif this clause were to come into force and the ICBs that are no longer coterminous with the local authority upper-tier or unitary authority areas, would there be a duplication of work? My other concern would be that it would lead to a situation where there might be one director of public health with a vision to go one way, and another with a direction to go the other way. If that happened, how would the negotiation process work? I think this measure was brought in with good intent by a lady who is an expert in the field, but I have more questions than answers about how the clause will work in practice.

Gregory StaffordIt is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee.

It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses.

I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill.

That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex.

Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?

Karin SmythFurther to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners.

On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work.

NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions.

As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice.

On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities.

At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee.

There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals.

The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.

Dr JohnsonI beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 12

Corridor Care Accountability

“(1) Six months after the passage of this Act, and every 12 months thereafter, the Secretary of State must produce and lay before Parliament a report on the prevalence of corridor care in NHS hospitals.

(2) A report under subsection (1) must include—

(a) an analysis of data on the number of corridor incidents at the national, integrated care board, trust, and hospital level,

(b) the steps the Secretary of State has taken that year to reduce the number of corridor care incidents,

(c) the Secretary of State’s plans to reduce the number of corridor care incidents in the coming year, and

(d) information regarding the amount of funding directed toward reducing the number of corridor care incidents that year and funding allocated for such efforts in the future.

(3) Following the publication of a report under subsection (1) the Secretary of State must give evidence in front of a panel (to be called the “Corridor Care Tribunal”) including—

(a) patients,

(b) bereaved or affected families, and

(c) frontline NHS staff who have been impacted by corridor care.

(4) Panel members for a Corridor Care Tribunal under subsection (3) shall be identified by local Healthwatch organisations and NHS Royal Colleges.” This new clause requires the Secretary of State to publish an annual report about corridor care and give evidence before a panel of affected patients and staff. — (Helen Morgan.) Brought up, and read the First time.

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

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

New clause 56— Accident and Emergencywaiting times —

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision relating to Accident and Emergency Department admission.

(2) Provision under subsection (1) must include the requirement for every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.

(3) The Secretary of State must establish and implement an Accident and Emergency Scheme (“the Scheme”) to support NHS hospital trusts to achieve the requirement set out in subsection (2).

(4) The Scheme must consider—

(a) creating safety-net social care beds, (b) increasing step-down care,

(c) publishing a dedicated accident and emergency care workforce plan, and

(d) mandating a qualified clinician is present in every Accident and Emergency waiting room.

(5) The Secretary of State must have due regard to the final report of the Independent Commission on Adult Social Care in establishing the scheme.” This new clause gives patients a legal right to be admitted into A&E within 12 hours from decision to admit and requires the Secretary of State to introduce a scheme to achieve this. New clause 84— Publication of data on avoidable deaths —

“(1) The Secretary of State must publish every quarter the number of avoidable deaths where waits of more than 12 hours in accident and emergency departments was a contributory factor.

(2) The Secretary of State must make the data under subsection (1) available by integrated care board area.” This new clause would require the Secretary of State to publish data on avoidable deaths caused by waits over 12 hours in A&E departments.

Helen MorganNew clause 12 would require the Secretary of State to publish an annual report about corridor care and to give evidence before a panel of affected patients and staff.

In the main Chamber yesterday, we had a Backbench Business debate on corridor care, introduced by the hon. Member for Tooting (Dr Allin-Khan). There was a great deal of consensus across the House about the harm that corridor care causes to both patients and staff, and the requirement for urgency in dealing with that issue.

I am not going to remake the same speech that I made yesterday on corridor care for the Minister’s benefit, because she heard it yesterday and there is little value in repeating it. What I will say is that it is important that there is an understanding at a ministerial level of the personal impact that corridor care has on patients and their families.

That is the purpose of this new clauseto ensure that the Secretary of State is taking the concerns of patients and staff very seriously, hearing them at first hand and then reporting back progress to the House on dealing with the issue. At the moment, it feels as if every year we acknowledge the problem in the House, every winter there are statements on winter crisis and corridor care, and we never really seem to take any steps forward. The new clause aims to ensure that is no longer the case.

New clause 56 is intended to give patients a right to be admitted to accident and emergency

“within 12 hours from decision to admit”,

and would require the Secretary of State

“to introduce a scheme to achieve this.”

We have discussed the legal right to admit and the legal right of patients on a number of occasions. I just want to clarify our intention, because it always raises some questions. The NHS constitution enshrines legal rights for certain things: for example, the two-week wait for a cancer referral to a specialist and the right to receive elective care within, I think, 18 weeks, if so referred. The other targets in the NHS are pledges; there is an aspiration for the Secretary of State to meet them, but it is not a right of the patient that the Secretary of State meets them. We think that 12-hour waits on corridors in hospitals merit the same urgency as cancer referrals, because they lead to awful outcomes.

12:15:00

Yesterday in the main Chamber we discussed how the Royal College of Emergency Medicine has estimated that 15,000 people died because of corridor care in the past year—I will correct the record if I have got that number wrong. A recent study published in the Annals of Emergency Medicine concluded that patients are more than twice as likely to die if they wait for more than 12 hours in A&E. We cannot overstate the urgency of this issue. We are concerned that the current targets are focused on demand and admission avoidance as the solution to corridor care, but there needs to be equal focus on discharge.

Delayed discharge into social care accounts for one in seven hospital beds. If we want to free up hospital beds and end the scandal of corridor care, we need to grasp the nettle on social care, as we discussed at length yesterday. The Liberal Democrats have set out our plan to end corridor care, which I put on the record in yesterday’s debate. Our £1.5 billion plan would provide 6,000 more beds across the whole system, including in social care, and boost step-down care so that thousands more people can leave hospital each week. We would increase support for carers and hospices to ease pressure across the system, cut readmissions and help to deal with the corridor care crisis.

I hope that the Minister understands the intention of this new clause, the urgency with which we think corridor care needs to be addressed, and the importance of putting it on the same footing as referrals for cancer treatment and elective care waits. Corridor care waits kill, and it is time that we got rid of them.

Edward Argar (Melton and Syston) (Con)I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point.

Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition.

The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.

Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)On the publication of data on avoidable deaths, new clause 84 states

“where waits of more than 12 hours in accident and emergency departments was a contributory factor.”

Does the right hon. Member consider it likely that there is any great accuracy in the assessment of whether a death was avoidable?

Edward ArgarThe hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable.

I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point.

I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge.

The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.

Helen MorganNew clause 56 speaks about the importance of creating capacity across the system, including social care, and about having regard to the outcome of Baroness Casey’s commission on social care to deal with the issue of capacity and flow through the hospital. We have discussed at length in Committee other amendments that would deal with the front door, in terms of GP access and trying to ensure that people are treated at first in the community, rather than ending up in A&E as a last resort. I wonder if the right hon. Gentleman would just acknowledge those points.

Edward ArgarThe hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted.

The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order.

The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time.

I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them.

I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system.

While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital.

Arguably, that is less safe than corridor care, for two reasonsfirst, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care.

I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions.

I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.

12:30:00

Gregory StaffordI rise to support a lot of what my right hon. Friend the Member for Melton and Syston said. Across the Committee, I think we all agree that corridor care and care in other inappropriate settings should have no place in the NHS. No patient should be assessed, treated or left waiting in a corridor, in a cupboard or anywhere else because there is nowhere for them to go.

We owe it to patients and our constituents to be honest about the scale of the problem and be serious about ending it. That starts with measuring it properly, because if we do not collect the data, publish the evidence and track progress, inappropriate care settings risk becoming normalised. In May, nearly 3,000 patients were in corridor care, which was a 2.5% increase from the same time last year. In the same month, 50,000 patients waited in A&E for more than 12 hours, which was a 17% increase from the same period last year. The Government continually miss their target on the 12-hour wait. I am not making a political point; this is a serious problem, and successive Governments are still struggling to ensure that it does not happen. We all know from our casework and our inboxes, and some of us know through personal experience or from loved ones, that too many patients are experiencing unacceptably long waits in A&E after a decision has been taken to admit them. That is bad for patients, bad for staff and bad for the wider functioning of our hospitals.

New clause 56 in the name of the hon. Member for North Shropshire acknowledges that the causes of delays extend far beyond the emergency department itself, and I will touch on that in a moment. Challenges in social care, discharge processes, step-down provision and workforce capacity all contribute to bottlenecks that leave patients waiting longer than they should. Although there might be legitimate questions about the precise mechanisms proposed in the new clause, I do not think there is any disagreement among the Committee about the principle that patients deserve timely access to a hospital bed and that excessive admission delays should not be accepted as the norm.

That is why I fully support new clause 84 in the name of my hon. Friend the Member for Sleaford and North Hykeham. Publishing data on avoidable deaths associated with waits of more than 12 hours would help to ensure that we, as a Parliament and as policymakers, remain focused on outcomes for patients, not just performance indicators. I am particularly persuaded by the proposal to publish that information at ICB level, notwithstanding the concerns raised by my right hon. Friend the Member for Melton and Syston, which I agree with entirely. It would at least give some allowance for those making decisions to look at the local variation and ensure that it is identified, however less local that will become.

Hopefully, good practice will be able to be shared between different areas, and the areas that face the greatest challenges will be able to receive both appropriate scrutiny and appropriate support. Of course, collecting and publishing data will not by itself reduce waiting times, but we cannot effectively tackle a problem that we do not properly measure. Sunlight is often the best disinfectant in these cases, and greater transparency can be a powerful driver of improvement.

At the heart, new clause 84 recognises the simple truth that every statistic represents a person, a family and a life, and if avoidable deaths are occurring as a consequence of prolonged A&E waits, we should have the courage to measure them, publish them and learn from them. That is why I support the new clause. As has been touched on in other speeches, and as I mentioned earlier, the issue of corridor care does not sit in isolation. In fact, it is not a cause of the problem; it is the symptom of many other problems within our health and social care network.

Dr PrinsleyWhen I was a young doctor—a registrar—in the 1980s, we had 300,000 beds in our health service. By the time I was a senior doctor in the 2020s, we had 140,00 beds—less than half the number of beds we had before. When I was a young doctor, corridor care did not exist; I had never heard the term. The hospitals were simply big enough. Does the hon. Member agree that the many years of decline in the total number of beds in our hospitals is an extremely important factor in the fact that we do not have enough beds for the patients sitting in the A&E departments?

Gregory StaffordI respect immensely the hon. Gentleman’s experience. He described being a young doctor, but he is still a very young doctor/politician now. Of course, capacity is an essential part of this. He is a clinician, so I will not lecture him on this, but my suggestion would be that it is not about just capacity within hospitals. The Government’s shift is to try to get people out of hospitals and into community settings as much as possible, so it is capacity within the whole system that needs to be looked at. Going back and putting loads more beds into hospitals would not somehow solve this problem or create a healthcare system that is aligned with what the Government want, which is hopefully treating more people at home. On his general point, I accept that the more capacity there in the system as a whole, the more likely we are to solve some of the problem.

That neatly moves me on to my next point, which is about the whole-system approach to this. As hon. Members have mentioned, we have a potential problem with ambulances waiting in carparks, and unfortunately, trusts gamify the system when targets are put in place—they do not admit people through the door because it will hit their targets. As my right hon. Friend the Member for Melton and Syston mentioned, that has a knock-on effect for the people sitting in the ambulances and those who are potentially not receiving an ambulance because the capacity is not there. Likewise, at the other end of the system—though I suppose it is both ends of the system—social care needs to improve significantly. I am deeply disappointed that the Government have pushed another social care review that is probably not going to report until 2028, which is kicking the can down the road. I think it is essential that we get social care correct.

Liz Twist (Blaydon and Consett) (Lab)Some excellent points have been made about corridor care; I know that all of us want to see that improved. It is a serious issue for all of our residents, and the Minister and others will be working hard to do all they can to address it. May I gently point out the irony of colleagues on the official Opposition side raising all these issues now as if they have had a Damascene conversion, when they had 14 years to try and address them? I remember raising these issues in the House when my party was in Opposition. We are not undermining in any way the concerns about corridor care, because we all care deeply about it. [ Interruption. ]

The ChairOrder. Can we have less chuntering from a sedentary position?

Liz TwistI just gently wanted to make that point.

Gregory StaffordI am grateful to the hon. Member; she makes an interesting point. She talks about irony, and I respond in the same manner as that which she intervened on me with a gentle response, which is to ask why, if everything was going so swimmingly well, she and the rest of her colleagues got rid of the Prime Minister?

Joe RobertsonI am grateful to my hon. Friend for giving me an opportunity not to chunter from a sedentary position and to remark that this tedious rhetoric about the last 14 years—when all the public want to do is hear about plans for the future and how they will work—is the reason why we are in the state that we are. Will my hon. Friend continue and address the points that the public want, which he had already begun to do?

Gregory StaffordMy hon. Friend is absolutely right. The public do not want to hear about the last 14 years or the rhetoric around them.

Liz Twistrose —

Gregory StaffordI will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do.

On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.

Karin SmythAs the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.

The ChairOrder. I think we are moving a little out of scope here. Could we bring it back to the contents of the Bill?

Gregory StaffordI will do that. As I have already said, no party has necessarily covered itself in glory with this issue. It might have taken us four years to dump it; it took the Chancellor of the Exchequer less than two weeks.

Liz TwistI want to touch on the point made by the hon. Member for Isle of Wight East in his intervention. We absolutely agree that the public are concerned with what we do for the future. We are talking about a specific Bill here. There is a huge concentration of effort in getting those figures down. We absolutely agree that people want to look to the future and whether this is the way to do it.

Gregory StaffordI look forward to the new Prime Minister coming in and, I hope, providing a position where the hon. Member is able to achieve some of that. [Interruption.] I note for Hansard that that received acclamation across the Committee Room.

Getting back to the Bill, as you have suggested I do, Dr Huq—I take your suggestions very seriously—the social care element is extraordinarily important. It is important to ensure that people do not enter the secondary care system if at all possible, especially through attending A&E. When I worked on the Getting It Right First Time programme, our accident and emergency reports put forward some interesting methods that could potentially help with that. Some of that has been implemented and some has not, but I recommend all hon. Members look at that report, because it contains a number of interesting proposals.

This is not only about stopping people entering the system, but about ensuring that people come out of the system in a timely manner, freeing up the capacity we have just talked about. In my constituency, Haslemere hospital had 16 step-down inpatient rehabilitation beds. Unfortunately, last year, that service was “temporarily paused”—that is how it was described, but it has been over a year now, so it has essentially stopped. That service is not happening in my constituency, which is down to the fact that it was a GP-run service and the trust could no longer get a GP who was willing to run that service.

Haslemere hospital and the Royal Surrey NHS Foundation Trust that runs the hospital have some really fantastic ideas, very much in keeping with the Government’s push towards neighbourhood health, and I fully support those proposals, but it is a shame that we have had 16 beds sitting empty for more than a year, which could have been used for rehabilitation. We as a body politic should be looking at how we can improve and expand our step-down/step-up capacity, so that people do not have to go into acute settings.

I turn briefly to the specifics of new clause 12. I am concerned about subsections (3) and (4), which talk about a tribunal system. I do not quite understand how that would work. The way it is set out almost gives it an adversarial, inquiry-type, case-by-case element. It would include patients, bereaved or affected families, and frontline NHS staff. I can see how that kind of body might work if one was investigating a failure around a single patient or at a single trust, but I would be grateful if the hon. Member for North Shropshire could expand on how she sees the national report coming forward and then a group of people being selected to interrogate it. It is also not clear what would be the consequences of the interrogation, or otherwise, once it has happened.

12:45:00

New clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham, suggests that we collect and publish the data so that patients and the public can see it, and the Government can act on it, either in their position as the controller of healthcare or by encouraging ICBs, as the providers of local healthcare, to make improvements. That seems to me a more sensible, appropriate and proportionate approach, rather than setting up another bureaucratic oversight body with no real sense of how it would operate, what it would investigate or the possible outcomes of its investigations.

Dr JohnsonNew clauses 12, 56 and 84 are about care in our accident and emergency departments and care in corridors. I do not want to rerun the debate on corridor care that we had in the Chamber last night, but corridor care does not provide safety, privacy and dignity, and it is unpleasant for the patient, their family and staff. If someone is in a corridor, how can they get changed, or use a commode or a bed pan? How can they be examined privately, and give information about their medical history without being overheard by a person walking down the corridor or the person in the bed next to them? Corridor care also has safety issues; for example, a patient may not be proximal to as much equipment, such as oxygen supplies and other equipment that might be required in the event of a collapse or arrest. It is not right and should not be the case that patients are cared for in corridors.

The hon. Member for Blaydon and Consett talked about the history, but I agree with my hon. Friend the Member for Isle of Wight East that the current situation and the future are what is important. A&E services are under pressure. Attendances went up by 2.5% last year, but in March 2025, 46,766 people waited more than 12 hours in A&E following a decision to admit before being moved to a more appropriate bed. That figure is up 8.8% on the previous year. The Government’s urgent and emergency care plan sought to improve that poor performance, but things have got worse. The latest NHS figures, from May 2026, show that more than 50,000 patients waited more than 12 hours following a decision to admit—17.1% higher than the May 2025 figure. The narrative that there was a problem but now things are getting better is not necessarily accurate. We keep being told that waiting lists are coming down, but they are higher than they were a month ago, and for those waiting for an admission or procedure, they are than they were a month ago and higher than they were a year ago.

Dr PrinsleyI wonder whether the hon. Member remembers that in 2010, when I believe there was an election— [ Interruption. ] Yes. The point I wish to make is that at the end of the previous Conservative Government, before Labour came back into office, waiting lists had reached an absolute record. Under the previous Labour Administration, waiting lists came down to almost nothing, but after 2010 they crept up and up, and by the time of the election in 2024 they had reached a record. I think she will recognise that Labour Governments have had strong records of reducing waiting lists, which is what we are doing now. We are only getting started, but it would be good to have some words of encouragement.

Dr JohnsonI am always happy to encourage the hon. Gentleman; I hope that in the impending reshuffle, he is given the opportunity to put his experience into practice. I have one word for him: pandemic. The pandemic made a huge difference to the numbers on waiting lists, and there is no current pandemic. It is possible to make arguments about whether the Government at the time—I was not in the Government at the time—were too harsh in their policies around elective care, whether patients would have come into hospitals for elective operations during covid or whether they would have preferred not to, and whether the waiting lists grew more than they may have done in other circumstances, but to try to say that the pandemic had no effect is going a stretch too far.

Karin SmythTo correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.

Dr JohnsonI think what members of the public want is the people who are in government now to do something to improve their lives. I am in danger of repeating myself, which could present an extra concern when so many people are questioning my memory, but there has been a 2.5% increase in the number of A&E attendances, but a 17.1% increase in the number of people waiting more than 12 hours after a decision to admit. That suggests that the Government are not going in the right direction. The public may enjoy a history lesson from time to time, but what they really want to know is what is happening now to make their lives better. I am sure the Minister will give us the answer to that in her summing up, but at the moment the Government are not bringing down the long waits in A&E.

Let me return to the new clauses. Corridor care needs a whole-pathway approach. In last night’s debate we talked about the importance of preventing admissions—I know that is one of the Government’s shifts—in order to increase hospital capacity. The hon. Gentleman for Bury St Edmunds and Stowmarket talked about capacity and the number of beds having reduced over a long period—another history lesson—but when my mum had me, a good few years ago, it was common for women to stay in hospital for quite a long time after having their child, and it was quite common for people to stay in bed for many days after having an operation. We now know that it is better for people to be up and about, and people leave hospital more quickly. That is a good thing. The reason for bed numbers coming down over successive Governments of different parties is clinical as well as managerial. I think that is worth saying.

Will the Minister answer a question that I asked in last night’s debate but, unless I missed it, she did not answer in her summing up? Does the NHS have more beds now than it did when Labour came to power in July 2024, or fewer? I believe the answer is fewer.

Edward ArgarDoes my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.

Dr Prinsleyrose—

Dr JohnsonI will come to the hon. Gentleman in a minute, but I need to answer my right hon. Friend’s question first. My right hon. Friend has a much better memory than me—I was much younger then—so I am sure his statistics will be accurate.

Dr PrinsleyI think the principal reduction that the right hon. Member for Melton and Syston described was a result of the change of practice in the way that psychiatry was managed. During that period, we closed the asylums—large hospitals on the outskirts of almost every town and city. That was the result of a change in clinical practice—the idea that patients should be managed within the community. However, we continued to close acute beds, and it is the acute beds in the district general hospitals that are the problem we are talking about.

Dr JohnsonI think we are going back full circle to the hon. Gentleman’s intervention on my hon. Friend the Member for Farnham and Bordon, when he suggested that the problem was that beds had historically been closed. Now he is making the point that there were clinical reasons why that happened, not just managerial reasons. I think that is an important thing to note.

Moving on from capacity, we also need to look at the workforce. I would be grateful if the Minister could tell us how soon “imminent” is in terms of the workforce plan. There was also a point picked up earlier—I cannot remember who picked it up; it might have been the hon. Member for North Shropshire—about discharge from hospital and pharmacies. One of the challenges that I find as a clinician is that hospital pharmacies often close relatively early, which means that it is more difficult to discharge patients in the evening. That is something for the Minister to look at. There is also, of course, the importance of social care, and ensuring the provision of social care beds both to prevent admission and to get people out of hospital as quickly as is safely possible.

That is the background to this group of new clauses. New clause 12, in the name of the hon. Member for North Shropshire, would require a report on corridor care to be produced six months after the passage of the Act, and then every 12 months, containing data at the hospital, trust and ICB level on the number of individuals receiving care in an inappropriate place. That seems sensible data to collect, but I believe the Government may already to be collecting it; the Minister may be able to enlighten us on that. The report would also set out the steps taken in that year to reduce the number of patients in inappropriate care spaces, the plans for the coming year to reduce that number further—as I said, it is going up at the moment—and the funding allocated to that. There is some sense to that. Then the Secretary of State would have to give evidence in front of a panel, called the “corridor care tribunal”, which would include patients, affected families and impacted NHS staff, who would be selected by Healthwatch and NHS royal colleges. I have just a couple of points on that. One is that Healthwatch will be abolished by the Bill, which would make that challenging—perhaps the new clause would need to be redrafted. Also, I am a member of the Royal College of Paediatrics and Child Health and an NHS consultant paediatrician and, as far as I am aware, the royal colleges are independent of the national health service. They are separate; they are connected in terms of training, standards and advice, but I believe that they are organisationally independent. I am sure that the Minister will correct me if I have got that wrong.

I wonder whether the hon. Member for North Shropshire has considered whether the Health and Social Care Committee, which is elected and politically balanced, might be the right body to scrutinise those Government plans. My hon. Friend the Member for Isle of Wight East, who is a member of the Select Committee, is not here now, but—

Gregory StaffordI am, too.

Dr JohnsonSorry; I forgot. I am sure that my hon. Friend the Member for Farnham and Bordon will tell me if I am wrong, but that is an elected Select Committee, with political balance, that is set up specifically to scrutinise the work of the Department of Health and Social Care. If the Department is working to try to reduce the number of patients receiving corridor care, and to measure it, it seems to me that the right organisation to scrutinise that work is already in place: the Health and Social Care Committee. I therefore think this measure would be a duplication. However, I understand the need to get patient voice into the picture; that is why it is unfortunate that the Government are choosing to abolish Healthwatch, which I think would do that very effectively.

New clause 56, also in the name of the Member for North Shropshire, talks about A&E waiting times. I will start by saying that we all want A&E waiting times to be shorter—we all want people to be seen quickly and do not want patients to suffer—so the intent behind this proposal, to get people seen more quickly, is obviously a good one.

However, the new clause would require, within six months, provision to be made requiring “every patient to be admitted into an Accident and Emergency Department within 12 hours of approval of their admission being made.”

I have a question about the wording of that, because my understanding is that someone is admitted to A&E when the decision is made to admit them to A&E and they become an A&E patient. I wonder whether the hon. Lady intends it to mean admission to an appropriate bed, whether in the trust or elsewhere. Usually, people waiting in corridors or in A&E are waiting for admission to the ward, rather than for someone to make a decision.

New clause 56 would also require the Secretary of State to establish and implement an A&E scheme to help trusts to achieve that requirement, and provides that the scheme must consider creating safety nets, step-down beds and a dedicated workforce plan for A&E—it will be nice to see the workforce plan, which the Government are supposed to have written—and mandating the presence of a “qualified clinician” in the waiting room. Will the hon. Member for North Shropshire tell the Committee what she means by a qualified clinician? Does she mean a consultant, a senior nurse or a healthcare assistant? What sort of qualifications does she think that they must have? The Secretary of State must also have regard to Baroness Casey’s report, but that is not due to be written in time for the new clause, which creates a little tension. However, again, I agree with the principle that social care is important in this context.

In summary, the principle of new clause 56 is good and important, but I think that there are some issues with the drafting of it. New clause 84 in my name, which has been well covered by my colleagues, would just require the publication of data. In her speech earlier, the hon. Member for North Shropshire gave a figure of 15,000, but I looked back at Hansard and last night she said that the Royal College of Emergency Medicine reported that long waits caused 15,860 deaths. That figure tells us what a serious problem this is. Being able to measure that figure and, I hope, see it falling would be a helpful step. Ordered, That the debate be now adjourned. —(Emma Foody.)

13:01:00

Adjourned till this day at Two o’clock .