Threads / Health Bill / Health Bill

Parliamentary Debate Published 7 Sep 2026 ↗ View on Parliament

Health Bill

[1st Allocated Day] Consideration of Bill, as amended in the Public Bill Committee [Relevant documents: First Report of the Health and Social Care Committee, Health Bill 2026-27, HC 219; and Oral evidence taken before the Health and Social Care Committee, on the Work of NHS England, 20 May, HC 583.] New Clause 96 Integrated care boards: duty as to visiting etc “After section 14Z36 of the National Health Service Act 2006 insert— “14Z36A Duty as to visiting etc (1) Each integrated care board must, in the exercise of its functions, promote appropriate opportunities for anyone provided with accommodation in pursuance of arrangements made by the board to receive visitors. (2) Each integrated care board must, in the exercise of its functions, promote the option for relevant patients attending hospitals or hospices provided in pursuance of arrangements made by the board to have someone accompany them, so far as appropriate. (3) In subsection (2) “relevant patient” means an outpatient, day pat

Attachments

↗ Download transcript (text)
text/plain

▤ Verbatim text from source document

[1st Allocated Day]

Consideration of Bill, as amended in the Public Bill Committee

[Relevant documents: First Report of the Health and Social Care Committee, Health Bill 2026-27, HC 219; and Oral evidence taken before the Health and Social Care Committee, on the Work of NHS England, 20 May, HC 583.]

New Clause 96

Integrated care boardsduty as to visiting etc

“After section 14Z36 of the National Health Service Act 2006 insert—

“14Z36A Duty as to visiting etc

(1) Each integrated care board must, in the exercise of its functions, promote appropriate opportunities for anyone provided with accommodation in pursuance of arrangements made by the board to receive visitors.

(2) Each integrated care board must, in the exercise of its functions, promote the option for relevant patients attending hospitals or hospices provided in pursuance of arrangements made by the board to have someone accompany them, so far as appropriate.

(3) In subsection (2) “relevant patient” means an outpatient, day patient or other person attending a hospital or hospice for the provision of care or treatment that does not involve an overnight stay.””—(Karin Smyth.)

This broadly requires an integrated care board to promote appropriate opportunities for those who are provided with accommodation in pursuance of arrangements made by the board to receive visitors and the option for outpatients and day patients etc to have someone accompany them.

Brought up, and read the First time.

19:26:00

The Minister for Secondary Care (Karin Smyth)I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Ms Nusrat Ghani)With this it will be convenient to discuss the following:

Government new clause 97—Care and supportinvolvement of others and visitors.

New clause 1—National Maternity Commissioner—

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

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

(a) oversee NHS maternity services;

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

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

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

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

(3) The person appointed as Commissioner must—

(a) be a person with knowledge, expertise and experience relevant to the discharge of functions of the role;

(b) have first-hand experience of working in maternity services, so far as reasonably possible; and

This new clause would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services.

New clause 2—Assessment of risks posed by contracts with non-UK based suppliers—

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

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

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

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

(d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and

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

(3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to use or develop domestic technologies, systems or products in place of those provided under the relevant contract.”

This new clause would require the government to publish a risk assessment of contracts between NHS organisations and suppliers based outside of the UK.

New clause 3—Duty on the Secretary of State to prioritise domestic suppliers—

In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—

1CD Duty to prioritise domestic suppliers

(1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom.

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

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

(a) patient groups,

(b) national security experts, and

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

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

(5) If a contract is awarded for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must place a statement before both Houses of Parliament setting out whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided by the contract.”

This new clause would place a duty on the Secretary of State to prioritise domestic, UK-based, suppliers for technology systems and contracts handling NHS patient data, and places restrictions on the signing of contracts for such systems with non-UK based suppliers.

New clause 4—NHS Digital Sovereignty Strategy—

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

(a) assessing, managing and mitigating risks—

(i) associated with foreign interference,

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

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

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

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

(a) include risks associated with—

(i) hardware,

(ii) software,

(iii) supply chains, and

(iv) procurement processes;

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

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

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

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

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

New clause 5—Health Data Charter—

“(1) The Secretary of State must, within 6 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;

(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.”

New clause 6—Maternity Safety—

“(1) The Secretary of State must ensure that every NHS maternity unit is rated “good” or

“outstanding” by the CQC.

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

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

(b) one-to-one midwifery care,

(d) ringfenced maternity service development funding, and

(e) a dedicated neonatal workforce plan.

(3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.”

This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.

New clause 7—Healthy life expectancy target—

“(1) Within six months of the passage of this Act, the Secretary of State must—

(a) make regulations to set a statutory target for improving overall healthy life expectancy for the population of Great Britain, and

(b) publish a cross-governmental strategy, renewed every 24 months, to set out how the target set by regulations under subsection (1)(a) will be achieved.

(2) The strategy under subsection (1)(b) must be laid before both Houses of Parliament.

(3) Upon publication of a strategy under subsection (1)(b) the Secretary of State must make a statement before the House of Commons regarding progress made towards the target set by subsection (1)(a).”

This new clause would require the Secretary of State to make regulations to establish a statutory target for healthy life expectancy in Great Britain and publish a strategy every two years setting out how this target will be achieved.

New clause 8—Impact of trade deals on the NHS—

“(1) Any trade negotiation which would require NHS spending or funding to exceed £100 million must be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

(2) Before laying regulations under subsection (1) the Secretary of State must publish an impact assessment about how the trade negotiation will affect NHS frontline services and patients.”

This new clause would require any trade negotiation which would require NHS spending or funding to exceed £100 million to be laid before Parliament by the Secretary of State in the form of regulations subject to the affirmative procedure.

New clause 11—Duty as respects waiting times for women’s health—

“In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—

“1CD Duty as respects waiting times for women’s health

The Secretary of State must exercise functions in relation to the health service with a view to ensuring that average waiting times for the diagnosis and elective treatment of conditions primarily affecting women do not exceed the overall average waiting times for NHS diagnosis and elective treatment.””

This new clause would ensure that the average waiting time for diagnosis and treatment for elective conditions for women’s health issues do not exceed the average wait time for wider NHS elective treatment.

New clause 12—Inquiry into women’s health outcomes—

(1) The Secretary of State must, within six months of the passing of this Act, commission an independent inquiry into women’s health provision and outcomes in England.

(2) Any inquiry established under subsection (1) must consider—

(a) the causes of—

(i) poorer health outcomes, and

(ii) disparities in patient safety,

for women;

(b) the effectiveness of existing commissioning arrangements in meeting the needs of women, and

(c) recommendations to assist the Secretary of State in discharging the duty to reduce inequalities in health outcomes under section 1C of the National Health Service Act 2006.

(3) The Secretary of State must lay a report on the findings of the inquiry before Parliament within the period of 12 months beginning with the day on which this Act is passed.”

This new clause would establish an inquiry into the poorer health outcomes faced by women.

New clause 15—Public Health Committee—

(1) The Secretary of State must establish a Public Health Committee within six months of the passage of this Act to ensure a cross-governmental focus and consideration of the promotion of public health in government policy and address national health inequalities.

(2) The Public Health Committee under subsection (1) must—

(a) include at least one minister from each government Department in its membership,

(b) include all cabinet ministers in its membership,

(d) meet once in each annual quarter.

(3) Under subsection 2(b), cabinet members must attend at least three quarters of the Public Health Committee's meetings each year.

(4) Each government Department must publish an annual report on their department's consideration of public health in its policy and the extent of joint policy formulation with other government Departments.

(5) The Secretary of State must establish a Health Creation Unit to support the Public Health Committee.

(6) The Health Creation Unit must submit an annual report on its activities, decision-making and cross-government progress to the Liaison Committee.”

This new clause would establish a Public Health Committee and Health Creation Unit to promote public health and cross-government policy making.

New clause 16—Duty to promote public health—

“All Ministers of the Crown have a duty to consider health outcomes and the promotion and protection of public health when exercising their duties.”

This new clause will place a duty on all ministers to consider health outcomes and the promotion of public health when exercising their duties.

New clause 17—Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing—

“(1) The Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing may be ratified only if—

(a) a Minister of the Crown has laid before the House of Commons a copy of the Arrangement, and

(b) the Arrangement has been approved by a resolution of the House of Commons on a motion moved by a Minister of the Crown.

(2) Before tabling a motion under subsection (1)(b) the Secretary of State must publish and lay before the House of Commons an impact assessment on the potential effects on the health service of implementation of the Arrangement.”

This new clause would require the Arrangement between the United States of America and the United Kingdom on pharmaceutical pricing to be brought before the House for a vote.

New clause 18—Access to dental provisionDental deserts—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must establish a scheme to improve access to dental provision (“the Scheme”).

(2) The purpose of the Scheme is to end dental deserts.

(3) A dental desert is defined as any local authority area with fewer than ten active dental practices per 100,000 people.

(4) The Scheme must make provision to support integrated care boards to—

(a) guarantee emergency access to an NHS dentist,

(b) provide free dental check-ups for—

(i) children,

(ii) mothers within one year of having given birth,

(iii) pregnant women, and

(iv) low-income households,

(i) surgery,

(ii) chemotherapy, or

(iii) transplant procedures.

(5) The Secretary of State must, before publishing the Scheme, issue a reformed dental contract.

(6) The Secretary of State must, within six months of the establishment of the scheme, publish a dental workforce plan to support delivery of the scheme.”

This new clause would establish a scheme to support integrated care boards to end dental deserts.

New clause 21—GP representation on integrated care boards—

“(1) An integrated care board must include as a member at least one individual who—

(a) is a registered medical practitioner, and

(b) has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

(2) In appointing a member under subsection (1) an integrated care board must have regard to the member’s potential contribution to improving—

(a) patient journeys across services,

(b) coordination and continuity of care,

(d) integration of services at neighbourhood level.”

This new clause would ensure that each integrated care board includes at least one member who is a registered medical practitioner, and has current or recent experience of providing primary medical services under Part 4 of the National Health Service Act 2006.

New clause 22—Duty to engage primary care providers in integrated care boards—

“(1) An integrated care board must take all reasonable steps to secure the meaningful involvement of primary care providers in the exercise of its functions relating to—

(a) service redesign,

(b) integration of health services,

(d) population health planning.

(2) In this section, “primary care providers” includes—

(a) providers of primary medical services,

(b) community pharmacy contractors,

(d) providers of ophthalmic services.

(3) Under subsection (1), “meaningful involvement” includes—

(a) involvement at an early stage in the development of ICB proposals,

(b) provision of sufficient information to enable informed participation of primary care providers in ICB functions,

(d) opportunities for primary care providers to deliver feedback on how their views have been taken into account in the delivery of ICB functions.

(4) An integrated care board must publish an annual statement describing—

(a) how it has complied with this section, and

(b) the impact of primary care providers’ involvement on decisions taken by the ICB.

(5) The Secretary of State may issue guidance about the application of this section to which integrated care boards must have regard.”

This new clause ensures a certain range of primary care providers are consulted by integrated care boards in the development of their healthcare plans.

New clause 23—Duty of care for victims of domestic abuse and violence against women and girls—

“The Secretary of State and integrated care boards have a duty of care to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.”

This new clause would place a duty of care on the Secretary of State and integrated care boards to consider the needs of victims of domestic abuse and violence against women and girls when exercising their functions in relation to the provision of healthcare services.

New clause 25—Continuity of care and clinical responsibility—

“(1) The Secretary of State must by regulations ensure that every patient has access to a named NHS General Practitioner.

(2) Regulations under this section must make provision for pregnant women to have access to a named clinician for the period of their pregnancy.

(3) Regulations under this section are subject to the affirmative procedure.”

New clause 29—Senior leadership training at NHS trusts—

“(1) Within six months of the passage of this Act, the Secretary of State must publish a review on the effectiveness of training for senior leadership in NHS trusts on—

(a) workplace culture standards,

(b) addressing bullying, and

(i) sex,

(ii) race, and

(iii) any other protected characteristic which the Secretary of State considers appropriate.

(2) Within one month of the publication of the review under subsection (1), the Secretary of State must publish guidance based on the review for the Department of Health and Social Care to administer to NHS trusts.”

New clause 32—Privacy by design in NHS Single Patient Record and Federated Data Platform architecture—

“(1) The Secretary of State must ensure that there is privacy by design as part of the delivery of the NHS Federated Data Platform architecture.

(2) For the purposes of subsection (1), privacy by design includes—

(a) patient data anonymisation outside its usage by clinicians and within the National Data Integration Tenant; and

(b) patient consent for the processing of personal information by NHS.”

New clause 33—NHS ownership of connection software—

“(1) The Secretary of State must ensure that there is NHS ownership of any data connector software architecture used as part of the delivery of the NHS Single Patient Record or Federated Data Platform.

(2) In this section, a data connector means an interface or connection between the NHS Federated Data Platform and any other health system.”

New clause 34—Retendering of contract for the NHS Federated Data Platform—

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

New clause 35—NHS contracting for IT or data services—

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

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

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

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

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

(d) the department or NHS organisation must, at the end of the contract period (or following any extensions) conduct a competitive retendering process; and

(e) where a retendering process takes place under subsection (2)(d), the contractor may not assist in the preparation of the contract specification.

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

New clause 36—Transition strategy for the abolition of NHS England—

“(1) The Secretary of State must, before the abolition of NHS England takes effect, prepare and lay before Parliament a report setting out a transition strategy for the abolition of NHS England (the "strategy").

(2) The strategy must—

(a) identify and map critical functions and areas of expertise currently exercised by NHS England, including clinical, operational, analytical and patient engagement capabilities;

(b) assess the risk of loss of knowledge, skills and organisational capacity arising from the abolition of NHS England;

(c) set out the steps the Secretary of State proposes to take to ensure the retention and effective transfer of such functions, expertise, knowledge and skills; and

(d) assess the likely impact of the transition on the delivery of key health programmes and services, including cancer services.

(3) The Secretary of State must, at intervals of not more than 12 months, lay before Parliament a report on the implementation of the transition strategy.

(4) A report under subsection (3) must include—

(a) progress on workforce retention;

(b) arrangements for the transfer of knowledge, expertise and institutional capability; and

This new clause would require the Secretary of State to prepare and lay before Parliament a formal transition strategy before the abolition of NHS England, setting out how critical functions and expertise will be identified, retained and transferred. It would also require the Secretary of State to report to Parliament at least annually on the implementation of that strategy.

New clause 38—General Ophthalmic Servicesnational framework, tariff and protected funding—

“(1) The Secretary of State must by regulations establish and maintain a national service specification for the primary ophthalmic services referred to in section 115 of the National Health Service Act 2006 (in this section referred to as general ophthalmic services, "GOS"), setting out the minimum standards of access and provision that integrated care boards are required to secure.

(2) Regulations under subsection (1) must establish and maintain a national tariff for GOS, setting out the prices at which GOS must be commissioned by integrated care boards.

(3) An integrated care board must commission GOS in accordance with the national service specification and national tariff established under subsections (1) and (2), and may not exercise any discretion to vary, restrict or reduce provision below the standards so specified.

(4) The Secretary of State must ensure that funding for GOS is allocated to integrated care boards as a ring-fenced, protected funding stream, which—

(a) may not be applied by an integrated care board to purposes other than GOS; and

(b) may not be reduced by an integrated care board in order to meet expenditure requirements in respect of other services.

(5) In determining any expenditure limits or resource allocations for integrated care boards under the National Health Service Act 2006, the Secretary of State must calculate and separately identify the GOS component of each board's allocation.

(6) The Secretary of State must lay before Parliament a report in each calendar year assessing the extent to which integrated care boards have complied with their obligations under this section.”

New clause 39—Community equipment and wheelchair servicesstandards, performance and outcomes—

“(1) Each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services.

(2) Each integrated care board must monitor its performance against the standards under subsection (1).

(3) Each integrated care board must publish an annual report including—

(a) performance against the standards under subsection (1),

(b) waiting times for the assessment for and supply of community equipment and wheelchair services,

(d) outcomes achieved for people by the provision of community equipment and wheelchair services, and

(e) steps taken by the integrated care board to improve the assessment for, and supply of, community equipment and wheelchair services.

(4) For the purposes of this section—

“community equipment and wheelchair services” means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.”

This new clause would require each integrated care board must publish standards which apply in its area in relation to the assessment for and supply of community equipment and wheelchair services and publish an annual report on their adherence to these standards.

New clause 40—Regulation of online fertility services—

“(1) The Human Fertilisation and Embryology Act 1990 is amended as follows.

(2) After section 5 insert—

“5A. Regulation of online fertility services

(1) The Human Fertilisation and Embryology Authority shall be responsible for the licensing of organisations providing online fertility services in England and Wales.

(2) The Secretary of State may by regulations make further provision regarding the arrangements for the licensing of organisations under subsection (1).

(3) Regulations made under subsection (2) are subject to the affirmative procedure.””

This new clause would implement a recommendation of the Human Fertilisation and Embryology Authority to extend its regulatory remit to include organisations providing online fertility services.

New clause 43—Duty to reduce variation in clinical research funding—

“In exercising functions in relation to the health service, the Secretary of State must have regard to the need to—

(a) reduce inequalities between the people of England with respect to their ability to access clinical research opportunities and participate in clinical trials, and

(b) reduce regional variation in the distribution of clinical research funding across England.”

This new clause would require the place a duty on the Secretary of State to reduce inequalities across England with respect to access to clinical research opportunities and participate in clinical trials and the distribution of clinical research funding across.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

This amendment is consequential on NC67.

New clause 48—National Maternity and Neonatal Investigation final report and recommendations—

“(1) The Secretary of State must, within six months of the passing of this Act, publish a response to the final report and recommendations of the National Maternity and Neonatal Investigation.

(2) The response under subsection (1) must include an action plan covering each of the recommendations of the Investigation.

(3) The action plan must have regard for hospitals—

(a) where negligent care has been identified in the provision of maternity and neonatal services, or

(b) where risk factors have been identified that are associated with potential negligent care in the provision of maternity and neonatal services.

(4) The Secretary of State must report to Parliament each year on the progress made in delivering the action plan.”

This new clause would require the Secretary of State to produce an action plan in response to the final report and recommendations of the National Maternity and Neonatal Investigation.

New clause 50—Independence of appointments—

“The Secretary of State must make provision to ensure that operational decisions regarding the appointment, suspension or removal of—

(a) chairs and directors of NHS trusts and NHS foundation trusts, and

(b) chief executives of integrated care boards,

are made exclusively by persons employed in the civil service, upon strictly merit-based criteria.”

This new clause would ensure that any decisions over NHS trusts and ICB leadership are made by civil servants, rather than the Secretary of State, to ensure appointments are made on merit.

New clause 51—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 by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS Constitution for England 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,

(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 new right in the NHS constitution 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 53—Right to a GP appointment—

“(1) The Secretary of State must by regulations, within six months of the passing of this Act, establish a scheme to provide every patient with the right to a GP appointment within seven days of seeking one, or 24 hours if urgent.

(2) The Secretary of State must amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to make the right under subsection (1) a right in the NHS constitution.

(3) The Secretary of State may review the scheme every three years from the day on which this Act is passed and amend it through regulations made by statutory instrument.

(4) A statutory instrument under this section may not be made unless a draft has been laid before and approved by a resolution of each House of Parliament.

(5) For the purposes of this section—

“GP appointment” means an appointment with an appropriate clinician within a GP practice.

“Urgent” means the current definition under GP triaging protocols.”

This new clause requires the Secretary of State to give patients a new right in the NHS constitution to receive a GP appointment within 7 days, or 24 hours if urgent, and establishes a scheme to deliver this.

New clause 54—Duty to identify and record unpaid carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to identify and record unpaid carers

(1) An integrated care board must take reasonable steps to identify persons within its area who are unpaid carers.

(2) An integrated care board must make arrangements to ensure that NHS bodies and providers of NHS services within its area—

(a) maintain appropriate systems for recording whether a person is an unpaid carer,

(b) use consistent coding standards for the recording of unpaid carers in health records,

(d) ensure that the identification and recording of unpaid carers forms part of—

(i) primary care registration processes,

(ii) hospital discharge procedures,

(iii) care planning processes, and

(iv) other relevant patient contact pathways.

(3) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to identify and record unpaid carers when they come into contact with NHS services.

New clause 55—Duty to promote the health and wellbeing of carers—

“After section 14Z44 of the NHS Act 2006 insert—

“Duty to promote the health and wellbeing of carers

(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.

(2) In exercising its duties under this section, an integrated care board must have regard to—

(a) reduction of health inequalities experienced by carers,

(b) prevention of deterioration in carers’ physical and/or mental health,

(d) the need to ensure carers are able to access appropriate preventative and other health services and support.

(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—

(a) consider the health and wellbeing needs of carers in care planning and discharge processes,

(b) involve carers appropriately in decisions relating to care and treatment, and

(4) In preparing a Joint Forward Plan, an integrated care board must include—

(a) an assessment of the health and wellbeing needs of carers within its area,

(b) steps the integrated care board proposes to take to improve outcomes for carers, and

(5) For the purposes of this section, "unpaid carer" means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work.””

This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.

New clause 56—National Respite Care Scheme—

“(1) Within six months of the passage of this Act, the Secretary of State must establish a National Respite Care Scheme.

(2) The scheme under subsection (1) must make provision for—

(a) where a local authority carries out an assessment of the needs of an unpaid carer, under any enactment for the time being in force in England, it must assess whether the unpaid carer is able to take sufficient breaks from their caring responsibilities,

(b) unpaid carers to receive support to take breaks from their caring responsibilities to—

(i) maintain their physical and mental health and emotional wellbeing,

(ii) participate in work, education, training or recreation, and

(iii) participate in family and community life,

(c) a carer to receive appropriate support if a local authority carrying out an assessment under subsection (2)(a) determines that a carer is unable to take sufficient breaks from caring.

(3) Under subsection (2), “support” may include—

(a) replacement care for the cared-for person;

(b) respite services;

(4) The Secretary of State must provide sufficient support to local authorities to ensure the scheme under subsection (1) is delivered in every local authority.

(5) For the purposes of this section—

“unpaid carer” means a person who provides or intends to provide care for another person otherwise than by virtue of a contract or other voluntary work;

“parent carer” has the same meaning as in section 17ZD of the Children Act 1989;

“young carer” has the same meaning as in section 96 of the Children and Families Act 2014.”

New clause 57—Integrated Care BoardsScrutiny Committee—

“(1) Each integrated care board must establish a Scrutiny Committee.

(2) Each Committee established under subsection (1) must—

(a) oversee the operation of the integrated care board,

(b) ensure accountability of the integrated care board with regards to—

(i) allocation of resources;

(ii) grievance and complaint management;

(iii) innovation and service redesign in line with Government objectives;

(iv) delivery of services;

(v) integration with social care;

(vi) advancing public health objectives;

(vii) issues relating to workforce or estate; and

(viii) any other issues as designated by the Secretary of State.

(3) The Committee must comprise—

(a) Members of Parliament representing constituencies in the area covered by the integrated care board,

(b) Chairs of local government health and social care committees in the area covered by the integrated care board,

(c) representatives from Healthwatch England or any patient participation network designated by the Secretary of State, and

(d) Representatives from trade unions including—

(i) two representatives from unions involved in negotiations on Agenda for Change, and

(ii) one representative from a trade union representing doctors or dentists.

(4) The Committee must meet six times each year.

(5) The Chair of the Committee must be elected at an annual general meeting of the Committee.

(6) The Committee must report to the Board of the integrated care board.

(7) The Chair and Chief Executive of each integrated care board and leaders of health providers and services must attend a meeting of a Committee when requested to do so.

(8) Each Committee will report to the Secretary of State for Health and Social Care.”

New clause 66—Maternity servicessafe staffing levels—

“(1) The Secretary of State must ensure that maternity staffing levels are sufficient to ensure all residents in England can access a staffed maternity unit within 45 minutes of their home.

(2) The Secretary of State must ensure adequate workforce planning, including through delivery of a consultant obstetrician and gynaecologist recruitment and retention plan, to ensure that maternity units are not required to close as a result of staffing issues.

(3) The Secretary of State must lay before Parliament an annual report on the progress made on national maternity staffing levels under this section.”

This new clause would ensure that no maternity units are forced to close as a result of staffing issues and that every person in England has access to a maternity unit within 45 minutes of their home.

New clause 67—Workforce planning and supply—

“(1) After section 1 of the National Health Service Act 2006 insert—

“1ZA Secretary of State’s duty as to workforce planning and supply

(1) The Secretary of State must promote in England a comprehensive system of workforce planning and supply designed to secure that there are sufficient people with the necessary skills and experience to provide services as part of the health service.

(2) In meeting the requirement under subsection (1), the Secretary of State must exercise the functions conferred by this Act so as to secure that the workforce needs of the health service are assessed and met.

(3) The Secretary of State retains ministerial responsibility to Parliament for workforce planning and supply for the health service in England.”

(2) For section 1GA of the National Health Service Act 2006 substitute—

“Workforce strategy

(1) The Secretary of State must prepare and publish a strategy setting out how the Secretary of State proposes to discharge the duty under section 1ZA.

(2) The strategy must include—

(a) an assessment of the current workforce of the health service;

(b) projections of the workforce required to meet the needs of the health service over periods of five, ten and fifteen years beginning with the day on which the strategy is published;

(d) an assessment of any difference between the projected workforce requirements and expected workforce supply;

(e) the measures that the Secretary of State proposes to take to address any such difference; and

(f) an assessment of the financial and other resources required to implement those measures.

(3) In preparing or revising the strategy, the Secretary of State must consult—

(a) integrated care boards;

(b) NHS trusts and NHS foundation trusts;

(d) trade unions representing persons employed or otherwise engaged in the provision of those services;

(e) professional bodies and professional regulators;

(f) persons concerned with the provision of education and training for the workforce;

(g) persons representing patients; and

(h) such other persons as the Secretary of State considers appropriate.

(4) The first strategy under this section must be published before the end of the period of 12 months beginning with the day on which this section comes into force.

(5) The Secretary of State must—

(a) review the strategy before the end of the period of five years beginning with the day on which it was last published, and

(b) following each review, publish a revised strategy.

(6) The Secretary of State may revise the strategy before the end of that period if the Secretary of State considers it appropriate to do so.

(7) The Secretary of State must lay before Parliament a copy of each strategy published under this section.

(8) The Secretary of State must have regard to the strategy when exercising functions in relation to the health service.””

This new clause places responsibility for workforce planning and supply for the health service in England on the Secretary of State, including ministerial responsibility to Parliament. It also requires the Secretary of State to publish a strategy setting out projected workforce requirements and supply, and the measures and resources needed to meet those requirements.

New clause 69—Self-care—

“In the National Health Service Act 2006, after section 1C insert—

“1CA Duty as to self-care

In exercising functions in relation to the health service, the Secretary of State must have regard to the importance of—

(a) promoting self-care and improving health literacy as part of the prevention of illness and the improvement of health and wellbeing;

(b) supporting people to manage self-treatable conditions independently where appropriate; and

(c) the role of community pharmacy in supporting self-care and prevention and helping people to access appropriate care.””

This new clause would require the Secretary of State, when exercising functions in relation to the health service, to have regard to the importance of promoting self-care and improving health literacy, supporting people to manage self-treatable conditions, and the role of community pharmacy in supporting self-care and prevention.

New clause 74—Protection of pharmacy staff during provider failure—

“(1) The Secretary of State must establish arrangements to protect the pay and essential employment protections of staff employed by a provider of pharmaceutical services where the provider—

(a) becomes insolvent,

(b) ceases to provide pharmaceutical services,

(d) is otherwise unable to meet its obligations to its employees.

(2) Arrangements under subsection (1) must provide for—

(a) the continuation, so far as reasonably practicable, of payment of wages to affected staff,

(b) the preservation of essential employment protections during the period of emergency intervention,

(d) the transfer, continuation or replacement of employment arrangements where necessary to secure continuity of pharmaceutical services.

(3) The Secretary of State may make payments to, or in respect of, affected staff for the purposes of this section.

(4) The Secretary of State may recover from the failed provider any sums paid under subsection (3).

(5) Arrangements under this section must be capable of operating at the same time as arrangements made under section 133 of the National Health Service Act 2006 to secure alternative provision of pharmaceutical services.

(6) The Secretary of State must publish guidance about the operation of arrangements under this section.”

This new clause would protect pharmacy staff's pay and essential employment rights when a provider fails, while supporting continuity of services.

New clause 75—Integrated primary care teams—

“(1) Each integrated care board must make arrangements to promote the provision of joined-up primary care services across general practice, primary dental services and pharmaceutical services.

(2) Arrangements under subsection (1) must, so far as reasonably practicable, provide for—

(a) general practitioners, dentists, pharmacists and other relevant primary care professionals to work together as part of integrated local primary care teams;

(b) the sharing of relevant patient information between those professionals through secure and interoperable digital systems;

(c) the use of common or interoperable care records, so that relevant clinical information can be accessed by an authorised professional involved in a patient's care;

(d) appropriate mechanisms for referral and communication between general practice, dental practices and community pharmacies;

(e) the reduction of duplication in assessments, prescribing, referrals and administrative processes; and

(f) improved continuity and coordination of care for patients with multiple or ongoing health needs.

(3) In exercising its functions under this section, an integrated care board must have regard to the need to ensure that patients can move between general practice, primary dental services and pharmaceutical services without unnecessary duplication, delay or loss of relevant clinical information.

(4) The Secretary of State may by regulations make provision about—

(a) minimum interoperability standards for systems used by providers of primary medical, dental and pharmaceutical services;

(b) standards for the secure exchange of patient information;

(d) electronic referrals and communications between providers; and

(e) such other matters as the Secretary of State considers necessary to support integrated primary care.

(5) Regulations under subsection (4) must include appropriate safeguards for patient confidentiality, information governance and the lawful processing of personal data.

(6) In this section—

“primary care team” means a group of health professionals and providers working together to provide or coordinate primary care services;

“primary dental services” has the meaning given by section 98C of the National Health Service Act 2006; and

“pharmaceutical services” includes services provided under Part 7 of that Act.”

This new clause would promote joined-up working between GPs, dentists and pharmacists to improve coordination and continuity of care.

New clause 79—Voluntary sector role in neighbourhood health plans—

“(1) In preparing a neighbourhood health plan, a responsible local authority and integrated care board must take and demonstrate reasonable steps to ensure the plan is co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in that area, including the development, design, implementation, monitoring and evaluation of the plan.

(2) In meeting the requirement under subsection (1) a local authority and integrated care board must in particular have regard to—

(a) organisations representing people with lived experience of health conditions;

(b) organisations working with underserved or marginalised populations; and

(3) The responsible local authority and integrated care board must demonstrate how they have ensured ongoing and meaningful representation of voluntary, community and social enterprise organisations across the governance, decision-making and commissioning arrangements relating to neighbourhood health plans at all stages of the planning process.”

This new clause would require local authorities and integrated care boards to take and demonstrate reasonable steps to ensure neighbourhood health plans are co-produced with meaningful involvement by the local voluntary, community and social enterprise sector in the local area.

New clause 80—Power to enable reservation and prioritisation of contracts for the voluntary, community and social enterprise sector—

“(1) In exercising their commissioning functions, integrated care boards must take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services.

(2) The Secretary of State must through regulations enable integrated care boards to reserve and/or prioritise contracts to be delivered by voluntary, community and social enterprise organisations as part of their commissioning process.

(3) Circumstances in which contracts may be appropriate to be reserved or prioritised under subsection (2) include—

(a) services that are, or could be, community-based;

(b) services that are intended to reach populations that are underserved, marginalised, or experiencing health inequalities; or

(c) where voluntary, community and social enterprise organisations are best placed to deliver person-centred and/or culturally competent care.

(4) In exercising functions under this section, integrated care boards must have regard to—

(a) the need to reduce health inequalities;

(b) the importance of securing equitable access to services across different areas; and

This new clause would require integrated care boards to take reasonable steps to secure the participation of voluntary, community and social enterprise organisations in the provision of services through the ICB commissioning process.

New clause 85—Duties on integrated care boards regarding education, health and care plans—

“(1) The Secretary of State must exercise the powers in Part 3 of the Children and Families Act 2014 (children with special education needs) with a view to securing that integrated care boards (“ICBs”) are subject to the same relevant requirements as local authorities in relation to the duty to secure the specified special educational provision for a child or young person in the preparation of education, health and care plans (“EHC plans”) under that Part.

(2) For the purposes of subsection (1), the relevant requirements are—

(a) that the special educational provision set out in section F of an EHC plan meets the needs identified by an EHC needs assessment;

(b) that ICBs can be required to provide such special educational provision;

(d) that ICBs are subject to appeals to the First-tier Tribunal in accordance with section 51 of the Children and Families Act 2014; and

(e) that any duty on ICBs to provide such special educational provision does not impact upon an ICB’s duty to arrange health care provision, where this is required by an EHC plan.”

This new clause would require the Secretary of State to make regulations placing a statutory duty on integrated care boards to ensure that where an EHC plan specifies special education provision, they are subject to the same duty as local authorities to ensure that this is arranged for the child or young person.

New clause 90—Duty to reduce health inequalities—

“(1) Section 2B of the National Health Service Act 2006 (functions of local authorities and Secretary of State as to improvement of public health) is amended as follows.

(2) In the heading, after “health” insert “and reduction of health inequalities”.

(3) In subsection (2)—

(a) for “may” substitute “must”; and

(b) after “England” insert “and reducing health inequalities between the people of England”.

(4) In subsection (3), after paragraph (g) insert—

“(h) collaborating with any government department or local authority.”

(5) After subsection (5) insert—

“(6) In this section, “health inequalities between the people of England” means health inequalities between persons, or persons of different descriptions, living in England or in different parts of England.

(7) In this section, “health inequalities” means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants.

(8) In subsection (7), “general health determinants” include—

(a) standards of housing, transport services or public safety;

(b) environmental factors, including air quality and access to green space and bodies of water;

(d) the degree of ease or difficulty with which persons have access to public services;

(e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health; and

(f) any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.

(9) In subsection (2), the reference to reducing health inequalities includes mitigating any increase in health inequalities which would otherwise be occasioned by the exercise of the Secretary of State’s functions.””

New clause 91—Health improvement and health inequalities strategy—

“(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a health improvement and health inequalities strategy.

(2) In preparing the strategy, the Secretary of State must consult such persons as the Secretary of State considers appropriate.

(3) The strategy must include—

(a) long-term targets relating to health improvement and the reduction of health inequalities in England throughout a person's life;

(b) provision for the establishment of a public authority with functions relating to the additional monitoring of, and reporting on, progress towards the targets included in the strategy in accordance with paragraph (a); and

(4) The long-term targets included in the strategy in accordance with subsection (3)(a) must include—

(a) at least one target relating to the improvement of the health of persons under the age of 18 in England; and

(b) at least one target relating to the improvement of the health of persons aged 18 or over in England.

(5) A Minister of the Crown must, in exercising the Minister’s functions, have regard to the strategy.

(6) The Secretary of State must prepare and publish a report on the implementation of the strategy—

(a) within 12 months of the publication of the strategy; and

(b) at intervals of no more than 12 months thereafter.

New clause 93—State of NHS Dentistry report—

“(1) The Secretary of State must publish and lay before Parliament a report on the state of NHS dentistry in England (“the State of Dentistry Report”) at least once every two years.

(2) The State of Dentistry Report must include an assessment of—

(a) access to NHS dental services and levels of unmet need;

(b) the adequacy, distribution and sustainability of the NHS dental workforce, including general dental services, community dental services, hospital dental services, dental public health consultants and dental academia;

(d) inequalities in access to NHS dental services and oral health outcomes between different socioeconomic groups and populations, including but not limited to people living in care homes and people experiencing homelessness;

(e) demand and waiting times for dental treatment in community dental services and secondary care;

(f) the extent to which inadequate access to NHS dental services contributes to avoidable pressure on other parts of the NHS, including primary medical care, urgent and emergency care, hospital services and the prescribing of medicines; and

(g) the measures required to address any deficiencies or inequalities identified under paragraphs (a) to (f).

(3) The report must include such indicators as the Secretary of State considers appropriate for assessing each of the matters set out in subsection (2), and those indicators must, wherever appropriate, be presented in a manner that enables comparisons to be made between different areas and populations and over time, including by reference to population size, full-time equivalent workforce and other relevant measures.

(4) In preparing the report, the Secretary of State must have regard to the need to ensure that NHS dental services are sufficient to meet the current and projected need for dental care in England.

(5) The Secretary of State must, within six months of publishing a State of Dentistry Report, set out the measures the Government intends to take in response to the findings of the report.

(6) The Secretary of State must make arrangements for each State of Dentistry Report, and the Government's response to it, to be debated in each House of Parliament.

(7) The first State of Dentistry Report must be published within 12 months of the passing of this Act.”

This new clause would require the Secretary of State to publish and lay before Parliament a regular report on the state of NHS dentistry in England, assessing access to and unmet need for NHS dental services, workforce capacity and distribution, geographical and wider inequalities, and the pressure that inadequate access to NHS dental services places on other parts of the NHS. It would also require the Government to respond to each report and ensure that both the report and response are debated in Parliament.

New clause 104—NHS-funded In Vitro Fertilisation—

“(1) Within six months of the passage of this Act, the Secretary of State must by regulations make arrangements for the standardised provision of NHS-funded In Vitro Fertilisation (IVF).

(2) Provision under this section must, in accordance with any existing NICE guidelines, set requirements for all integrated care boards in England relating to NHS-funded IVF.

(3) Requirements under subsection (2) include—

(a) standardisation of the minimum number of rounds of IVF available to one individual, and

(b) standardisation of the maximum and minimum age at which an individual can access IVF.”

This new clause would require the Secretary of State to make regulations standardising NHS-funded IVF provision across all integrated care boards in England, in accordance with existing NICE guidelines, including the number of rounds available to an individual and the age limits for access.

New clause 106—Report on the duty to co-operate—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must lay a report before both Houses of Parliament on—

(a) the operation of the duty to co-operate under section 72 of the National Health Service Act 2006 (co-operation between NHS bodies) and section 82 of that Act (co-operation between NHS bodies and local authorities), and

(b) the impact of those duties on the integration of health and social care in England.

(2) The report under subsection (1) must consider co-operation between—

(a) relevant NHS bodies, and

(b) relevant NHS bodies and local authorities,

in the delivery and commissioning of health and social care.

(3) Within six months of the report under subsection (1) being laid, the Secretary of State must—

(a) make provision to update guidance on the duty to co-operate, and

(b) implement actions to strengthen integration in the report which the Secretary of State considers most appropriate.”

This new clause would place a requirement on the Secretary of State to report to Parliament, within six months of the Act passing, on how well NHS bodies and local authorities are working together to integrate health and social care in England. It would also place a requirement on the Secretary of State to update the related guidance and take action to strengthen this cooperation six months later.

New clause 108—NHS ethical and sustainable procurement framework—

“(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must conduct a review of the NHS’s ethical and sustainable procurement framework.

(2) Following the review under subsection (1), the Secretary of State must by regulations ensure that contracting authorities can exclude companies from bidding for a tender on the basis of any proven—

(a) involvement in violations of international law and/or,

(b) breaches of internationally accepted standards of business conduct including—

(i) the UN Guiding Principles and,

(ii) OECD Guidelines for Multinational Enterprises.”

New clause 109—Artificial intelligence governance and auditing—

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must publish guidance on the—

(a) governance,

(b) monitoring,

(d) audit of artificial intelligence (AI) systems used in health and care settings.

(2) The guidance under subsection (1) must include—

(a) requirements for healthcare organisations to maintain an inventory of AI systems used in clinical and operational processes,

(b) requirements for proportionate monitoring, by the healthcare organisations, of AI systems throughout their operational lifecycle, including safety, performance and effectiveness,

(d) arrangements for documenting accountability and decision-making responsibilities relating to AI deployment and use,

(e) expectations regarding transparency, reporting, and ability to audit AI enabled services.

(3) Each health and care setting required to implement guidance under this section must designate a senior individual who is responsible for—

(a) the monitoring, assurance and audit of AI systems under subsection (1) in their health or care setting;

(b) supporting AI providers and vendors to perform their post market surveillance as required;

(d) addressing the governance and impact of decommissioning of AI systems.

(4) The Care Quality Commission must have regard to the guidance published under subsection (1) when exercising its functions.

(5) The Care Quality Commission should assess whether providers have appropriate arrangements in place for the—

(a) governance,

(b) monitoring, and

(c) safe use of artificial intelligence systems, and may require evidence that such arrangements are operating effectively.”

New clause 119—Report into digital health services in rural and coastal areas—

“(1) The Secretary of State must publish a report on the equality of access to and quality of digital health services in rural and coastal areas within 12 months of the passing of this Act.

(2) The report under subsection (1) must include an action plan to ensure rural and coastal practices are able to provide remote consultations and electronic prescription services.”

This new clause would require the Secretary of State to publish a report on equality of access to and quality of digital health services in rural and coastal areas.

New clause 120—Farmer friendly accredited general practice scheme—

“(1) The Secretary of State must create a farmer friendly accredited general practice scheme to recognise and resource GP practices that proactively reach farming communities.

(2) The scheme under subsection (1) should be modelled on Royal College of GPs’ Veteran Friendly Accreditation scheme.

(3) The Secretary of State must instruct the CQC to develop clear guidance for the farmer friendly accredited general practice scheme which supports delivery of care in non-clinical community settings with proportionate hygiene protocols that reflect the setting.”

This new clause places a duty on the Secretary of State to create a farmer friendly accredited general practice scheme.

New clause 121—Continuity of specified national diabetes programmes—

“(1) The Secretary of State must secure that the programmes listed in subsection (2) continue to be provided, to at least the same extent as immediately before the abolition of NHS England.

(2) The programmes referred to in subsection (1) are—

(a) the NHS Diabetes Prevention Programme;

(b) the NHS Type 2 Diabetes Path to Remission Programme;

(d) the national roll-out of hybrid closed loop (“artificial pancreas”) technology for people with type 1 diabetes;

(e) the National Diabetes Audit programme, including the National Diabetes Footcare Audit and the National Diabetes Inpatient Safety Audit;

(f) any other programme specified for the purposes of this section in regulations made by the Secretary of State.

(3) Before making a scheme under section 2 for the transfer of property, rights or liabilities relating to a programme listed in subsection (2) the Secretary of State must publish a statement explaining how continuity of that programme is to be maintained.

(4) Before the end of the period of 12 months beginning with the day on which this section comes into force, and at least once every subsequent period of 12 months, the Secretary of State must lay before Parliament a report on the provision of the programmes listed in subsection (2), including information on patient access, waiting times and outcomes.

(5) Regulations under subsection (2)(f) are subject to annulment in pursuance of a resolution of either House of Parliament.”

This new clause would require the Secretary of State to maintain existing national diabetes prevention, treatment and audit programmes following the abolition of NHS England, to explain how continuity will be secured before transferring related functions, and to report annually to Parliament on their provision.

New clause 122—Report on effect of abolition of NHS England on diabetes services—

“(1) Before the end of the period of 12 months beginning with the day on which section 1 comes into force, and no less frequently than every 12 months thereafter for the following 3 years, the Secretary of State must publish and lay before Parliament a report assessing the effect of the abolition of NHS England on the planning, funding and delivery of diabetes prevention, treatment and care services in England.

(2) A report under subsection (1) must include an assessment of—

(a) any change in funding allocated to diabetes prevention, treatment and care programmes;

(b) any change to the operation or continuation of national clinical audits relating to diabetes;

(d) the impact on workforce capacity in specialist diabetes services.”

This new clause would require the Government to monitor and report to Parliament on the impact of NHS England's abolition specifically on diabetes services.

New clause 133—England and Wales cross-border healthcarestatement of values and principles—

“(1) The Secretary of State and each integrated care board must, in exercising functions relating to the provision or commissioning of health services to persons residing in an area of England or Wales close to the border between England and Wales, have regard to the 2018 England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) For the purposes of this section, “the England / Wales Cross-border Healthcare Services: Statement of Values and Principles” means the statement published by NHS England and the Welsh Ministers on 6 November 2018, or a revised statement designated by regulations under subsection (3).

(3) The Secretary of State may by regulations designate a revised version of the Statement for the purposes of this section.

(4) Before making regulations under subsection (3), the Secretary of State must consult—

(a) the Welsh Ministers;

(b) each integrated care board whose area is close to the border between England and Wales;

(d) such organisations representing patients affected by cross-border healthcare arrangements as the Secretary of State considers appropriate.

(5) Regulations under subsection (3) are to be made by statutory instrument.

(6) A statutory instrument containing regulations under subsection (3) may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”

This new clause would require the Secretary of State and integrated care boards to have regard to the England / Wales Cross-border Healthcare Services: Statement of Values and Principles when exercising relevant functions in areas close to the England-Wales border. It would also enable the Secretary of State to designate a revised version of the Statement, following consultation with the Welsh Ministers, relevant integrated care boards and Local Health Boards, and organisations representing patients affected by cross-border healthcare arrangements.

New clause 134—England and Wales cross-border healthcare arrangements—

“(1) The Secretary of State must, within 18 months of the passing of this Act, seek to agree with the Welsh Ministers a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles.

(2) In preparing the revised Statement under subsection (1), the Secretary of State must consider—

(a) the effectiveness of existing arrangements for the provision and commissioning of cross-border health care services;

(b) the interests of patients who live in England or Wales and receive, or may receive, health services on the other side of the border;

(d) arrangements for resolving disputes between relevant bodies in England and Wales; and

(e) the appropriate means of placing the principles governing England and Wales cross-border health care services on a statutory footing.

(3) The Secretary of State must, within two years of the passing of this Act—

(a) publish the revised Statement agreed under subsection (1), or, where no revised Statement has been agreed, publish a report setting out the steps taken to seek such agreement and the reasons why agreement has not been reached;

(b) lay the revised Statement or report before Parliament; and

(c) lay before Parliament proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.”

This new clause would require the Secretary of State to seek agreement with the Welsh Ministers on a revised England / Wales Cross-border Healthcare Services: Statement of Values and Principles within 18 months of the passing of the Act. It would also require the Secretary of State, within two years, to lay the revised Statement, or a report where agreement has not been reached, before Parliament and to bring forward proposals for placing the principles governing England and Wales cross-border healthcare services on a statutory footing.

New clause 135—Reporting on mortality inequalities for autistic people and people with learning disabilities—

“(1) Within 12 months of the passage of this Act, the Secretary of State must prepare and publish a report on the mortality inequalities experienced by autistic people and people with a learning disability.

(2) The report under subsection (1) must specify targets for reducing mortality inequalities between people without a learning disability and autistic people and people with any learning disability.

(3) Within 3 months of the publication of the report under subsection (1) the Secretary of State must make regulations which require ICBs to publish an annual report which includes—

(a) mortality rates for—

(i) autistic people,

(ii) people with any learning disability,

(iii) people without a learning disability.

(b) identification of any areas in which data collection on mortality inequalities experienced by autistic people and people with learning disabilities is inadequate,

(d) a plan for reducing inequalities in mortality rates between people without a learning disability and autistic people and people with any learning disability.

(4) Regulations under subsection (3) must make provision for the annual reports to continue for as long as mortality inequalities between people without a learning disability and autistic people and people with any learning disability exist.

(5) The Secretary of State must publish an annual report summarising the information in the ICB reports under subsection (3), identifying national trends in—

(a) mortality rates,

(b) reasons for inequalities in mortality rates,

This new clause would require the Secretary of State to publish a report on the mortality inequalities experienced by autistic people and people with a learning disability and make provision for ICBs to publish annual reports on such inequalities in their area and proposed actions for remedying such inequalities.

New clause 136—North CornwallDental appointments—

“(1) Within one year beginning on the date on which this Act is passed, the Secretary of State must ensure that there is adequate provision of NHS dentistry in North Cornwall.

(2) Adequate provision under subsection (1) means—

(a) access to urgent dental appointments for any person with an urgent need, and

(b) improved access to routine dental appointments.

(3) The Secretary of State must explain any failure to meet the requirement set out in subsection (1) at a public event in the local area.”

This new clause places a duty on the Secretary of State to ensure there is adequate provision of NHS dental appointments in North Cornwall.

New clause 144—Prioritising British citizens for the UK foundation programme—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 4, after subsection (4) insert—

“(4A) A person is within this subsection if they—

(a) are a British citizen, and

(b) hold a primary medical qualification from an international branch campus of a higher education institution in the United Kingdom.””

This new clause amends the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places.

New clause 145—Response to the Hughes Reportoptions for redress for those harmed by valproate and pelvic mesh—

“The Secretary of State must, within 30 days of the day on which this Act is passed, publish the Government’s response to the Hughes Report.”

This new clause would require the Secretary of State to publish the Government’s response to the Hughes Report within 30 days of this Act being passed.

New clause 152—Requirement for merit-based job allocations for doctors—

“(1) The Medical Training (Prioritisation) Act 2026 is amended as follows.

(2) In section 1, at end insert—

“(2) Applicants eligible under this section shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(d) skills, and

(e) ability to perform the duties of the post.”

(3) In section 2, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(d) skills, and

(e) ability to perform the duties of the post.”

(4) In section 3, after subsection (1) insert—

“(1A) Applicants eligible under subsection (1) shall be prioritised based on merit, determined by reference to the applicant’s—

(a) qualifications,

(b) professional competence,

(d) skills, and

(e) ability to perform the duties of the post.””

New clause 153—Redundancies—

“The Secretary of State must publish, within 12, 24, and 48 months of the passage of this Act, the number of persons—

(a) employed by the Department for Health and Social Care, and

(b) made redundant following the abolishment of NHS England under subsection (1) of this Act.”

This new clause would require the Secretary of State to publish the number of staff in the Department for Health and Social Care and the number of people made redundant following the abolishment of NHS England.

New clause 154—Medical training places—

“The Secretary of State must increase the number of medical school training places to 15,000 by the year 2031-32.”

This new clause would put a duty on the Secretary of State to double the number of medical school training places.

New clause 155—Self-care and health literacy in neighbourhood health plans—

“(1) Guidance issued by the Secretary of State under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act (neighbourhood health plan) must require that every neighbourhood health plan includes arrangements for—

(a) supporting self-care and self-management, including by enabling people to manage minor and long-term conditions, and conditions that are self-limiting, themselves where it is safe and appropriate to do so;

(b) improving health literacy and ensuring that people living or working in the area have access to trusted, quality-assured information, advice and digital tools to support them in managing their own health and wellbeing;

(c) facilitating access to community pharmacy services, including pharmacy services that support self-care, the management of minor ailments and medicines optimisation;

(d) supporting patients to access the most appropriate level of care for their needs, including through patient-facing digital services connected to any system established under section 250E of the National Health Service Act 2006 (single patient record); and

(e) reducing avoidable demand on NHS services through the promotion of self-care and prevention.

(2) In preparing guidance under section 14Z58 of the National Health Service Act 2006 as amended by section 24(4) of this Act, the Secretary of State must have regard to—

(a) improving health literacy,

(b) the role of community pharmacy as an accessible point of contact for self-care support and health advice, and

(c) the contribution of digital tools and patient-facing services to enabling self-care, self-management and appropriate care navigation.

(3) The Secretary of State must, within 12 months of the date on which this Act is passed, publish a self-care strategy for England (the "self-care strategy") which must set out—

(a) the national framework within which neighbourhood health plans will be required to embed self-care and self-management, including the management of self-limiting conditions, as a core component of local health and care services;

(b) the steps the Secretary of State will take to promote self-care and health literacy as part of the prevention and early intervention agenda across the NHS;

(c) the role of community pharmacy in delivering the self-care strategy, including the services and information that community pharmacy is expected to provide in support of self-care;

(d) the role of patient-facing digital services, including any system established under section 250E of the National Health Service Act 2006, in supporting self-care, self-management and navigation to appropriate care;

(e) the steps the Secretary of State will take to reduce avoidable demand on NHS services through the promotion of self-care; and

(f) the measurable outcomes against which progress in implementing the self-care strategy will be assessed, and the arrangements for reporting on progress.

(4) The Secretary of State must lay the self-care strategy before Parliament on the day on which it is published and must review and update it at least every three years.

(5) In this section—

“neighbourhood health plan” has the same meaning as in section 24 of this Act;

“self-care” means the actions taken by individuals to maintain their own health, manage minor or long-term conditions, including conditions that are self-limiting, and prevent ill health, including through the use of over-the-counter medicines, health information and digital tools.”

This new clause would require neighbourhood health plans to include arrangements for supporting self-care and self-management. It would require guidance to the responsible local authority and integrated care boards to reflect the guidance and require the Secretary of State to publish a national self-care strategy.

New clause 157—Report on delivery of transformative technology commitments—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed, publish and lay before Parliament a report setting out the Government’s approach to delivering the transformative technology commitments in the document entitled “Fit for the Future: the 10 Year Health Plan for England” published in July 2025.

(2) The report under subsection (1) must cover the following areas—

(a) data quality, interoperability and the use of NHS data for research and innovation,

(b) artificial intelligence,

(d) wearables and real-time monitoring, and

(e) robotics and precision technologies.

(3) The report must include—

(a) the principal milestones and intended outcomes for patients and the health service in each of the areas listed in subsection (2),

(b) the main risks to delivery and the steps being taken to mitigate them, and

New clause 158—Progress reports on the women’s health strategy—

“(1) The Secretary of State must, within 12 months of the day on which this Act is passed and at least once every two years thereafter, publish and lay before Parliament a report on progress in delivering the renewed Women’s Health Strategy for England (published April 2026) or any successor strategy.

(2) A report under this section must include—

(a) a summary of delivery against the actions listed in the strategy’s action summary tables, including which actions are on track, delayed or revised and the reasons why that is the case;

(b) data from the women’s health data dashboard (or any successor data publication) on performance, access, outcomes and experience at national and neighbourhood level; and

(c) a summary of ongoing engagement with women, including through the women’s voices partnership and patient-reported experience and outcome measures, and how that engagement has informed delivery.

(3) The report may incorporate or cross-refer to existing published material (including the action summary tables and the women’s health data dashboard) where this meets the requirements of subsection (2).”

New clause 160—Annual report on specialised services—

“(1) Within 12 months of the passage of this Act, and every 12 months thereafter, the Secretary of State must publish a report on the commissioning and performance of specialised services commissioned by integrated care boards.

(2) A report under subsection (1) must include information relating to—

(a) patient outcomes;

(b) access to services;

(d) workforce capacity;

(e) service sustainability;

(f) geographical variation in services;

(g) compliance with national service specifications; and

(h) arrangements for the coordination of specialist, community and neighbourhood care.

(3) A report under subsection (1) must be laid before both Houses of Parliament.”

This new clause would require the Secretary of State to publish an annual report on specialised services commissioned by integrated care boards.

New clause 162—Specialised servicesannual report and published data—

“(1) The Secretary of State must, prepare a report on the performance of specialised services in England, measured against the relevant national standards for those services.

(2) The Secretary of State must lay a report under subsection (1) before each House of Parliament as soon as reasonably practicable after the end of the financial year to which it relates.

(3) The Secretary of State must make arrangements for the regular publication of data on the quality and outcomes of specialised services, including, but not limited to, data of the kind currently published as Specialised Services Quality Dashboards.

(4) In this section, "specialised services" has the same meaning as in section 3B of the National Health Service Act 2006 (as amended by this Act).”

This new clause would place a duty on the Secretary of State to report annually to Parliament on the performance of specialised services against national standards, and to maintain regular publication of data on their quality and outcomes, equivalent to the Specialised Services Quality Dashboards currently produced by NHS England.

Amendment 102, in clause 1, page 1, line 2, at end insert—

“(2) Before NHS England is abolished, the Secretary of State must publish a document setting out the operating model for the exercise of functions by the Department of Health and Social Care following the abolition of NHS England (the "operating model document").

(3) The Secretary of State must publish a plan for the management of personnel affected by the abolition of NHS England and the transfer of its functions to the Department of Health and Social Care (the "workforce transition plan").

(4) The operating model document must include—

(a) a description of how each of the functions exercised by NHS England is to be exercised following its abolition;

(b) the governance and accountability arrangements for the exercise of those functions;

(c) the organisational structure of the Department of Health and Social Care as it will operate following the abolition; and

(d) the proposed timetable for the transition.

(5) The workforce transition plan must include—

(a) an assessment of the number of personnel whose employment is affected by the abolition of NHS England;

(b) the arrangements for the transfer, redeployment or redundancy of affected personnel; and

(c) proposals for consultation with recognised trade unions and staff representative bodies in connection with the abolition.”

This amendment would require the Secretary of State to publish an operating model for the merged DHSC/NHSE and associated plan to manage personnel before NHS England is abolished.

Amendment 19, in clause 4, page 3, line 29, at end insert—

“(c) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between coastal and inland areas, and

(d) reduce inequalities between the people of England with respect to the access to health services and outcomes achieved for them between rural and urban areas.”

This amendment would create a duty for the Secretary of State to reduce inequalities between coastal and inland areas and rural and urban areas.

Amendment 80, page 3, line 29, at end insert—

“(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.”

This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State's general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly.

Amendment 95, in clause 5, page 4, leave out lines 2 to 4 and insert—

“(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services.

(2) For the purposes of subsection (1), the Secretary of State must ensure that patients referred for a service to be provided outside a hospital setting (“out-of-hospital services”) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B.

(3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must—

(a) offer the patient a choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board;

(b) provide the patient with information about each available provider to support an informed choice, including—

(i) indicative waiting times,

(ii) the location at which the service would be provided,

(iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available, and

(iv) whether any costs may be incurred by the patient in travelling to or receiving the service with each provider;

(c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and

(d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe.

(4) For the purposes of this section, “out-of-hospital services” means services—

(a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department, and

(b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2).

(5) For the purposes of this subsection (4)(b), out of hospital services which the Secretary of State may specify by regulations may include—

(a) diagnostic services,

(b) audiology and hearing aid care,

(d) dietetics and nutrition,

(e) physiotherapy,

(f) ambulatory cardiac monitoring, and

(g) such other services as the Secretary of State considers appropriate.

(6) In specifying services under subsection (4)(b), the Secretary of State must have regard to—

(a) the potential for the expansion of choice to reduce waiting times for the relevant service,

(b) the availability of sufficient independent and NHS providers to make genuine choice meaningful, and

(c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas.

(7) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out—

(a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply,

(b) the timetable for extending the choice obligation to further services, and

(c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section.

(8) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.”

This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.

Amendment 37, in clause 6, page 4, line 11, at end insert—

“(1A) For the purposes of subsection (1) the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England, including by reducing inequalities in clinical research funding and clinical research capacity between different regions of England.”

This amendment would ensure that in exercising their duty to promote innovation in the provision of health services, the Secretary of State must ensure that innovation in the provision of health services is supported and developed equitably across all regions of England.

Amendment 81, page 4, line 11, at end insert—

“(1A) The duty in subsection (1) includes, in particular, promoting innovation in the prevention, diagnosis and treatment of diabetes, including through the adoption of glucose monitoring and automated insulin delivery technologies.”

This amendment would ensure that the existing duty to promote innovation is understood to cover the specific diabetes technologies (flash/CGM and hybrid closed loop systems) currently being rolled out by NHS England ,so that momentum on adoption is not lost through the transfer of functions.

Amendment 97, page 6, line 12, leave out clause 10.

Amendment 38, in clause 11, page 6, line 28, leave out lines 28 and 29 and insert—

“(1) Where the geographic area covered by an integrated care board sits within a Mayoral Combined Authority, the relevant Mayor may give integrated care boards directions as to the exercise of their functions.

(1A) Where the geographic area covered by an integrated care board does not sit within a Mayoral Combined Authority, the Secretary of State may give integrated care boards directions as to the exercise of their functions.”

This amendment would give direction-making powers over integrated care boards to Combined Authority Mayors where boards sit within their authority. The Secretary of State would retain direction-making power where there is no relevant Combined Authority Mayor.

Amendment 39, page 7, line 4, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 40, page 7, line 11, after “Secretary of State” insert “or relevant Combined Authority Mayor”.

This amendment is consequential on Amendment 38.

Amendment 103, in clause 12, page 9, leave out lines 33 to 39 and insert—

“(2) Before prescribing a service or facility under subsection (1)(b), the Secretary of State must publish an assessment of the likely impact of such a prescription on—

(a) patient safety;

(b) clinical outcomes;

(d) workforce capacity and specialist expertise;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(2A) The Secretary of State must lay the assessment under subsection (2) before both Houses of Parliament.

(2B) In deciding whether it would be appropriate to prescribe a service or facility under subsection (1)(b), the Secretary of State must have regard to the assessment published under subsection (2).

(2C) Where regulations made under subsection (1)(b) prescribe a service or facility for commissioning other than by the Secretary of State, the Secretary of State must publish and maintain a national service framework for that service or facility.

(2D) A framework under subsection (2C) must include provision relating to—

(a) service standards;

(b) care pathways;

(d) rehabilitation and long-term follow-up;

(e) collection and publication of outcome data;

(f) coordination between specialist, community and neighbourhood services; and

(g) coordination of care for persons receiving treatment through multiple clinical pathways.”.

This amendment would require the Secretary of State to publish an impact assessment before they make a decision to prescribe a service or facility under subsection (1)(b) of section 3B of the National Health Service Act 2006 and maintain a national service framework for any specialised service no longer commissioned directly by the Secretary of State.

Amendment 101, page 10, line 10, at end insert—

“(5) The Secretary of State must, within six months of this section coming into force, publish a specialised commissioning plan setting out—

(a) which services or facilities the Secretary of State intends to commission nationally under section 3B(1)(b), and

(b) the principles and criteria that will be used to decide whether a service or facility should be commissioned nationally or by integrated care boards.

(6) Before making regulations under section 3B(1)(b) that would make a significant change to the range of services or facilities commissioned nationally, the

Secretary of State must—

(a) publish a transition plan explaining the reasons for the change, the impact on patients, and the arrangements for continuity of care and clinical standards,

(b) consult such persons as the Secretary of State considers appropriate (including patients who use the affected services or their representatives, clinicians, and the bodies that would gain or lose commissioning responsibility), and

(7) The specialised commissioning plan under subsection (5) must be kept under review and revised as appropriate, and any revised plan must be published.”

Amendment 53, Clause 14, page 10, leave out lines 40 to 44 and insert—

“(a) confers functions on integrated care boards in relation to commissioning primary care services, including the provision of alternative general medical services for patients who—

(i) are unable to obtain appropriate care from the general practice responsible for their usual catchment area, or

(ii) no longer reasonably feel able or comfortable to receive care from that general practice,

(b) requires integrated care boards to make arrangements to support access to such alternative provision where it is necessary to meet the reasonable requirements of those patients,

(d) contains other amendments relating to primary care services.”

This amendment would require integrated care boards to support and arrange alternative general practice provision for patients who cannot access appropriate care from their usual catchment GP practice, or who reasonably no longer feel able or comfortable receiving care from that practice.

Amendment 76, in clause 15, page 11, line 33, at end insert—

“(4A) The Secretary of State must take reasonable steps to ensure that arrangements under subsection (2) are accessible and inclusive, having particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.”

This amendment would require the Secretary of State to take reasonable steps to ensure that arrangements for public involvement in commissioning are accessible and inclusive, with particular regard to the needs of persons with disabilities and persons with long-term, complex or fluctuating health conditions.

Amendment 79, in clause 16, page 11, line 10, at end insert—

“(3) Regulations under this section must, in relation to children and young people referred to child and adolescent mental health services, require integrated care boards to make arrangements for appropriate interim support during any period between referral and the commencement of substantive treatment or assessment.

(4) The arrangements under subsection (3) may include—

(a) regular appointments or check-ups with a GP or other primary care professional;

(b) support from a family support worker;

(c) regular wellbeing checks or support provided through a school, including by a school nurse or other appropriate professional; and

(d) access to appropriate peer support, youth clubs or other community-based support.

(5) The purpose of arrangements under subsection (3) is to ensure that a child or young person does not remain without appropriate support solely because they are awaiting the commencement of substantive assessment or treatment.”

This amendment would require interim support for children and young people referred to CAMHS while they are waiting for substantive assessment or treatment.

Amendment 32, page 12, line 10, at end insert—

“(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

(4) For the purposes of subsection (3)—

This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services.

Amendment 98, page 12, line 10, at end insert—

“(3) Regulations under subsection (1) must require the publication, at least monthly, of statistics on consultant-led referral-to-treatment pathways that include a breakdown of unreported removals, and the reasons for those removals, including distinguishing between—

(a) removals attributable to validation exercises (including administrative, technical or clinical validation), and

(b) other unreported removals.

(4) The statistics required by subsection (3) must be published—

(a) at national level,

(b) by integrated care board area, and

(5) In this section—

“unreported removals” means the residual figure calculated as the waiting list at the start of the period plus new RTT periods minus completed pathways minus waiting list at the end of the period;

“validation exercises” includes any systematic review of pathways for the purpose of removing those that should not remain on the waiting list.””

Amendment 99, page 12, line 10, at end insert—

“14Z45AA Prohibition on administrative minimum waiting times

An integrated care board must not adopt or apply any policy, contract term, activity planning assumption or other arrangement that has the effect of requiring or incentivising a minimum period of waiting before a patient may receive treatment, assessment, or a diagnostic test, where that minimum period is imposed for administrative, financial or capacity management reasons rather than clinical reasons.”

Amendment 34, page 12, line 16, at end insert—

“(1A) The regulations must impose a duty on integrated care boards to make provision for any person with a terminal illness diagnosis to be offered a conversation with a relevant healthcare professional about their needs for end-of-life care, including their—

(a) mental and physical health support needs, and

(b) financial support needs.

(1B) For the purposes of subsection (1A), if a person with a terminal illness diagnosis is unable to have the conversation, an integrated care board must ensure that the person’s next-of-kin are offered a conversation.

(1C) The regulations must make provision for any relevant authorities to have regard to the needs identified in a conversation under subsection (1A).”

This amendment would require the Secretary of State to make regulations which make provision for the any person with a terminal illness diagnosis to be offered a conversation with a relevant authority about their needs for end-of-life care.

Amendment 28, page 12, line 22, at end insert—

“14Z45BA Patient choice: community services substituting for consultant-led elective care

(1) The Secretary of State must by regulations make provision to enable patients to make choices in respect of non-consultant-led community services where those services are commissioned as a direct substitute for, or to prevent a referral to, consultant-led elective services.

(2) For the purposes of subsection (1), a service is to be regarded as a direct substitute for, or intended to prevent a referral to, consultant-led elective services if it—

(a) provides assessment, treatment or management for a condition that would otherwise be referred to a secondary care specialist; or

(b) is commissioned by an integrated care board for the purpose of reducing or managing demand on secondary or elective care.

(3) Services to which this section applies include, but are not limited to—

(a) community audiology services;

(b) community glaucoma management and monitoring services; and

(4) Regulations made by virtue of this section must ensure that—

(a) patients are offered a choice of any clinically appropriate provider commissioned under a qualifying NHS contract for the relevant service;

(b) no limitation on the number of providers from which a patient may choose is imposed solely on grounds of cost or demand management; and

(c) patients are provided with information enabling them to make an informed choice, including information about waiting times and quality.

(5) An integrated care board must not commission a community service of a kind falling within subsection (2) in a manner which has the effect of restricting patient choice below the standard that would apply to an equivalent consultant-led elective service.”

Amendment 36, in clause 20, page 15, line 25, at end insert—

“(2A) Performance assessments must include details of how each integrated care board is meeting its duty to provide palliative care services or facilities to meet the reasonable requirements of the people for whom it has responsibility.

(2B) For the purposes of subsection (2A) the following guidance are considered reasonable requirements—

(a) NICE guideline [NG31] “Care of dying adults in the last days of life 2015”,

(b) NICE guideline [NG142] “End of life care for adults: service delivery 2019”,

(d) NHS England “Palliative and End of Life Care” Statutory Guidance for Integrated Care Boards (September 2022).”

This amendment would require annual performance assessments to incorporate an assessment of whether each integrated care board is providing a reasonable standard of palliative and end of life care.

Amendment 104, in clause 20, page 15, line 28, at end insert—

“(4) In conducting a performance assessment under this section, the Secretary of State must assess the discharge by an integrated care board of any functions relating to specialised services.

(5) An assessment under subsection (4) must consider—

(a) patient outcomes;

(b) access to services;

(d) workforce capacity;

(e) service sustainability; and

(f) geographical variation in access to, and outcomes from, services.

(6) The report published under subsection (3) must include a summary of the assessments undertaken under subsections (4) and (5).”

This amendment would require the Secretary of State to undertake and publish a national assessment of the performance of integrated care boards in relation to specialised services.

Amendment 45, page 15, line 29, leave out clause 21.

Amendment 91, in clause 21, page 15, leave out line 32 and insert—

“(a) for sub-paragraph (4), substitute—”

Government amendment 60.

Amendment 29, page 15, line 38, at end insert—

“(2A) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”

This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area.

Government amendment 61.

Amendment 30, page 16, line 3, leave out from “mayor” to “must” and insert

“or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A)”

This amendment is consequential on Amendment 29 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State.

Amendment 83, page 16, line 6, at end insert—

“(5) The constitution of an integrated care board must provide for the appointment of one or more members of the board with explicit responsibility for—

(a) people with learning disabilities;

(b) autistic people;

(d) children and young people with special educational needs and disabilities.

(6) The integrated care board must publish details of the member or members appointed under sub-paragraph (5).”

This amendment would require each Integrated Care Board to appoint one or more board members with responsibility for people with learning disabilities, autistic people, people with Down syndrome, and children and young people with special educational needs and disabilities (SEND), placing existing NHS England board-level leadership guidance on a statutory footing following the abolition of NHS England.

Amendment 92, page 16, line 6, omit subsection (b).

Amendment 96, page 16, line 7, leave out subsection (b) and insert—

“(b) for sub-paragraph (5) substitute—

“(5) The constitution must provide for the ordinary members of the integrated care board to include—

(a) at least one qualified, professionally registered, consultant in public health who provides wholly independent, transparent, leadership and advice to the board on preventing and reducing disease and improving the health of the population it serves,

(b) at least two clinicians with current experience of providing primary care services, at least one of whom is a general practitioner, and

(5A) A person appointed under sub-paragraph (5) must not be appointed to represent the interests of a provider organisation whose services are commissioned by the integrated care board.””

This amendment would require every Integrated Care Board to include an independent qualified and registered consultant in public health, at least two clinicians from primary care, and a clinical representative from secondary care.

Amendment 93, page 16, leave out line 8 and insert—

“after sub-paragraph (7) insert—”

Government amendment 62.

Amendment 31, page 16, line 9, at end insert—

““local authority” has the meaning given by section 2B;”

This amendment is consequential on Amendments 29 and 30 and defines the term “local authority”.

Amendment 94, page 17, line 12, leave out clause 23.

Amendment 77, in clause 24, page 17, line 35, at end insert.

“A neighbourhood health plan must include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions”

This amendment would require neighbourhood health plans to include consideration of how health services will meet the needs of persons with long-term, complex or fluctuating health conditions.

Government amendment 63.

Amendment 84, in clause 29, page 21, leave out line 7.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Government amendment 64.

Amendment 55, in clause 42, page 30, line 29, at end insert—

“(5) After subsection (6) insert—

“(7) Where the Secretary of State is satisfied that a pharmacy provider has materially failed to comply with contractual, patient-safety or workforce obligations, the Secretary of State may by direction require the relevant integrated care board—

(a) to suspend or terminate arrangements with that provider, where appropriate,

(b) to make arrangements with another provider for the provision of pharmaceutical services,

(d) to take such other emergency measures as may be specified in the direction.

(8) A direction under subsection (7) may be given where the Secretary of State considers that there is a significant risk to patient safety, continuity of medicines supply or the provision of pharmaceutical services.

(9) The Secretary of State must ensure that arrangements made under subsection (7) are implemented as soon as reasonably practicable.

(10) A direction under subsection (7) must specify the period for which it has effect and must be published.””

This amendment would enable intervention where a pharmacy provider seriously fails to meet contractual, safety or workforce obligations, ensuring continuity of services and medicines supply.

Amendment 58, page 30, line 29, at end insert—

“(7) Where a situation or event has resulted, or is likely to result, in the closure, failure or disruption of a provider of pharmaceutical services, the Secretary of State and the relevant integrated care board must provide such assistance and support as is necessary to enable a new provider to establish or continue the provision of pharmaceutical services.

(8) Assistance or support under subsection (7) may include facilitating and establishing a relationship between a new provider and the manufacturers or suppliers of medicines and other pharmaceutical products.

(9) The assistance and support under subsection (7) must be available, in particular, where a new provider is—

(a) taking over premises previously operated by a provider of pharmaceutical services that has failed or closed,

(b) taking over premises where there has been evidence of serious misconduct, including malpractice or failure to pay staff, or

(10) The purpose of assistance and support under this section is to enable the new provider to secure supplies of medicines and other pharmaceutical products as quickly as reasonably practicable and to minimise any interruption in the provision of pharmaceutical services.”

This amendment would require the Government and integrated care boards to support new and independent pharmacy owners taking over failing, closed or disrupted pharmacies, including by helping them establish relationships with pharmaceutical manufacturers and suppliers so that they can secure medicines and other supplies quickly and maintain continuity of service.

Amendment 59, in clause 47, page 32, line 15, after subsection (4) insert—

“(4A) In determining the amount to be allotted to an integrated care board under subsection (1), the Secretary of State must have regard to the additional costs of providing health services in rural and coastal communities.

(4B) The matters to which the Secretary of State must have regard under subsection (4A) include—

(a) rurality,

(b) population age,

(d) seasonal changes in demand,

(e) recruitment and retention difficulties,

(f) the loss of economies of scale arising from sparsely populated communities, and

(g) unmet need for primary medical, dental and pharmaceutical services.

(4C) The Secretary of State must ensure that the methodology used in determining allotments does not rely predominantly on measures of deprivation where those measures fail adequately to reflect the costs or unmet need as set out in subsection (4B).

(4D) The Secretary of State must publish the methodology used in determining allotments under this section and must review that methodology at intervals of not more than five years.”

This amendment would require ICB funding allocations to reflect the additional costs and unmet health needs of rural and coastal communities.

Amendment 10, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on mental health services at least in line with the change in level of their total programme funding.”

This amendment would place the original mental health investment standard on a statutory footing, requiring integrated care boards to increase spending on mental health services at least in line with the growth in their total programme (healthcare) funding.

Amendment 17, page 32, line 30, at end insert—

“(2A) The Secretary of State must give integrated care boards directions to increase spending on Primary Care services.

(2B) The increase in spending set out in subsection (2B) must be in line with the change in level of their total programme funding.”

This amendment would introduce the primary care Investment standard, requiring integrated care boards to increase spending on primary care services at least in line with the growth in their total programme (healthcare) funding.

Amendment 11, page 32, line 34, after “subsection (1)” insert “and (2A)”.

This amendment is consequential on Amendment 10 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on mental health services in line with the growth in their total programme (healthcare) funding.

Amendment 18, in clause 47, page 32, line 34, after “subsection (1)” insert “and (2A) and (2B)”.

This amendment is consequential on Amendment 17 and would enable the Secretary of State to implement financial penalties if an integrated care board fails to comply with a direction to increase spending on primary care services in line with the growth in their total programme (healthcare) funding.

Amendment 26, in clause 51, page 35, line 38, after “available” insert

“for the purpose of delivering or improving patient health or social care”.

Amendment 42, page 36, line 1, leave out “health” and insert “direct patient”.

This amendment clarifies that the Secretary of State’s regulation-making powers in respect of the single patient record are limited to the provision of direct patient care and social care.

Amendment 105, page 36, line 8, at end insert—

“(ba) enabling a patient, following diagnosis of a health condition, to consent to the sharing of such information as is necessary for the purpose of enabling the organisation to offer or provide condition-specific support to the patient with an approved voluntary, community or charitable organisation providing condition-specific support services;

(bb) facilitating referral, where consent has been provided, to such an organisation under subsection (ba);”

This amendment would ensure that regulations establishing the Single Patient Record may include provision enabling patients, following diagnosis, to consent to referral and information sharing with approved voluntary, community and charitable organisations providing condition-specific support services.

Amendment 43, page 36, line 11, leave out “including” and insert “solely for the purposes of”

This amendment would ensure that regulations requiring or authorising the making available of patient information through the single patient record system can only make provision in respect of the circumstances set out in the Bill.

Amendment 15, page 36, line 13, after “behalf” insert “, including nominated carers”

This amendment makes it explicit that nominated carers can access the single patient record on behalf of those they care for.

Amendment 27, page 36, line 21, leave out lines 21 to 23.

Amendment 35, page 36, line 21, at end insert—

“The regulations must make provision for patient information to be readily available to providers of palliative and end-of-life care including voluntary sector providers.”

This amendment would ensure the single patient record is available to all palliative and end of life care providers.

Amendment 23, page 36, line 23, at end insert—

“(3A) The regulations must make provision for medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of introducing a statutory requirement for mandatory medical markers for firearms licence holders to be used by those relevant in providing patient care.”

This amendment would require medical markers for firearms licence holders to be visible to all relevant health workers under the establishment of a single patient record.

Amendment 24, page 36, line 23, at end insert—

“(3A) The regulations must make provision for prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record.

(3B) The regulations must include a requirement for the Secretary of State to prepare and publish a report on the potential merits of making prior membership in the armed forces visible on the single patient record.

(3C) A report under subsection (3B) must consider—

(a) the ability of veterans to access the necessary NHS support, and

(b) the ability of medical staff to provide former members of the armed forces with appropriate care.”

This amendment would require prior membership in the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record and require the Secretary of State to publish a report on making prior membership in the armed forces visible on the single patient record.

Amendment 88, page 36, line 26, at end insert—

“(4A) Regulations may not be made under this section unless the Secretary of State has first published and laid before both Houses of Parliament a Single Patient Record Outline Plan.

(4B) The Outline Plan under subsection (4A) must set out, as a minimum—

(a) the intended high-level design and scope of the single patient record, including the core data categories expected to be included and the principal care settings to be connected in the first phase;

(b) the proposed technical and architectural approach, including how existing source systems will be linked rather than replaced;

(d) the intended access model for patients, clinicians and other relevant care professionals, including arrangements for proxy access and digital inclusion;

(e) the key safeguards for privacy, security, audit and prevention of inappropriate access; and

(f) the proposed approach to public engagement and awareness before the system becomes operational.

(4C) The Outline Plan must be published at least three months before any regulations under this section are laid.”

Amendment 22, page 36, line 32, at end insert—

“(6A) Before making regulations under this section, the Secretary of State must prepare and publish a risk assessment on the potential for digital exclusion under the establishment of a single patient record.

(6B) In preparing a risk assessment under subsection (6A) the Secretary of State must consult all stakeholders the Secretary of State considers relevant, including patient representation groups.

(6C) In preparing a risk assessment under subsection (6A) the Secretary of State must have particular regard for—

(a) those without access to a suitable electronic device,

(b) those without access to suitable broadband connectivity,

(d) those belonging to groups considered socially excluded, and

(e) those considered lacking digital skills.

(6D) The Secretary of State must lay a copy of the risk assessment under subsection (6A) before both Houses of Parliament.”

This amendment would require the Secretary of State to prepare and publish a risk assessment on the potential for digital exclusion under the establishment of single patient record.

Amendment 87, page 36, line 32, after subsection (6) insert—

“(6A) Regulations under this section must make provision to ensure that the system—

(a) complies with the Accessible Information Standard, DAPB1605, or any standard which replaces it;

(b) uses and is interoperable with the Reasonable Adjustment Digital Flag, DAPB4019, or any system or standard which replaces it;

(c) enables patients’ communication, information and reasonable adjustment needs to be identified, recorded, flagged, shared, met and reviewed without avoidable repetition by the patient; and

(d) enables patients to receive and access information relating to their care in formats appropriate to their communication and accessibility needs.

(6B) In preparing regulations under this section, the Secretary of State must secure the participation of disabled people, including blind and partially sighted people, and organisations representing them, in the design, development, testing and review of the system.”

This amendment seeks to ensure that the Single Patient Record supports the communication, information and reasonable adjustment needs of blind and partially sighted people and other disabled patients by embedding existing NHS accessibility standards within the system. It also requires disabled people and their representative organisations to be involved in the design, development, testing and ongoing review of the Single Patient Record to ensure accessibility is embedded from the outset.

Amendment 52, in schedule 1, page 57, line 15, at end insert—

“83B Primary care estate investment programme

(1) The Secretary of State must establish and maintain a programme for providing capital funding for the improvement and modernisation of premises used for the provision of primary medical services.

(2) The programme must prioritise practices where premises—

(a) are no longer fit for purpose,

(b) require substantial repair, adaptation or modernisation, or

(3) The Secretary of State must ensure that the process for applying for and accessing capital funding under this section is proportionate and does not impose unnecessary administrative burdens.

(4) The arrangements must be designed to ensure that a viable provider of primary medical services is not prevented from carrying out essential improvements because of insufficient access to capital funding.

(5) In this section “premises” includes premises owned, leased or otherwise occupied for the provision of primary medical services.”

This amendment would establish a capital funding programme to improve and modernise primary care and General Practice premises.

Amendment 50, page 57, line 26, at end insert—

“5A after section 87 insert—

“87A Sustainable funding for general practice

(1) The Secretary of State must ensure that arrangements for payments under general medical services contracts provide for sustained investment in general practice.

(2) In exercising functions under this section, the Secretary of State must have regard to the role of general practice in—

(a) preventing illness,

(b) managing long-term conditions,

(d) reducing avoidable hospital admissions.

(3) Arrangements for funding general practice must have regard to the volume, complexity and value of care delivered through general practice.

(4) The Secretary of State must publish, for each financial year, a statement setting out how the arrangements for payments under general medical services contracts are intended to support the matters in subsections (1) to (3).””

This amendment would require sustained investment in general practice reflecting the volume, complexity and value of care provided.

Amendment 51, page 57, line 26, at end insert—

“5A After section 87 insert—

“87A Rural and coastal general practice funding

(1) Arrangements for payments under general medical services contracts must take account of the additional costs of delivering primary medical services in rural and coastal communities.

(2) The factors to which arrangements under subsection (1) must have regard include—

(a) rurality,

(b) the age profile of the population,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3) The Secretary of State must ensure that the funding arrangements under this section are reviewed periodically and amended where necessary to reflect changes in the costs of providing services in rural and coastal areas.””

This amendment would require GP funding to reflect the additional costs of providing services in rural and coastal areas.

Amendment 47, page 60, line 6, at end insert—

“99C Dental training hubs

(1) The Secretary of State must make arrangements for the establishment and support of dental training hubs in areas where there is an unmet need for NHS dental services.

(2) The arrangements under subsection (1) must include provision for dental training hubs in Dorset, including provision in west Dorset.

(3) In exercising the duty under subsection (1), the Secretary of State must work with—

(a) universities and other providers of approved dental education and training,

(b) local authorities, and

(4) The purpose of dental training hubs is to—

(a) increase the capacity for dental education and training,

(b) increase the availability of NHS dental services in areas of unmet need,

(d) support the development of the long-term dental workforce.

(5) Arrangements under this section must provide for students in the final year of an approved course of dental education to provide NHS dental treatment under appropriate supervision.

(6) Treatment provided by a student under subsection (5) must—

(a) be NHS treatment carried out on an NHS patient,

(b) be provided under the supervision of a suitably qualified dental professional, and

(c) be free at the point of use to the patient where the supervising provider is receiving, or is entitled to receive, the relevant NHS tariff or other NHS payment in respect of that treatment.

(7) A dental training hub must provide, or participate in, structured pathways into dental apprenticeships and other appropriate employment-based dental training.

(8) Arrangements under this section must include measures to support retention of dental professionals trained through the hubs to meet future workforce commitments.

(9) In this section “dental training hub” means a facility or network of facilities at which dental education, supervised clinical training and NHS dental service provision are integrated.”

This amendment would establish dental training hubs in areas of unmet need, including Dorset and west Dorset, to expand training, improve NHS dental access and strengthen the workforce.

Amendment 48, page 60, line 6, at end insert—

“99C Allocation of NHS dental funding according to unmet need

(1) The Secretary of State must make arrangements to ensure that NHS dental funding is allocated according to local unmet need.

(2) Where funding allocated for primary dental services in a financial year is not used for the purpose for which it was allocated, the Secretary of State must ensure that, so far as reasonably practicable, that funding is redirected to measures designed to increase access to NHS dental services.

(3) Measures under subsection (2) may include—

(a) additional NHS dental capacity,

(b) additional NHS dental appointments,

(d) outreach dentistry,

(e) domiciliary dental services, and

(f) dental services provided in or in connection with schools.

(4) The arrangements must include mechanisms to ensure that funding allocated for the purpose of increasing access results, so far as is reasonably practicable, in additional NHS dental capacity, appointments or reduced waiting times.

(5) In making arrangements under this section, the Secretary of State must have particular regard to people who face barriers to travelling to dental services, including older people, people with disabilities, vulnerable people and schoolchildren.”

This amendment would require dental funding to reflect local unmet need and redirect unused funding towards improving access.

Amendment 49, page 60, line 22, after paragraph 18 insert—

“18A After section 103 insert—

“103A Rural and local-need factors in NHS dental funding

(1) Directions made under section 103 must provide for NHS dental funding arrangements to take account of local need.

(2) In making provision under subsection (1), the Secretary of State must have proper regard, in particular, to—

(a) the rurality of the area,

(b) the age profile of the population,

(d) local transport and travel costs,

(e) seasonal changes in demand for services,

(f) difficulties in recruiting and retaining dental professionals, and

(g) the loss of economies of scale arising from sparsely populated communities.

(3) Provision made under section 103 must proportionately weight other measures alongside deprivation when determining the level of NHS dental funding required in an area.

(4) The Secretary of State must every three years review and by regulations amend the factors mentioned in subsection (2).””

This amendment would require dental funding to properly take account of rurality, local need, travel costs, workforce challenges and other factors alongside deprivation.

Amendment 56, page 64, line 34, at end insert—

“45A After section 133 insert—

“133A Emergency intervention in pharmaceutical services

(1) Where an integrated care board considers that a person providing pharmaceutical services is failing, or is likely to fail, materially to comply with—

(a) a contractual obligation,

(b) a patient-safety requirement, or

the board must consider whether emergency intervention is required to protect patients or continuity of pharmaceutical services.

(2) Where the board considers that emergency intervention is required, it may—

(a) require the provider to take specified remedial action,

(b) suspend specified arrangements,

(d) make arrangements with another provider for the provision of pharmaceutical services, or

(e) take any combination of the steps in paragraphs (a) to (d).

(3) The powers in subsection (2) must be exercised with regard to the need to maintain continuity of medicines supply and protect patients from avoidable disruption.

(4) An integrated care board must not continue arrangements with a provider where it is satisfied that the provider is demonstrably unfit to provide pharmaceutical services safely and effectively.

(5) Before exercising a power under subsection (2), the board must, except in an emergency, give the provider a reasonable opportunity to make representations.

(6) Nothing in this section prevents an integrated care board from taking immediate action where delay would materially risk patient safety or continuity of medicines supply.””

This amendment would give integrated care boards powers to intervene where a pharmacy provider is failing to provide their required services to protect patients and medicines supply.

Amendment 57, page 72, line 40, at end insert—

“(3D) Regulations made under subsection (1) must ensure that the remuneration arrangements for pharmaceutical services take account of the costs of providing those services in rural and sparsely populated areas.

(3E) In making provision under subsection (3D), the determining authority must have regard to—

(a) rurality,

(b) the age profile of the population,

(d) seasonal changes in demand,

(e) difficulties in recruiting and retaining staff, and

(f) the loss of economies of scale arising from sparsely populated communities.

(3F) The remuneration arrangements must be designed to support the financial sustainability of pharmacies providing essential NHS services in rural and sparsely populated areas.

(3G) The Secretary of State must review the operation of the remuneration arrangements periodically and make such changes as are necessary to ensure that the matters in subsections (3D) to (3F) continue to be reflected.”

This amendment would require pharmacy funding to reflect the additional costs of providing services in rural and sparsely populated areas.

Government amendments 70 and 71.

Amendment 85, in schedule 3, page 86, line 14, leave out paragraphs 5 to 8.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 86, page 86, line 30, leave out paragraph 14.

This amendment would retain the requirement for NHS Foundation Trusts to have a Council of Governors.

Amendment 16, page 88, line 19, at end insert—

“(1A) The function under sub-paragraph (1) must be exercised by a person employed in the civil service of the State, and a Minister of the Crown or a special adviser must not be involved in any decision relating to such an appointment, suspension or removal.”

This amendment would ensure that civil servants are responsible for the decision making and appointment processes for trust and ICB leaders, rather than Ministers or Special Advisers.

Amendment 54, in schedule 8, page 106, line 33, at end insert—

“5A After section 254 insert—

“254A Interoperability of health and social care information systems

(1) The Secretary of State must make regulations requiring providers of NHS health services to use interoperable digital information systems.

(2) Regulations under subsection (1) must apply, so far as appropriate, to—

(a) providers of primary medical services,

(b) providers of primary dental services,

(d) NHS trusts,

(e) NHS foundation trusts, and

(f) providers of community health services.

(3) The regulations must provide for the secure exchange of relevant patient information between providers using interoperable systems.

(4) The regulations must include provision for electronic prescribing across NHS care settings where prescribing is clinically appropriate.

(5) The Secretary of State must ensure that the arrangements under this section are designed to—

(a) reduce duplication,

(b) reduce unnecessary administrative work,

(d) reduce avoidable delays in diagnosis, treatment and referral, and

(e) enable clinicians to access relevant information securely when providing care.

(6) Regulations under this section must include appropriate requirements relating to information governance, cyber security, patient confidentiality and the lawful processing of personal data.

(7) Before making regulations under this section, the Secretary of State must consult such persons as the Secretary of State considers appropriate, including representatives of general practice, hospitals, community services and patients.””

This amendment would require interoperable NHS digital systems to improve information sharing, reduce duplication and support continuity of care.

Amendment 13, page 106, leave out lines 34 and 35 and insert—

“For section 255 (power to request NHS England to establish information systems), substitute—

“255 Powers to request the Secretary of State to establish information systems

(1) Any person (including a devolved authority) may request the Secretary of State to establish and operate a system for the collection or analysis of information of a description specified in the request.

(2) A request may be made under subsection (1) by a person only if the person considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the person to have in relation to the person's exercise of functions, or carrying out of activities, in connection with the provision of health care or adult social care.

(3) The Secretary of State must comply with a mandatory request unless the Secretary of State considers that the request relates to information of a description prescribed in regulations.

(4) For the purposes of this Chapter a request under subsection (1) is a mandatory request if—

(a) it is made by a principal body, and

(b) the body considers that the information which could be obtained by complying with the request is information which it is necessary or expedient for the body to have in relation to its discharge of a duty in connection with the provision of health services or of adult social care in England.

(5) Subsection (6) applies where the Secretary of State has discretion under this section as to whether to comply with—

(a) a mandatory request, or

(b) other request under subsection (1).

(6) In deciding whether to comply with the request, the Secretary of State—

(a) must, in particular, consider whether doing so would interfere to an unreasonable extent with the exercise by the Secretary of State of any of its functions, and

(b) may take into account the extent to which the principal body or other person making the request has had regard to—

(i) the code of practice prepared and published by the Secretary of State under section 263, and

(ii) advice or guidance given by the Secretary of State under section 265.

(7) In this section “principal body” means—

(a) the Care Quality Commission,

(b) the National Institute for Health and Care Excellence, and

(8) In this Chapter “health care” includes all forms of health care whether relating to physical or mental health and also includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition.””

This amendment would enable the Care Quality Commission and NICE to continue to make mandatory requests to the Secretary of State to establish an information system, following the transfer of NHS England’s functions.

Amendment 14, page 110, line 37, leave out paragraph 14.

This amendment is consequential on Amendment 13.

Amendment 41, page 112, leave out lines 1 and 2 and insert—

“23 For section 274A (Secretary of State’s guidance about NHS England data functions) substitute—

“274A Secretary of State’s guidance in respect of their data functions

(1) The Secretary of State must publish guidance about the exercise of—

(a) their relevant data functions, and

(b) their other functions in connection with their relevant data functions.

(2) Before publishing guidance under this section the Secretary of State must consult any other persons that the Secretary of State considers appropriate in relation to the guidance.

(3) The Secretary of State must have regard to the guidance published under this section.””

This amendment would transfer the existing statutory requirement for published guidance about data functions from NHS England to the Secretary of State.

Amendment 46, in schedule 12, page 151, leave out paragraph 98.

Karin SmythI wish at the start to take a moment to thank the Members on both sides of the House who served on the Public Bill Committee during what was a very hot end of June and July—if we can remember back that far. As part of that process, the Committee scrutinised every clause of the Bill and debated over 195 amendments, and we on the Government Benches are grateful for their diligence. The implementation of the Bill is better for all that hard work. I also welcome the spirit of collaboration that has greeted the main provisions of the Bill from both sides of the House, most notably on Second Reading but also in Committee, and I hope that we can continue in that spirit at this stage. For our part, we remain committed to working with MPs and peers across the House and other stakeholders to ensure that the end result is a Bill that strengthens the NHS.

I know that we have a large number of amendments on a variety of topics, so I will keep my remarks short. New clauses 96 and 97 relate to visiting rights. They strengthen the role of integrated care boards and local authorities in promoting visiting, supporting people to have someone with them and ensuring the involvement of family, friends and carers in decisions. They complement the existing legal requirements and the work already under way to drive a change in culture and practice by embedding visiting at the heart of the responsibilities of commissioners.

New clause 96 explicitly places duties on integrated care boards to promote opportunities for visiting and accompaniment, while new clause 97 builds on local authorities’ existing wellbeing duties by emphasising the importance of involving other people in decision making, receiving visitors and maintaining opportunities to take trips outside the care home. Maintaining meaningful contact and connection with family, friends and carers is critical to the health and wellbeing of so many people in our health and care settings. They provide invaluable practical help, emotional support and advocacy for their loved ones in accessing care and treatment, and commissioners should do what they can to support these relationships.

I turn to Government amendments 60 to 62. The question of who is required to sit on ICBs has raised comments from all across this House. I am grateful to all Members who have raised the importance of local government having a voice in ICBs, including my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) and the other members of the Health and Social Care Committee, who have continually advocated on this issue. We agree. It was never the intention to weaken the voice of local government in the NHS. We recognise that local authority board members are an important voice for commissioning on the ICB, and often provide helpful challenge and a very different perspective on commissioning decisions.

19:30:00

Layla Moran (Oxford West and Abingdon) (LD)I thank the Minister for accepting our amendment on this issue. We pressed her and her colleagues over and over again—to the extent that we got a letter back that we honestly thought had been generated by AI, because the logic in it had no follow-through at all. I am delighted that she has listened. On what else does she intend to listen to us? In particular, there are amendments on the Health Services Safety Investigations Body, Healthwatch and health inequalities, which we will consider tomorrow, and, most importantly, the special needs amendment, which we are considering today. What else will she listen to us on?

Karin SmythI thank the Chair of the Select Committee—I can assure her that I am Karin, not Claude. She tempts me to go further on the rest of the Bill, but I genuinely thank her and the Committee; I hope she would agree that I spent a lot of time over the past months, before Report stage and Committee stage, meeting her, members of the Committee and many hon. Members from across the House. We have some provisions—we might call them simple provisions—in the Bill to democratise the NHS’s accountability, to reinforce the single patient record, and to improve the patient experience and patient safety landscape. We recognise that there is a lot of complexity within those simple propositions, and we will continue to listen to hon. Members. We want to ensure that the NHS is strengthened.

In relation to the ICBs and local authority voice, it was particularly significant over the summer to have heard from my right hon. Friend the Prime Minister about his commitment to rewiring the state and our ongoing reform to social care. With that in mind, I am pleased that amendments 60 to 62 will re-establish a requirement for ICBs to have at least one board member jointly nominated by local authorities in their area. That will sit alongside the existing duty to have a member nominated by the mayor of each mayoral strategic authority, as well as duties on ICBs and local government to work together, including on health and wellbeing boards. In Committee, we had a useful discussion about health and wellbeing boards, neighbourhoods and local accountability. I should also note that ICBs can appoint other people to their boards if they would benefit from their expertise. That is a decision to be taken locally.

Finally, let me briefly pre-empt the hon. Member for North Shropshire (Helen Morgan) by making a few comments about new clause 1. I thank her for the way she worked with me in Committee on the issue of a maternity commissioner—an issue that I think unites the House. As the hon. Member knows, we have accepted the recommendation from Baroness Amos’s national investigation into maternity and neonatal care. I can announce that, to deliver on this commitment, we will table an amendment to the Bill in the other place to establish a statutory maternity and neonatal commissioner. We are determined to get this right. For too long, too many women, babies and families have not received the care and support they deserve. The establishment of a commissioner represents a significant opportunity to strengthen accountability and champion their interests across the system. I hope that will give the hon. Member the reassurance she needs not to press her amendment.

Madam Deputy Speaker (Ms Nusrat Ghani)Before I call the shadow Minister, I must tell hon. Members that this debate is heavily oversubscribed; Back Benchers will immediately be on a speaking limit and not everybody will get in. I call the shadow Minister.

Dr Caroline Johnson (Sleaford and North Hykeham) (Con)I will try to keep my remarks brief. I thank my right hon. Friend the Member for Daventry (Stuart Andrew) for all the hard work he has done over the past year in holding the Government to account on health and social care, the whole Conservative health team for their support, and every member of the Committee that, as the Minister said, scrutinised the Bill in detail in such a hot and sticky room before the summer. I also thank my parliamentary team for their support. Finally, I congratulate the Minister on her reappointment and thank her for the time that she has taken to engage with the Opposition on the Bill. I must also declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health.

This is not a small Bill. It runs to more than 200 pages, and there are almost as many pages of amendments, with around 180 different MPs signing or supporting different amendments. I do not agree with every one, but I welcome thoughts and ideas from right across the House—well, from most of the way across the House; we did not see much from Reform. The Bill has scale, but does it have direction and clarity of purpose? Leadership sets direction—a destination—and from that follows a path, as smooth as possible, from A to B, with appropriate milestones. However, the Bill, like so many of this Labour Government’s, came as an announcement without enough thought.

Let us go back. The Government started with the Darzi report. I will not restate the arguments about why it was done or the weakness of the claims that it is independent, but suffice to say it is their report, published by a Labour peer and former Labour Minister for a Labour Government. It says a few things about reorganisation. Lord Darzi wrote that

“a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”,

yet the Government decided to abolish NHS England, restructure the ICBs and halve the ICBs’ budgets all at once, without properly planning for what would come next. That is clause 1—abolishing NHS England.

One of the main arguments provided related to the unnecessary bureaucracy and duplication of staff. As a Conservative, I accept that there is a strong case for efficiency: the Government must use taxpayers’ money wisely. In a letter that the permanent secretary sent to the Public Accounts Committee, officials estimated savings of £1 billion a year by abolishing NHS England and redundancy cost payments of approximately £1 billion to £1.3 billion, but we have not seen the calculations behind that. It was announced in March 2025 that the restructure would be completed in two years, yet we are now 18 months in and Ministers do not seem to be on track. From March 2025 to July 2026—a year, and three quarters of the time they have given themselves—total headcount across NHS England and the Minister’s Department decreased by 12.9%, which is nowhere near what the Government need to deliver their promised savings. We have therefore tabled amendment 102, which would require the Government to publish a full workforce transition plan, and new clause 153, which would require the Government to publish precisely how many people they make redundant.

I would like to raise a contradictionthe Government talk a lot about devolution and local decision making, but the Bill does the opposite. It will remove councils of governors from foundation trusts, give Ministers the power to hire and fire health leaders, and put an end to local Healthwatch. It will give the Secretary of State the power to set and adjust annual funding allocations for ICBs, and direct them to ringfence funding for service integration. It takes away local decision making.

The Bill is also inconsistent with what the Prime Minister said the other day. In response to a question about the Bill, he said:

“I do not like the idea of a postcode lottery in the national health service.” —[Official Report, 1 September 2026; Vol. 790, c. 61-62.] But if decisions are taken locally, they will be different in different areas, which will lead to a postcode lottery. Will Ministers shed some light on what they actually believe? Do this Government want decisions made locally and accept that those will be different, or do they want decisions made centrally?

Lord Darzi said something else in his report:

“Constant reorganisations are costly and distracting. They stop the NHS structures from focusing on their primary responsibility to raise the quality and efficiency of care in providers.”

Indeed. In fact, that is not too dissimilar from what the Minister for Secondary Care herself previously concluded, when in opposition. She said:

“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”. —[Official Report, 22 September 2020; Vol. 680, c. 809.] How is the NHS performing? Let us take a look. The total number waiting for appointment has gone down a bit, as the Government have said, but in trauma and orthopaedics, ophthalmology, cardiothoracic surgery, elderly medicine and gynaecology, it has gone up, and in some cases is higher than it was before the election. For those waiting for an admission who need a procedure or an operation, it is not only going up month on month and year on year; it is higher than it was at the time of the general election. What about accident and emergency? The number of people waiting for more than 12 hours after a decision to admit was 29% higher in July 2026 than in July 2024, and that is despite the fact that there were fewer such admissions in July 2026 than in July 2024.

How have the Government performed in other health areas? Childhood vaccination rates are in decline. The workforce plan has not been published, despite the Minister saying it was “imminent” months ago. Fracture liaison clinics have not been delivered, despite allegedly being one of this Government’s planned “first acts”. I could go on, but we do not have much time, and I think I have demonstrated the point: NHS reorganisation is distracting from delivery.

One of the things I want to talk about that the Government are not delivering is the response to the Hughes report. I thank Dr Henrietta Hughes, the Patient Safety Commissioner, for her hard work on the report. When the trauma and suffering that some people, particularly women, have experienced from mesh repairs, and the harm that children have suffered because of exposure to valproate in the womb, became apparent, we were all horrified. The previous Government changed the way that valproate was prescribed and commissioned regional surgical centres of excellence to provide care for women who suffer from the effects of a mesh repair. The Conservative Government also commissioned the Hughes report, published in February 2024, that investigated compensation schemes for those affected, but the general election was called just three months later, so delivering compensation and on the report became the Labour Government’s job.

Sadly, Ministers have dithered and delayed for more than two years now. We have had written question after written question, several debates and a lot of warm words, but still no response to the report. It is simply not good enough. Those suffering should not have to wait any longer, and that is why we have tabled new clause 145, which would provide a legal backstop, ensuring that the Government publish their response to the Hughes report within 30 days of the Bill becoming law at the latest. That is still not soon enough for those affected, but it is the only way of putting in an effective backstop so the Government can stop fobbing off victims and start delivering justice.

Let me turn to other amendments. The Government announced out of the blue that ICB running costs will be halved. Why 50%? I have no idea, but ICBs scrambled to respond. We know from those inside the health service that it has been a major distraction, with a massive opportunity cost for patient care. When the Bill came, Ministers chose to change the composition of ICBs, too, removing the voice of hospitals and primary care from boards as well as the voice of local authorities, severing that link with social care.

Integrated care partnerships will also be abolished. There will instead be a focus on mayoral representation, even for mayors where there is little role, if any, in delivering social care. In Lincolnshire, for example, instead of a local authority and an ICB on the same geographical footprint working together over the same area to cover health and social care, we now have the Government conspiring to give us an ICB covering three counties, with no voice for the local authorities, which are unsure after today’s announcement whether they will be split up. We discussed at some length in Committee the importance of health and social care working together, so I welcome the Government’s U-turn on day one of this term to reinstate local authority representation, but I urge the Minister to consider, as the Opposition parties have proposed, reinstating primary care and secondary care representatives, too.

Given the time, I will speak briefly to the three amendments on workforce. First, new clause 154 would require the Secretary of State to increase the number of medical school training places to 15,000 by 2031-32. Why? Put simply, because they promised they would and they have not. Secondly, new clause 152 is on merit-based applications. Doctors used to be allocated their first jobs through a system based on performance—that was the case when I was a junior doctor. Now it is done by computer algorithm prioritising choice. This is unfair, demoralising and destroys the incentive to study hard. We believe in meritocracy, and I urge the Government to accept the new clause.

Thirdly, I urge the Government to support new clause 144, which would address the plight of a small but significant group of people: a group of medical students subject to a great injustice. These are British citizens studying at a British university, predominantly Queen Mary University in London, who were told four and a half years into their degree that they would not be able to have places on the foundation programme but would be at the back of the queue. The Medical Training (Prioritisation) Act 2026 has meant that non-prioritised doctors got only 1.8% of the jobs—the last 1.8% left. That was the point of the Bill, but the Government should put this particular group of British citizens into the priority group.

We will no doubt talk about our other amendments in the Lords. New clause 155 on self-care would give people more autonomy over their own care. New clause 101 is on the national commissioning of low-volume, high-complexity services, and would ensure that the Government cannot just move them into ICBs without a proper consultation and plan. Amendment 95 on the patient choice duty would ensure that patients have choice over the care they receive in neighbourhood services as well as hospital services.

Amendment 88 is on the single patient record. The single has the potential to be truly transformative, bringing the NHS in line with other modern healthcare systems. It can prevent people from having to repeat themselves. But there are lots of questions for the Government that have not been answered. This is another example of making an announcement without thinking it through. How will existing health records be linked? How will patients, carers and clinicians have access? Who will control the data? How will it be kept safe? Amendment 88 would require the Secretary of State to publish a full plan before making changes.

There are some parts of the Bill that the Opposition can support, but in the Government’s hurry to make announcements, they often do not seem to think things through properly. That is the story of local government reform that we heard in the House earlier today; it is the story of the much-delayed workforce plan; and it risks becoming the story of this NHS reorganisation. In health, there are life and death situations, so we cannot afford for the Government to get it wrong. The Opposition have made a series of sensible amendments and will be grateful for the Minister’s support.

19:45:00

Madam Deputy Speaker (Ms Nusrat Ghani)Order. Back-Bench speeches are on a five-minute speaking limit.

Clive Efford (Eltham and Chislehurst) (Lab)I rise to speak to amendment 97 in my name, which would remove clause 10 from the Bill. Clause 10 gives powers to the Secretary of State to vary the proportion of public and private provision of health services if they consider that to do so is in the interests of the health service. In evidence to the Health and Social Care Committee, the chief executive of the Nuffield Trust said that clause 10

“seems to make it more possible for the Secretary of State to explicitly set out to increase private or public provision.”

Why does the Secretary of State need this power?

Introducing an extra level of nuance now, as clause 10 will do, has the potential to raise fears within the NHS that it could be abused in future. The clause has the potential to create unintended consequences. The explanatory notes for the Bill say that this new flexibility is necessary

“where there may otherwise be a breakdown in provision of a health service.”

Can we imagine a situation where the Secretary of State has concerns about a health service and that an approach to assist a local provider would be rebuffed? It is hardly likely to happen. The explanatory notes suggest that, in such circumstances, the Secretary of State needs the power to direct local decisions, rather than to work with local health service providers to resolve any difficulties. How does the power to influence the proportion of public and private provision help in resolving a breakdown in service?

Labour’s 2024 plan to make work pay set out a welcome desire to bring more essential services back into public control—something that is welcomed by health workers across the country, because so far the

“biggest wave of insourcing in a generation”,

as was promised, has felt more like a trickle when it comes to the NHS.

The new Prime Minister and new Secretary of State have inherited the Health Bill from their predecessors, so hopefully they will be able to stamp their own mark on it before it becomes law. Removing clause 10 would be one way of making that mark. The concern for those who work for the NHS and those who support it is that the clause has the potential to be exploited in future by those who would seek to move away from the public provision of healthcare. There are ample powers to enable the Secretary of State to intervene and resolve breakdowns in the provision of a health service. On clause 10, we must balance what it adds in those situations against its potential misuse by an ideologically driven Government that are determined to privatise our NHS. To remove any ambiguity and to protect the NHS from the possibility of the clause being abused by a future Secretary of State, I urge that it is dropped from the Bill.

Madam Deputy SpeakerI call the Liberal Democrat spokesperson.

Helen Morgan (North Shropshire) (LD)I have tabled several amendments to the Bill, but I will hopefully keep my remarks focused so there is a good opportunity for other Members to make their speeches.

The Bill should be about fixing the front and back doors of the NHS. It offers the opportunity to bring in tangible changes for patients to address pressing problems and introduce desperately needed improvements to patient safety and experience. The primary care and social care crisis, in particular, are millstones around the neck of the NHS. But instead of addressing them, the Bill has focused on a top-down reorganisation, which risks diverting time and money away from those pressing issues, and it gives sweeping powers to the Secretary of State, which is not in itself without risk.

The Liberal Democrats would instead have put social care and general practice at the heart of the Bill—a move that would represent real reform of the health service. In particular, new clauses 54 and 56 tabled by my hon. Friend the Member for Mid Sussex (Alison Bennett) would together transform the rights of family carers through guaranteed respite care and reform of the carer’s allowance. They would put free personal care, and an end to catastrophic care costs, at the heart of social care reform.

New clause 53, tabled by my hon. Friend the Member for Epsom and Ewell (Helen Maguire), would ensure that everyone can see a GP within seven days, or 24 hours if urgent, and amendment 17 would introduce a primary care investment standard. Although general practice is the core of a patient’s relationship with the NHS, it has seen its funding decline as a share of NHS spending. Less than 10% of the NHS budget is spent on primary care, although that is estimated to constitute 90% of a patient’s direct experience with the NHS. A primary care investment standard would help to reverse that trend. Dentistry is another area of primary care that has been neglected, leading to dental deserts and dangerous DIY dentistry. New clause 18 would introduce a scheme to end dental deserts, and guarantee appointments for children and those most in need.

Jim Shannon (Strangford) (DUP)New clause 82 refers to the family mental health pathway, but from diagnosis right through to treatment and, tragically for some, bereavement, mental health support for families cannot be an afterthought and must be a statutory proactive duty. Does the hon. Lady agree that the Government and the Minister should take that on board?

Helen MorganI broadly agree with the hon. Gentleman, and I am about to come to mental health. It is right to modernise the NHS and end some of the duplication that we see between NHS England and the Department of Health and Social Care, but the way it has been handled has been chaotic. It has been combined with 50% cuts to ICB budgets, unfunded redundancy payments, and chaos through the system. I was alarmed to read the report in The Times at the weekend about advice to the Secretary of State that the changes envisaged under the Bill are impossible to implement, given that the staff of NHS England are on different pay scales to those in the Department. Given those significant hurdles, I hope that in her closing remarks the Minister can provide some reassurance that abolishing NHS England in the way the Bill envisages is achievable.

We are particularly concerned that the functions of the Secretary of State under these reforms open the door to political capture, which is a huge risk given the unstable political climate we live in. Amendment 16 would create a firewall between the Secretary of State and operational decisions. These new powers are particularly worrying in the context of patient safety issues created by the Bill, which we will discuss in more detail tomorrow.

Beyond the Department, the Bill is complacent on taking seriously the vulnerability of our NHS to foreign interference and its implications for national security. That is why we tabled new clauses 2 to 5, which recognise and address the role of the NHS as part of our sovereignty, and the sensitivity of patient data. New clause 17 would require scrutiny in the House of the arrangement between the United States of America and the United Kingdom on pharmaceutical pricing. That deal, forced on us by Donald Trump with no say from the British people, will hike medicine prices in the coming years by billions of pounds, and deserves parliamentary scrutiny. All those shortcomings of the Bill attest to the fact that the NHS already spends far too much time and money responding to failure, rather than improving the safety and quality of services in the first place.

Gideon Amos (Taunton and Wellington) (LD)On safety, does my hon. Friend agree about the gravity of the national maternity review, which found that Musgrove Park hospital was the “most challenging” estate in the country? If it is the most challenging estate in the country, does my hon. Friend agree that that needs to be addressed sooner than 2033, so that mums get better treatment sooner than the 2040s? That is unacceptable if it is the most challenging estate in the country.

Helen MorganCrumbling estates are a big part of the problem across the whole NHS and in maternity, and my hon. Friend is right to highlight the state of his own local hospital and advocate for its quick remediation. Amendment 10, which I am sure my hon. Friend the Member for Winchester (Dr Chambers) will outline in more detail, would reintroduce the mental health investment standard. That is a crucial investment to avoid failures further down the line if interventions are not made for patients early on.

Nowhere is the cost of failure more obvious than in maternity—a devastating scandal which, despite many recent reviews, still deserves far more attention. Our amendments to make our maternity services finally safe for mothers and babies will therefore be the main focus of my remarks today. I thank the Minister for her constructive engagement with me on new clause 1, and the commitment that she made at the Dispatch Box today to table relevant amendments when the Bill reaches the other place, and to put that maternity commissioner in place. I am grateful to her for the discussions we have had, and the constructive approach she has taken both with me and with the many campaigners on the issue beyond this place. In the light of that, I will not be pushing new clause 1 to a vote.

I have seen up close the human costs of failures in our maternity system. Four years ago the Ockenden review found that over 200 babies and nine mothers in my community had died needlessly in Shrewsbury and Telford due to failures in maternity care. That has been devastating for my community, and we have heard since then that the situation was not isolated. There have been terrible stories from families around the country, most recently following the review into services in Nottingham. New clause 6 would introduce a scheme to ensure that every maternity unit in the country is rated “good” or “outstanding” by the Care Quality Commission. That new clause is essential if we are to meaningfully address the crisis in our maternity services and show families that lessons have been learned not just locally but nationally.

The Liberal Democrat maternity rescue package would require an estimated £600 million a year to bring safety in maternity units up to standard, investing in safe staffing and listening to mothers. The Government already spend £1.3 billion a year—more than double the cost of the package—on maternity negligence payments, so introducing that reset is a no-brainer. Rather than spending a fortune compensating for failure and heartbreak, the NHS should be getting it right in the first place. Recently we have seen the consequences of safety failures, with lack of staffing causing North Devon’s maternity unit to close, forcing women to take a 50 mile trip if they go into labour. My hon. Friend the Member for North Devon (Ian Roome), whose constituency has been hit hard by that news, has tabled new clause 66 to guarantee safe staffing levels and access to a maternity unit within 45 minutes.

While on women’s health, I also want to highlight new clauses 11 and 12. Earlier this year I wrote to the Equality and Human Rights Commission to highlight the stark inequality in research and investment in women’s health, with a huge gap in investment, governance and reporting mechanisms between women’s and men’s health strategies. The new clauses would set up an inquiry into women’s health outcomes, and ensure that average waiting times for women’s health conditions do not exceed the average waiting times for wider elective treatments.

The crisis in our maternity care is a national shame and reveals a systemic neglect of the safety of women and their babies over many years. However, that is indicative of even wider concerns for patient safety, which I urge the Secretary of State to address in the Bill, and which we will discuss in more detail tomorrow. If the Government are serious about using the Bill to improve our NHS, they must invest time and money in the front and back doors of the NHS rather than structural reorganisations. The safety of staff and patients must be at the centre of those changes, and I urge the Minister to consider the amendments tabled by me and my Liberal Democrat colleagues, which would improve the Bill to achieve just that.

Daniel Francis (Bexleyheath and Crayford) (Lab)I rise to speak to amendment 32 and new clause 39 tabled in my name, which seek to address the problems facing community equipment and wheelchair services across the country. I declare my interest as chair of the all-party parliamentary groups for wheelchair users and for access to disability equipment. As the parent of a wheelchair user, I know just how important getting such services right is for disabled people and their families, and the consequences and long-term impacts when it goes wrong.

Evidence gathered for an inquiry by the APPG for access to disability equipment last year found that one in three equipment users who responded to our inquiry are waiting a significant time for equipment, with one in five waiting over two months, and 55% stating that they do not have the equipment they need for their long-term needs. At a time when we are rightly focused on reducing waiting lists and improving patient flow, it makes little sense for somebody to remain in a hospital bed simply because the equipment they need to return home has not arrived. Some 74% of professionals and equipment providers report that patients experienced delayed hospital discharge because essential equipment was not available at home, increasing pressure on hospital beds and placing further strain on services. The current system is fragmented, inconsistent and lacks sufficient accountability and national oversight.

My amendments would introduce two things that the system lacksa clear expectation of how long people would wait, with clear, set timelines and accountability when things go wrong, and they would ensure that patients have a clear pathway for hospital discharge. Amendment 32 would require ICBs to provide community equipment and wheelchair services within 18 weeks of the date that a person is assessed. I know from experience of my daughter’s case when she was eight that the 18-week deadline was missed on two occasions, and she was without an adequate wheelchair for 21 months. These issues simply shunt costs to elsewhere in the NHS. The APPG for wheelchair users heard evidence from consultants within the NHS about the quality of assessment, interventions and aftercare.

We heard that delays led to children receiving a wheelchair that was no longer fit for purpose by the time they received it. The following are quotes that we heard:

“There is the additional care to consider as well. Poor equipment provision leads to pressure sores, increasing scoliosis, all of which have a wider impact on the sector.”

“In terms of inequity of care, when asked for information it is always the same eight or 10 ICBs who respond. The ones who don’t, are probably the ones we should worry about.”

“There is a level of bureaucracy in the NHS that stops things happening. Disability is not considered as important as other things in health parameters.”

The data available shows that the wheelchair deadline is being missed by many ICBs, and 29% of ICBs are not meeting the target of providing over 25% of wheelchairs in 18 weeks.

20:00:00

Danny Beales (Uxbridge and South Ruislip) (Lab)I thank my hon. Friend for his work on the all-party parliamentary group; he is a real champion of this cause. AJM Healthcare, the contractor in my constituency, has a similar level of failure. People are left for months—sometimes six months—without a wheelchair, bed-bound and unable to get out of the house. Does he agree that ICBs seem completely at sea on this issue, and are totally unaccountable? Does he agree that we need much tougher measures, such as those he suggests, to hold them to account?

Daniel FrancisI completely agree with my hon. Friend. As I will come on to, there is an inconsistent set of data across the country. This inconsistency is not just between ICBs but, in the case of my constituency and that of my hon. Friend the Member for Eltham and Chislehurst (Clive Efford), between neighbouring London boroughs, which may have the same ICB but different frameworks.

I also welcome the support for the amendment from the Children’s Commissioner, who has said:

“Across the country, children wait far too long for the right equipment that is essential for daily life. In recent research on children experiencing delayed discharge from hospital, the office was told that delays in getting equipment, and having equipment serviced, had led to children being stuck in hospital, away from family, friends and school.”

This postcode lottery is not just cross-country—I know of a number of ICBs in which there are significant issues—but within ICBs. In my part of south-east London, one patient can be discharged, while another, in the same hospital with the same condition, living on the opposite side of the road, cannot be discharged. That difference arises because a borough boundary runs down the road. There are different contractual arrangements between different London boroughs in the same ICB. I know at first hand that pupils in the same school class, and in the same ICB, can have completely different service standards for their wheelchairs because one lives in one London borough while another lives in the neighbouring borough.

I will speak briefly to new clause 85, tabled by my hon. Friend the Member for Thurrock (Jen Craft). Like me, she is the parent of a disabled child. We have fought these issues for many years, both as parents and on behalf of our constituents. In my case, I know that when Ofsted found that there were systemic failings in our SEND provision, we could hold our local authority to account, but we could not properly hold our ICB to account. The judgment was issued against the council, not the ICB.

Josh Fenton-Glynn (Calder Valley) (Lab)I thank my hon. Friend for his powerful speech, and for bringing his personal experience to the Chamber. I am sure that he will agree with me that the ‘H’ in EHCP stands for health; we need to see the health service doing its part. Does he agree?

Daniel FrancisI absolutely agree, and I was a Labour councillor and leader of the council’s Labour opposition back then. I was also married to a special educational needs co-ordinator who was employed by the local authority. I was employing my own professionals to get through this process and ensure that the health aspects of the EHCP were upheld. The situation is absolutely abhorrent. Many parents who do not have the opportunity and insight that my wife and I had cannot ensure that accountability for their child. When my borough received that judgment of systemic failings, that issue really came to the fore.

I would be grateful if the Minister or Secretary of State could outline how the Government intend to address the issues addressed by my amendment and the new clause tabled by my hon. Friend the Member for Thurrock. My amendment intends to ensure that we deliver basic objectives, set clear expectations for how long disabled people should wait, set consistent standards, and ensure meaningful accountability for ICBs when services fall short.

Sir Jeremy Hunt (Godalming and Ash) (Con)I want to start by thanking the Minister for the emphasis that the Bill places on a single patient record. Despite many problems in NHS care, that is an area where the NHS is a world leader, but putting a single patient record on the right legal footing, making it possible to share data with proper governance, gives the NHS an opportunity to become a world leader in artificial intelligence, and it creates the opportunity to transform care for patients, so that has my full support.

I speak in support of new clause 25. The biggest structural reform in this Bill is the abolition of NHS England, but my worry is that there are other structural reforms that are not in the Bill that would have a much bigger impact on patient care. New clause 25 is about continuity of care, particularly in general practice and maternity. It is now very clear to many people that the abolition of the old GP list system in the 2004 contract changes was a huge mistake. In fact, restoring the system so that GPs have their own patients was part of the Labour manifesto, so that is an issue that the Government understand, but it is not in the Bill.

A study in Norway, published in the British Journal of General Practice in 2022, of over 4 million patients showed that patients who have their own doctor for more than 15 years are 30% less likely to need out-of-hours care, 28% less likely to need hospital care and 25% less likely to die. Why is that? Because GPs who know their patients are less likely to make mistakes, more likely to give an accurate diagnosis and will better calibrate risk, as they will have situational awareness of a patient and their family. The experience of a patient is infinitely better when they are dealing with a GP whom they know.

Instead of that, we have moved to a system in which many GP surgeries effectively operate like call centres. People will contact a GP and they may never see that GP again. It is exactly the same when someone calls 111, if you get put through to a clinician. Contacting a GP in the NHS should never be like calling an Uber driver who will never be seen again.

Graham Stuart (Beverley and Holderness) (Con)Labour Members who had that commitment in their manifesto may want to reflect on how much more commitment we have to constituents because they are our constituents than we would if we shared constituents from day to day. We often go out of our way—I hope—to look after our constituents because of that sense of ownership and obligation. It is only because we are allocated those people and they are our responsibility that we go that extra mile. Why would doctors not be the same, and can colleagues not see the sense of what my right hon. Friend is saying?

Sir Jeremy HuntMy right hon. Friend is speaking wisely. Of course, this is not just about massively improving care for patients—it is also about improving motivation for doctors and GPs, who are among the most demoralised groups in the NHS.

There is a GP surgery in Horfield, in the Bristol area, that kept the old GP list system, as 10% of surgeries have done. When I chaired the Health and Social Care Committee, I interviewed Dr Lee from that surgery and he said that because around 60% of the patients they see every day are their own patients, they do not have any problem with GP retention. The GPs who go to work there are happy, because they are seeing people they know. That would be transformative for morale inside general practice.

People might very reasonably say, “Well, you were in that job for rather a long time. Why didn’t you restore that system?”. I want to share a little secret with the House: I did actually try to do that. I changed the GP contract in 2015 so that every NHS patient in England has a named, accountable clinician. Unfortunately, I was outfoxed by the system. As a result of that change, on every electronic patient record, every one of us here will have a named accountable GP on the record. However, absolutely nothing else changed, and the NHS continued as it had done.

The Bill offers a real opportunity to transform care, as well as transforming life for GPs and patients. The same principle applies to maternity care. We know from inquiry after inquiry that despite reams of recommendations, things have not been getting better. If every mum was told at the moment she knew that she was pregnant, “This is the team who will be responsible for the safe delivery of your baby, in antenatal, birthing and post-natal,” we would restore the personal connection to maternity care. That is one of the biggest issues coming from so many mothers; they say that they feel anonymous in the system, and not listened to.

At its best, the NHS delivers absolutely incredible care—I have three wonderful children who exist because of amazing NHS care—but at its worst, it turns patients into numbers and human suffering into box-ticking. Lots of things are necessary to turn that around, but one of the biggest things is restoring continuity of care, so that every patient always knows who is the doctor responsible for their care. That is why I urge the Government to consider how to restore continuity of care in both general practice and maternity, if that is not going to be done through this Bill.

Navendu Mishra (Stockport) (Lab)There is lots in this Bill that is very positive, but I want to raise a couple of local issues, including one relating to my local Stepping Hill hospital. I thank the Minister for meeting me and my constituency neighbour, the hon. Member for Hazel Grove (Lisa Smart), to discuss the hospital, because it is at the heart of healthcare provision in my town of Stockport. It serves around half a million patients per year and is one of the four specialist hub centres for emergency and higher-risk general surgery in Greater Manchester.

I appreciate that 14 years of austerity, imposed by the coalition Government of Liberal Democrats and Conservatives, and by subsequent Conservative Governments, have taken their toll on the NHS. The Labour Government have been trying to fix things over the last two years, but Stepping Hill hospital is a huge issue locally. I have mentioned the condition of the hospital a number of times in this Chamber, and a number of constituents frequently get in touch with me about the state of the hospital. At one point, Stepping Hill hospital was reported to be delivering only 51% of its usual outpatient services, which is simply not good enough. The staff do an amazing job, and an amazing set of volunteers support the hospital, but so much more needs to be done.

The backlog of repairs at the hospital is estimated to cost around £138 million. The Government have allocated £2.5 million for targeted essential repairs, fire safety and other works, and the foundation trust has been allocated £75 million by this Government over the next four years. That is a positive step, but I urge the Minister to go a bit further for Stepping Hill hospital in Stockport, Greater Manchester.

The second issue I want to raise is NHS-funded IVF treatment, which I have also mentioned previously. We live in a country where we have a postcode lottery in NHS funding for IVF treatment, and that should not be the case. I have signed new clause 104, tabled by the right hon. Member for Stone, Great Wyrley and Penkridge (Sir Gavin Williamson), which is about ensuring that the provision of NHS-funded IVF is in line with the National Institute for Health and Care Excellence guidelines.

Once again, a number of parents in my constituency have been in touch with me about this issue. Sadly, NHS Greater Manchester ICB has taken the step of reducing provision. It conducted a consultation a few months ago, and 74% of respondents either disagreed or completely disagreed with the proposed one-plus cycle offer. I have submitted a freedom of information request to NHS Greater Manchester ICB regarding the cost and resources that went into the consultation, because it did the consultation and then proceeded to reduce the provision. The change disproportionately impacts low-income women and people from poorer backgrounds, and that is simply not good enough. Greater Manchester has a population of almost 3 million people, and this is a regressive step.

The Government need to do a lot better on mandating legal access to NHS-funded IVF. Current data from a fertility unit in the north-east—one of the only two areas where an ICB funds three full rounds of IVF treatment—shows that the chance of a woman under 40 having a baby after three cycles of treatment is 70%, but the figure for people who get access to one cycle is just 46%. In England, we need standardisation of IVF treatment.

I also support new clause 108, tabled by my good and hon. Friend the Member for Liverpool West Derby (Ian Byrne). I will not say much on this point, because I have spoken on three separate occasions in Westminster Hall and in this Chamber about data hygiene and safety. I have had a very large volume of correspondence from constituents on this issue. Many people in Stockport are worried about foreign tech firms having access to their sensitive personal medical records. People need to have confidence that the personal details and data that they provide to the NHS will not be misused.

As I said earlier, this Government have achieved a lot in the last two years, but we need to recognise that there is so much more to be done. Labour Governments always fix things in the long run, but I ask the Minister specifically to go a bit further on Stepping Hill hospital and IVF.

20:15:00

Layla MoranLet me start by taking up the theme of maternity, which has already been mentioned by a number of Members. I welcome the Government’s commitment to instating a maternity commissioner. I sit on the expert reference group—that is what we are called—that feeds into the maternity and neonatal taskforce, so I see how the Government are trying to pull all these different issues together. The Health and Social Care Committee has heard repeatedly, and across a number of inquiries, how important this issue is, and we need someone who is independent of Government and able to knit it all together.

Our Committee’s “Black Maternal Health” report heard how workforce shortages are undermining efforts to improve maternity care, data is lacking, and there is a culture in which women, particularly black women, are not listened to. Investment and training are needed to tackle that.

The “First 1000 Days” report found that the UK has some of the worst early years health outcomes in Europe, including in infant mortality, and we have called for proper targets for early years professionals in the long-lost workforce plan. As an aside, where is the workforce plan? I would love to see it. Locally, Oxford University hospitals provide maternity care for my residents, and indeed for my own family—baby took their first steps this weekend, finally! It was a momentous occasion.

I also reflect genuinely that there are people in my National Childbirth Trust class who did not have as good an experience as we did. They have been proactively contacted by the hospital to have an apology and an explanation given for their awful, traumatic birth, and they did not even complain. In part, that is a result of the CQC inspections and, more importantly, the inclusion by Baroness Amos of OUH and John Radcliffe hospital in her report.

I toured the hospital again this summer and heard specifically from trust leaders and midwives. They are doing everything they can to respond to all the criticisms being levelled at them by families, but they told me that there is only so much that they can do without a new building. Baroness Amos’s report said:

“The maternity and neonatal units sit across multiple floors… We saw delivery suites that didn’t have windows, that were cold, small and cramped and had pillars in the middle of them affecting where equipment could be placed”.

A large number of the suites did not have en suites. Can you imagine what it must be like to give birth in those rooms? As the Government knit together their action plan, I beg them not to forget investment, particularly capital investment, when they empower the commissioner to do their good work.

Let me move on to a few other amendments. I support the work to tackle health inequalities in new clauses 90 and 91. Our Committee hears over and over again that if we want to unlock productivity in the NHS, that is where we need to focus. I also support the campaign of my hon. Friend the Member for Newton Abbot (Martin Wrigley) and his cross-party new clause 34, which echoes the findings of my Committee. The Government really need to think again when it comes to Palantir and instead supercharge the capability of UK-based companies.

Martin Wrigley (Newton Abbot) (LD)On that very point, does my hon. Friend agree that the recent NHS cost-benefit analysis showing that the Palantir project will cost £1.1 billion and deliver benefits of £800 million—a net loss of £300 million for the NHS—underlines the fact that we need to get rid of it now?

Layla MoranI thank my hon. Friend for his intervention; he has been a doughty campaigner on this issue, as have other members of the Committee, including the hon. Member for Chelsea and Fulham (Ben Coleman). We also know that much of the data is based on the data being taken from Chelsea and Westminster hospital, and not much else across the country. We have a lot of questions about that contract, hence why we came to the same conclusion.

However, I primarily urge the Government please to consider new clause 85, in the name of the hon. Member for Thurrock (Jen Craft), which would impose duties on ICBs for delivering education, health and care plans. In my constituency we held a roundtable to provide evidence for our own hearing on this issue—by the way, this was based on a recommendation that came out of the Education Select Committee’s work on EHCPs, so we decided to take up the “H” bit. In that roundtable, I heard movingly from families who kept saying things like, “Everything is a battle.” One child, Stefan, suffers from multiple epiphyseal dysplasia, which affects his hips, and needs support to get around. He is very bright and desperately wants to learn. His mother was at that roundtable, and told me that, exceptionally and against school policy, he is allowed to keep a phone on him. There is no one whom the school can employ to make sure he can be wheeled from class to class, so instead what happens—and mother and school have done everything they possibly can—is that Stefan rings his mum so that she can come from home and deliver him to his next class. Ridiculously, this is the kind of thing that goes to tribunal, and then those tribunals cannot hold the ICBs to the same level of accountability as local authorities. The whole thing is nonsensical.

Peter Swallow (Bracknell) (Lab)I agree with the point that the hon. Member is making. To add the voice of a member of the Education Select Committee, the Committee’s report equally found that we have to have a system where ICBs can be held to account for delivering on EHCPs.

Layla MoranI am grateful to the hon. Member for his intervention, and for the work of that Committee. We are doing work together right now on children’s mental health, so I am sure we will continue to pursue this theme.

The point is that the impact was not just on that child; it was also on the mother, who could not work, and there was also the distress of having to battle the system. The mental health of both parents was affected. It does not need to be this way, and I genuinely believe that accountability is part of the answer. As such, my plea to the Government is simply to say that it is past time that the “H” part of EHCPs is put on a statutory footing, and I urge the House to support new clause 85.

Danny BealesThere is much to support in the Bill, and I support its ambition to enable many of the provisions of the welcome 10-year plan for the NHS. The plan is the right one; the three shifts are correct, and we have to fundamentally reform the health system if we are to meet the modern health and care challenges that we all see in our constituencies. To some extent those challenges are not new, and neither are these ambitions—we have seen similar initiatives before—but the systems, the structures, the bureaucracy and the siloed budgets push against change in the health sector. They have been a hinderance, reinforcing silos and making the same investment choices. They have prevented digitalisation, kept care in acute settings and stopped joined-up working. This Bill could and should be a key lever in overcoming those challenges, which we need to do if we are to achieve those ambitions.

I very much support the digital single patient record, which is a key ambition in the shift from analogue to digital health. We have all heard from patients who have to tell their story over and over again at every single health appointment—between care and health, between community and secondary care—so a genuine single patient record has the potential to be transformational. We have, however, heard from pharmacies and community mental health services that if this is to work, they have to have a seat at the table. While this Bill enables the architecture, I hope that the delivery will ensure that the whole of the health and care system is part of the decision-making process when the single patient record is designed. That is crucial.

Turning to the abolition of NHS England, the idea of streamlining bureaucracy at the centre is a good one, and delivering power—including decision-making power—budgets and resources locally is also admirable. Success, however, will mean the right decisions being taken at the right scale.

Ben Coleman (Chelsea and Fulham) (Lab)One of my concerns about the abolition of NHS England is that highly specialised services for treating the rarest and most complex conditions—of which there are only 79 in the country—currently sit directly with NHS England. It is not clear whether those services will continue to be commissioned centrally. Does my hon. Friend think it would be helpful if the Minister could clarify that?

Danny BealesI thank my hon. Friend for that contribution. Having worked in neonatal care services and areas of specialised services in the NHS for 10 years, I understand that one of the benefits of NHS England was that it brought together highly specialised services, ensured consistent service specifications and uplifted the quality and availability of care across the country. I hope that when we make decisions about which specialised services will be devolved to ICBs, consideration will be given to that point. Equally, we have heard from national population health programmes such as the Diabetes Prevention Programme, which has been a huge success. As we make the final decisions about the level at which decisions are made, we cannot lose the benefits of public health initiatives at scale, such as vaccinations and prevention programmes. I would welcome the Minister’s thoughts and reflections on that.

Integrated working is also important—as I say, we have to blend budgets and bring together decision makers across current silo divides. In that spirit, I very much welcome the change made by Government amendment 60 to give local authorities a seat back at the table. We need a bigger voice for public health and social care in health decision making, not less, so I thank the Minister and the Government for listening to the Health and Social Care Committee and moving on that. In the view of the NHS Alliance, this is not enough; it would like to see a reciprocal duty to collaborate, which is an interesting suggestion. However, the Government’s amendment is an important start.

Anna Dixon (Shipley) (Lab)I congratulate my hon. Friend and others on the Select Committee who did the work on strengthening local authority representation on integrated care boards. Does he agree with the sentiments of my new clause 106, which says that we need a stronger duty to co-operate, both within the NHS and between the NHS and local authorities?

Danny BealesMy hon. Friend might have read my speech, because I was about to turn to her amendment’s proposal of a report on integrating health and social care. It is an interesting idea that has a great deal of merit, and I hope that the Minister, in her response, will outline the Government’s approach to enabling more progress on integrating health and social care, particularly with the ongoing Casey review.

Inequalities have already been mentioned in the debate. Obviously, one of the Government’s key ambitions is growth in every postcode; another is good health in every postcode. Time and again we see disproportionality and inequalities that are seemingly hardwired into our health system. To change that, we are going to have to do something differently, and I welcome new clauses 90 and 91, tabled by my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). Unfortunately, those amendments have not been selected for debate, but they definitely reinforce the Government’s 10-year plan commitment to halve the gap in healthy life expectancy between the richest regions and the poorest, and to raise the healthiest generation of children ever. Unfortunately, we have moved away from those goals over the past 10 years, and we will have to do something differently if we are to bridge that gap. In my own constituency, from north to south, there is a huge divide in the quality of health and outcomes based on postcode. That must change.

Although the Government are not minded to accept those amendments, I know that the Minister is passionate about inequalities and that the Bill requires neighbourhood health plans to be developed. That will be an important new measure when responding to neighbourhood health needs, and in preparing those plans,

“the responsible local authority and…partner integrated care boards must have regard to any guidance issued by the Secretary of State.”

I hope that the Minister will explore using this guidance to ensure that as they are developed, neighbourhood health plans specifically address inequalities between neighbourhoods.

Finally, I turn to the SEND system, which is another major challenge with which the Government are rightly grappling. I thank my hon. Friend the Member for Thurrock (Jen Craft), a fellow member of the Health and Social Care Committee, for new clause 85, which would address the chasm between the education system and the health system. While this is fundamentally a health Bill, it is right to ask what more the health system could and should be doing. As the Chair of the Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has rightly said already, the “H” is far from present in EHCPs. Decision makers are not required to come round the table, and the specialists are not provided. I have been to specialist schools in my constituency where there is no nursing provision, so people miss school days, and where there is no specialist transport, so people cannot even get to school, because bus drivers do not have the proper health knowledge. We need to have an education and health response. I therefore hope that the Minister will address in her closing remarks how, if this Bill is not the right mechanism, future SEND reforms may pick this issue up and how the Department of Health and Social Care will contribute.

There is a great deal to support in this Bill. It is a major step forward, particularly for digital healthcare, giving people control of their records and joined-up care. I hope that the Government will continue to drive forward reform of our health system.

20:30:00

Sir Gavin Williamson (Stone, Great Wyrley and Penkridge) (Con)We all often have a common memory that is so incredibly important and special: holding our child for the very first time. Sadly, so many people up and down this country cannot have that memory because of their difficulty in having children.

In 2004, the National Institute for Health and Care Excellence recommended a way forward on IVF, which was to give all a minimum three cycles of IVF treatment. That was set out 22 years ago, so we would hope that over time all ICBs would have moved towards delivering that. Sadly, it is something that people have moved away from, and that is not because the issue has got easier or better or is impacting fewer people. The reality is that the issue has got more difficult and is impacting more people, meaning that more people will not have that amazing joy of holding their own child.

I ask the Minister to look at new clause 104, which has been tabled in my name, with the support of 16 other Members from all parts of the House. The issue of people not being able to have children is growing. Male fertility has been collapsing over the past few decades. As people are dealing with greater pressures to buy their own home, they are having children later in life, rather than earlier.

We have a postcode lottery. Only two ICBs across the country offer the NICE recommendation of three cycles. In fact, as we have already heard, the offer in Manchester has been decreased. That is also the case in Cheshire and Merseyside. In Staffordshire, which I represent, people are not even entitled to one full cycle of IVF, meaning that unless someone is incredibly rich, they are condemned to probably never being able to have children. That is just not right, and I urge the Minister to be proactive in looking at how it can be addressed.

We face a demographic issue in this country. We have a falling birth rate, with fewer than 600,000 babies born in this country last year. That will only get worse. It is sad that the NHS is not prioritising this issue. I understand the pressures that ICBs operate under, and it may always be seen as an easy, no-cost option to deprive people of the ability to have a child, but for those people who desperately spend their whole life doing everything they can—remortgaging their homes, begging for money from family and friends—to have a cycle of IVF, it is destroying them. There is no humanity in this system. I urge the Minister to look at new clause 104 and give families the opportunity—the greatest blessing that they can have—to hold their own child. I urge her to take action, as opposed to ignoring something that is so important to so many.

Jen Craft (Thurrock) (Lab)I strongly welcome this landmark Bill, which will protect and strengthen our health service for decades to come, but for children with special educational needs and disabilities who are disproportionately impacted by not getting the healthcare that they need, I believe that it should go further. That is why I tabled new clause 85, which seeks to address the fundamental imbalance in the provision of health services for disabled children and young people. Currently, the statutory duty to deliver education, health and care plans—the legal mechanism by which children with special educational needs and disabilities can receive support—sits entirely with local authorities.

Jim ShannonI commend the hon. Lady for all her endeavours in this regard. Does she share my concern that when a child is diagnosed with cancer, the parents are instantly overwhelmed by medical jargon, by appointments and by sheer panic? Does she agree that the Minister, and the Government, should accept the common-sense duty to ensure that no family faces those critical first two weeks completely alone?

Jen CraftI do agree. The hon. Gentleman has made a very good point about the impact of childhood illness, not only on the child but on the family. I also agree that support for families is crucial. They are part of the care team for children when they are unwell, and that acknowledgment needs to be strengthened and acted on.

As I was saying, the statutory duty to deliver EHCPs sits solely with local authorities. In practice, that means that councils are the only bodies that can be held legally responsible for providing the service that a disabled child needs to access education, including health services such as occupational or speech and language therapy. Health bodies are not subject to the same requirement, and I know from my work as a member of the Health and Social Care Committee and a constituency MP, and as a parent of a disabled child, that that too often means that they are not at the table when it comes to delivering services for children with special educational needs and disabilities. There is a fundamental lack of accountability in the system. That, in practice, can force local authorities or families to procure privately, which can drive shortages in the NHS workforce or can mean that provision is substandard or non-existent.

My constituent’s son Haider, for example, has an EHCP which outlines his need for speech and language therapy to gain full access to education. Despite his mother Qaila’s relentless efforts, that support was not delivered for months. Qaila tells me that she has been forced to watch while Haider has become withdrawn, anxious and isolated. My constituent Elizabeth has a similar story. She has been fighting to get occupational and physical therapy for her son William, but significant delays in securing assessments from healthcare professionals have resulted in inaccurate, unhelpful support arrangements.

Josh Fenton-GlynnI thank my hon. Friend for making such a powerful speech, and for all the work that she does in this regard. These long waiting times are particularly difficult when children are involved, because a child's life is so attenuated. If a parent is waiting for 18 months, that amounts to one and a half or two school years. Does my hon. Friend agree that the key to prevention is to ensure that these matters are dealt with as quickly as possible?

Jen CraftI completely agree with my hon. Friend. Owing to the lack of early intervention for my constituent Elizabeth and her son William, he has missed countless hours and days and weeks of schooling at a critical point in his development.

At a drop-in that I hosted last week, I met a woman called Annika. Her daughter Winnie has cerebral palsy, and her EHCP clearly states that she requires a physiotherapist, but the family have been forced to arrange that for themselves. Countless other families are in the same position. I think that every single Member in this House will have encountered similar constituency cases, and it is just not good enough.

Graham StuartThe hon. Lady is making a most powerful speech. We will all have experienced the frustration of parents with a child whose EHCP lacks the health element. Does the hon. Lady share my concern that, furthermore, the abolition of Healthwatch might remove one of the few elements that externally and independently marks the homework of the NHS, and that we are moving to a situation in which the NHS itself, and Ministers, will collect the data and mark their own homework, and we will lose yet another of the few tools that a frustrated parent has to hold the system to account?

Jen CraftI agree that there needs to be better accountability in the health service. It currently does not work, and the mechanisms by which we can hold healthcare bodies to account are few and far between. I believe that it is most acutely felt in paediatric care and in the special educational needs and disabilities system, where a mechanism for holding public bodies to account already exists: EHCPs. The idea that the responsibility should fall entirely on local authorities is misguided, because roughly 50% of what a child with an EHCP needs in order to access education is healthcare, which should be provided by a healthcare service. There must be better accountability and transparency for parents, and for their children, when that does not happen. I know that parents often have to go out of their way and spend, on average, £8,500 a year on their child’s healthcare so that they can access education.

Ben ColemanWill my hon. Friend give way?

Jen CraftI will not, because I am going to run out of time.

Roughly 40% of people have paid privately for therapies, and many are forced to fundraise for the vital medical equipment to which their child is legally entitled. It is worth noting that beyond the direct costs, many parents are forced to miss work because the right support is not available for their child to attend school. Around 40% report cutting back their hours, and 35% have left the job market completely. Before I became a Member of Parliament, I stopped work to become a full-time carer for my daughter. I do not regret that choice for a second, but it was a difficult and sometimes lonely period. Like many parents, I had not anticipated just how hard it would be to secure basic support for my child. Even to this day, I struggle to secure the basic healthcare support that she needs to support her education and her place at school. I am wearing a dragon for her today, and she will know why that is. I will not share it with the House, but if she watches this debate, she will see the dragon and it will make her smile.

New clause 85 is intended to fix the inequality. It would place a statutory duty on ICBs to deliver the health part of EHCPs, matching the existing duty on local authorities. The fundamental concept that there must be a meaningful legal requirement on health services to deliver the support set out in EHCPs is critical. If we do not act and do not rightly demand that health services pull their weight, the status quo of young people missing out on education will continue, and I am afraid the planned SEND reforms will be doomed to failure. Disabled children are no less worthy of a decent education than their peers and are no less capable of thriving in school, but we are denying them access to the tools they need to succeed.

I am grateful to the Health and Social Care Committee and the Education Committee for their support for new clause 85, and to the nearly 100 Members from across the House who put their name to it. I want to express my thanks to the charities involved for their continued campaigning efforts, and to the many parents who have contacted me. I sincerely hope that the Government will give the new clause the attention it deserves. If they cannot accept it in whole, I hope that they will give a commitment to deliver proper accountability.

Madam Deputy Speaker (Caroline Nokes)Order. After the next speaker, there will be a four-minute time limit, but I will not reduce it further than that.

Tom Gordon (Harrogate and Knaresborough) (LD)I would like to start by welcoming the commitment from the Minister at the Dispatch Box to bring forward a maternity commissioner, and by thanking my hon. Friend the Member for North Shropshire (Helen Morgan) for her tireless campaigning on this issue. When I worked for her many years ago, I was all too aware of the scandal at the Shrewsbury and Telford hospital NHS trust, after sitting in on surgeries with her. Indeed, in my own constituency of Harrogate and Knaresborough, I have ended up with tireless campaigners coming to me when they face maternity issues at Leeds hospital.

I turn to the amendments tabled in my name. The first is new clause 36, which would require the Government to bring forward a formal transition strategy and to report back to Parliament on what happens when NHS England is abolished. I have tabled the new clause out of concern for families who have lost loved ones at the hands of the Tees, Esk and Wear Valleys mental health trust. They have said time and again that they are concerned about the delayed appointment of a chair to the inquiry. They are really worried about that as we see the largest changes to the health service in a generation, and they do not want the inquiry to be lost. I press the Minister on whether she might be able to push that forward or get her colleagues to do so.

New clause 43 would reduce inequalities in access to clinical research funding and trials. I have been working closely with Yorkshire Cancer Research, based in Hornbeam Park in my constituency. We know that funding for clinical research and trials across Yorkshire is about a quarter of what is received in London. If areas outside London and the south-east are getting less research funding, the logic follows that we will struggle to close inequalities in those areas.

Dan Aldridge (Weston-super-Mare) (Lab)I think the hon. Member’s point about health inequalities is really important. The number of cancer cases is expected to rise by about 30% by 2040, and England already has fewer radiotherapy machines per head than comparable European countries. Weston-super-Mare does not even have one, despite being the size of the city of Bath. Does he agree that that needs to come in conjunction with the rest of the investment he is talking about?

20:45:00

Tom GordonI completely agree with the hon. Gentleman. My hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), who is not here, is campaigning tirelessly on radiotherapy and radiography. The point I was making about those health inequalities is that regions such as Yorkshire have a high incidence of cancer and of poorer outcomes, so we need to close that funding gap to close those inequalities.

New clauses 61 and 93, both in my name, pertain to NHS dentistry, and I have also added my name to and support many other new clauses. New clause 61 would have made sure that there is adequate provision of dental appointments in Harrogate and Knaresborough. Over the last two years in my constituency and across North Yorkshire as a whole, the number of people with access to an NHS dentist appointment is down from 50% to just 37%. When this arises in casework and at surgeries, the issue is often precipitated by those who work in A&E telling me traumatic stories of people reaching A&E as a result of emergency dental care or the lack of it. In particular, we have heard some harrowing stories from local children about their inability to focus in school. New clause 93 would require the Secretary of State to publish before Parliament a regular report on the state of NHS dentistry, including that unmet need, and also to pay particular attention to workforce capacity and distribution.

Vikki Slade (Mid Dorset and North Poole) (LD)In Dorset, we have lost 44 dentists in the last five years, and there has not been a single new contract for 10 years. Is my hon. Friend suggesting that his new plan would reverse that by enabling us to see exactly where the gaps are in the system?

Tom GordonI agree with my hon. Friend that we need to see that, and I tabled new clause 93 to get the answers to some of those questions that not just constituents in my patch but those in hers are asking us as Members of Parliament. It is particularly frustrating that we are in the third year of this Labour Government, and although talk of dental contract reform kept cropping up at the outset, we have seen little progress since, so I would press the Minister on what more can be done to make sure those gaps are filled.

On new clause 121, I am the chair of the all-party parliamentary group for diabetes, and we have some fantastic care and world-leading practice for diabetes, as was mentioned by the hon. Member for Uxbridge and South Ruislip (Danny Beales). This new clause would maintain existing national diabetes prevention, treatment and audit programmes, and would mean we see an explanation from the Government with regular reports in Parliament about how those are being continued.

Overall, Members across the House have tabled a fantastic number of amendments. I hope the Minister will pay attention to them and can provide us with some responses.

Anna DixonI worked as a civil servant for the coalition Government, and I saw at first hand some of the duplication and confusion caused when NHS England was set up, so I welcome this Bill and the decision to abolish NHS England. However, reversing the fragmentation caused by the Tories’ failed reforms of the NHS will not on its own create a more integrated and joined-up service for patients and carers. That is why I have tabled new clause 106, which would require the Secretary of State to report to Parliament within six months of the Act passing on how well NHS bodies and local authorities are working together to integrate health and social care in England.

Having worked in the health and care sector, I know how vital it is to have integrated services, and I know as an MP, as I am sure do others, and from personal experience how devastating unco-ordinated care can be for patients, their families and our NHS. One of my constituents, Ellerie Carroll, was diagnosed with diffuse intrinsic pontine glioma, an inoperable brain tumour, in September 2024. Very sadly, she died in May this year, aged just nine. Ellerie and her parents, Freya and Christian, suffered in ways that are unimaginable, but it was a lack of co-operation between services that added to their suffering. To give just one example, after going for a MRI scan at Great Ormond Street hospital, Ellerie had to endure a repeated scan at Leeds General Infirmary in Leeds due to an inability to share results between hospitals. I hope that the single patient record, which the Bill also creates, will help to join up systems and reduce such problems.

We see disjointed care within the NHS between hospital and community services, but also between health and social care. Another constituent, Roger, in his 90s, had a fall and serious head injury last year. After the acute hospital treatment in Leeds, there was a failure in the NHS to join up his care with Bradford social services, resulting in delays to his discharge. He developed infections and delirium. After nine months of being moved from one hospital to another, and despite his wife fighting to get him home with support, he died in hospital. These are the consequences when our health and care systems are not integrated. It is also expensive. Around one in 10 hospital beds in England are occupied by someone who does not need to be there, often because community care or social care are not available.

Any reform of the NHS will ultimately fail unless we simultaneously reform adult social care. That is why I welcome the priority given to this issue by the Prime Minister and the commitment he made to bring forward the conclusion of the Casey commission. But even if we build a national care service, which we must, there is a risk if it does not work in sync with our national health service. It is essential that we place very clear obligations on all parts of the NHS to co-operate and integrate with social care.

I ask the Minister to set out in her closing remarks how she and the Secretary of State will monitor the Bill’s impact on integration, and how they will ensure co-operation remains a critical priority for the NHS—not just on paper, not just in law, but in the way that we all experience health and care in a joined-up way.

Steve Barclay (North East Cambridgeshire) (Con)I rise to speak to clause 1 on the abolition of NHS England and clause 6 on promoting innovation.

What characterises the first of those is an announcement without any clear plan. That is what has driven the cost and confusion that a number of Members across the House have spoken about. Those in any doubt about that can just look at NHS England’s own 2025-26 annual accounts, which show that the costs are already more than £100 million higher than forecast and now sit at above half a billion pounds. I do not recall seeing that on election leaflets. Indeed, just six directors at NHS England are being paid over £800,000, and that points to the cost.

Sometimes such big figures are hard for constituents to get their heads around. Just to localise it to my own constituency, the Cambridgeshire and Peterborough ICB alone paid out £14 million in redundancies last year. It merged with a number of other ICBs to form the Central East ICB, yet we know hear from the Government that it should align with metro mayors, which means going back to exactly what it was before: the Cambridgeshire and Peterborough ICB.

That is just one of many confusions around the announcement. The hon. Member for North Shropshire (Helen Morgan) spoke about confusion over the timetable and what was described to the media as now an impossible timetable. We also saw reports in the media this weekend about the destination of staff in NHS England. Can they actually go into the Department, or will another body be set up because of the pay disparity between the two? All this is around 18 months on from the actual announcement.

The confusion seems to extend to the Government themselves, because they seem unable to answer pretty straightforward written parliamentary questions. Given the time limit, I will give just a few examples. I asked how many people have been hired to NHS England since the announcement of its abolition, not least given the huge cost—over half a billion pounds—of voluntary redundancies. Despite the deadline passing, the Minister has not answered the question. We know from another written parliamentary question that more than 1,000 jobs have been advertised. It is relevant to know, in an organisation that is paying people to leave, how many people it is hiring. I also asked how many people had accepted voluntary redundancy, another written parliamentary question that has passed the deadline without answer. The process is characterised by a lack of transparency.

Graham StuartMy right hon. Friend is giving a typically punchy speech. Does he agree that every signal suggests that this measure has not been thought through? While the Government have conceded by saying, “Oh we’re going to have local government coming back onboard,” how could they have conceived of health and social care without local government being engaged? On every front, it looks as if they have not thought it through, abolishing everything from the safety inspectorate to Healthwatch England. We have a Government that are out of control, spending tens if not hundreds of millions on redundancies with no clear end destination in view, wasting a huge opportunity.

Steve BarclayMy right hon. Friend is absolutely right: the Government are spending millions of pounds and there is no plan. The measure was announced without working that out, it came as a surprise to many within the system, and it has had a chilling effect on many decisions.

That is not isolated. Just today, we had the complete shambles of local government reorganisation. On the last day before the summer recess, the then Secretary of State rushed to the House to push through an announcement, which the new Secretary of State for Housing, Communities and Local Government is now reversing, while the Chief Secretary to the Treasury is contradicting her by saying that the Government want to have a higher legal appetite for risk and fewer consultations. There is confusion across Departments, and the issues with clause 1, which a number of Members have spoken to, illustrate that.

Given the time limit, I will turn to clause 6. I do not doubt for a minute that the Health Minister and the Secretary of State—anyone in the Department—want to promote innovation. My right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) spoke a lot about capital to revenue switches in his book, and the pressure that takes away from innovation. As Health Secretary, I used to have a wry smile at the battles I had with him, when I was pushed by the Treasury to do exactly the same thing. The issue is not the lack of will; the issue is the alignment between procurement, regulation and clinical leadership, particularly in the colleges, as well as the ability to scale innovation—it is not about having more ministerial pilots.

Finally, because I am almost out of time, I will pick up on the Chair of the Health and Social Care Committee’s good points around data. When I was in the Department, my frustration was that I often had to go on open-source dashboards to get information that should have been available to me as a Minister, and I suspect that that is still the case. We should make data dashboards a common theme—the CSV files that the Department publishes are extremely difficult to access. Make data more transparent; it will help the debate in Parliament and, I dare say, it will help Ministers get more support.

Janet Daby (Lewisham East) (Lab)I thank the Minister for the Bill. I put it on record that I am chair of the all-party parliamentary group on sickle cell and thalassaemia. I rise to speak to new clause 162. It is well known that the NHS commissions specialised services unevenly across England. I am confident that this Government’s ambition is to end the postcode lottery of specialised services, and I would like to hear more about that. New clause 162 is designed to do something simple: to ensure that Parliament can identify where inequalities exist, measure where they are improving and hold the Secretary of State to account when they are not.

I will make the case for the provision through the experience of people who live with sickle cell. Sickle cell disorder is the fastest growing serious genetic condition in England. It causes episodes of serious chronic pain, spasms and a crisis that will continue if left untreated. It can damage organs and frequently requires hospital care. When the crisis strikes, patients have to attend A&E and wait for hours, often only to be seen by medical staff who may have little or no familiarity with their condition. Due to past experiences, many sufferers do not trust the NHS to meet their needs, and stories of sufferers who have died in hospital due to complications, such as Evan Nathan Smith, are well known.

In 2021, the “No One’s Listening” report demonstrated that people with sickle cell need to be listened to. That report prompted NHS England to act. It initiated the sick cell and thalassaemia quality improvement programme, from which came seven pilot emergency department bypass units.

These dedicated facilities allow sickle cell patients to avoid A&E and receive immediate care to bring a crisis under control. The service works, but there is a problem, which brings me to the new clause. When the APPG met last week, we heard from stakeholders that this progress is fragile. There are only seven bypass units across the country, and with the transfer of commissioning responsibilities under the Bill, there is a real and legitimate fear that what has just begun to be built will not be protected to continue.

21:00:00

Ben ColemanI am also a member of the APPG, and I was also at that meeting. On the Health Committee, we raised the point about these short-term pilots, and we managed to get an extra year’s funding. I have to say—I will say this as the person I am—that I feel that if this was a problem that predominantly affected white people instead of black people, it would be taken a lot more seriously. I think that the Government need to reflect on that when they are deciding whether to accept this amendment and whether they wish to give sickle cell sufferers the full support that they need, which they are not getting.

Janet DabyI thank my hon. Friend. He could not have said that more clearly. This is absolutely about inequalities in the health service. He has explained and expressed that extremely well. I know that he, like me, will continue to advocate for people from ethnic minority and diverse backgrounds.

New clause 162 would require the Secretary of State to do two thingsfirst, to lay an annual report before Parliament on the performance of specialised services against national standards; secondly, to ensure the regular publication of data on quality and outcomes of the kind currently captured in the specialised services quality dashboards, which NHS England has maintained on a non-statutory basis. Without legislation, those dashboards could quietly disappear when NHS England does, and that must not happen. The new clause would make their continuation, or the continuation of something equivalent, a legal requirement.

I want to be clear about the modesty of this ask. We are not asking the Government to build new services, ringfence budgets or second-guess local commissioning decisions. We are asking them to measure, publish and report, in order to ensure basic accountability for patients with rare conditions, and for geographically dispersed people, predominantly from black and minority ethnic backgrounds, so that they have services that work.

The patients who rely on specialised services are often marginalised twice overonce by their condition, and again by a system that does not always see them clearly. New clause 162 would require the Secretary of State to identify them, and to report back to this House on what they find. I urge the Government to take this new clause seriously and to respond appropriately.

Steff Aquarone (North Norfolk) (LD)Amendment 19 closes a dangerous gap in the Bill and commands the support of Members from across the House. It is right that clause 4 calls for the Health Secretary to reduce inequality of access to health services, but the Bill must explicitly cover rural and coastal health inequalities, or else less densely populated communities will always lose.

At face value, it makes sense to measure success by the greatest number helped; however, in the long run, that is a false economy, as delayed diagnosis and treatment ultimately cost the NHS more. It is a little bit like access to high-speed broadband—we rolled out the first phase to the places where the most people could be connected, which rewarded the Government and providers with some impressive-sounding numbers while disguising failure in the margins. Rural and coastal communities are literally and politically at the end of the line, and are therefore reached last.

Sarah Dyke (Glastonbury and Somerton) (LD)As my hon. Friend will know, the chief medical officer’s rural health report is due later this year. Rural health cannot be seen as an afterthought. That is why I tabled new clause 120, which would create a farmer-friendly general practice scheme, similar to the veteran-friendly accreditation scheme; it would recognise GPs who proactively reach out to isolated farming communities. Does my hon. Friend agree that the Government must treat the rural health report’s recommendations as a genuine test of action, and not just warm words?

Steff AquaroneI absolutely agree. In order to achieve genuine equality of access, the Government must go outside-in; in other words, they must design provision around the hardest places to serve—my hon. Friend gives a great example—and then work inwards from there.

“If Australia can effectively serve communities living in the remote outback, we can meet the needs of people living in rural and coastal England.”

Those are the words of the right hon. Member for Ilford North (Wes Streeting) when he was Health Secretary. Not only do I agree with him, but I challenge the current Health Secretary to turn her Government’s own words into law. We got it wrong with broadband; we cannot afford to get it wrong with people’s health.

In North Norfolk, I see the struggle for health access and outcomes at first hand. People living on the coast start with half the access that those in inland areas have. Conventional service models assume that people can access healthcare from any direction, but for our coastal communities, half of the area is the sea. The sea may be beautiful, but it does not run a bus service, staff a clinic, or provide a patient catchment. Coastal communities, which may have sparse populations and poor transport, need more local points of care, not fewer. On top of that, the services we do have are burdened by exceptionally long waits. We are not unique in this; some of the poorest healthcare access and outcomes can be found in communities like mine.

We know the challenges for health and wellbeing in these areas from the excellent work of Professor Sir Chris Whitty. He spelled out that we suffer from shorter life expectancy and higher rates of major chronic illness, higher rates of alcohol and drug-related harm, and more cardiovascular and chronic lung conditions. These are very serious problems, and they cannot remain an afterthought in national health policy. National systems must not mistake population density for severity of need.

Besides, when problems are caught earlier and treated faster, it leads to better outcomes. That is one of the reasons why I was so frustrated to be told by the Government before recess that they have “no plans” to provide an urgent treatment centre at Cromer hospital in my constituency, although it would transform access to urgent care across North Norfolk. I am putting the Department on notice today: my constituents and I will continue pressing the case until Ministers reconsider.

Let me tell the House what these inequalities mean in human terms. They mean that constituents like Kelly, who has been waiting more than 70 weeks for a hip replacement, are living every day in pain. Another constituent, Samantha, told me that she waited 30 weeks to see a gynaecologist. The NHS standard is 18 weeks. Appallingly, our wait times made a young woman so unwell that she was forced to sacrifice her education; during the wait, her symptoms worsened to the point that she had to step back from the degree that she was studying for.

I heard from Ian, who has metastatic prostate cancer and requires treatment at the Norfolk and Norwich hospital. It is a half-day trip for him by car to get the essential treatment that he needs. He told me that he considered using a local bus service, but that it would be an hour just to get there. He lives with a damaged bladder, due to his condition, and he told me that it makes life “very unpleasant”. I would go further and say that it is undignified and dehumanising.

Graham StuartThe hon. Gentleman is giving a powerful speech on behalf of rural and coastal areas. One word that he has not used yet is “age”. Age is the clearest proxy for health need that there is. It is not deprivation or anything else—it is age. The distribution of health funding in this country has, under successive Administrations, failed to recognise that and allocate funding accordingly. That is why cancer patients in his constituency and mine find themselves with chronically less spent on them than cancer patients in areas where there are many fewer of them.

Steff AquaroneI could not agree more. That is one of many respects in which rural and coastal communities around the country have much more in common with each other than with their inland neighbours just a few miles away. Theoretically available treatment becomes practically inaccessible if it requires a journey to be made without reliable toilet access, as in Ian’s case, and in cases where access to private transport is more limited, as in the cases that the right hon. Gentleman raises.

Kelly, Samantha, Ian and so many more are entitled to the same access to good treatment and the same chance of good health as people living in urban and inland communities. It is absolutely right for the Government to pursue this Bill, and I support their aim wholeheartedly, but I challenge them to assess the Bill based on who is left behind, not just who can be helped. Accept this amendment, or explain why rural and coastal communities do not merit explicit protection.

Dr Simon Opher (Stroud) (Lab)My remarks will focus mainly on new clause 69, which is in my name. Getting rid of NHS England is one of the best things that this Government have done. As working clinicians, we can at least now get away from so much admin and management.

My amendment is a simple one about self-care and health literacy. Demand for healthcare has increased enormously. Since 2019, for example, GP consultations in Stroud have gone up 30%. When I started work as a GP, patients saw me on average three times a year; it is now about eight times a year. Indeed, A&E attendance has gone up 20% over the last decade, yet the health of the nation remains the same. This is the demand side of the NHS that we very rarely discuss, and this is what I am asking the Secretary of State to address.

Let me turn to the causes of this increase in demand. There is a concept in medicine called the symptom iceberg. Most of us get symptoms every day, but we do not go to the doctor. We only go to the doctor when we have certain symptoms, and it is a very small number of symptoms, but that has increased over the last 20 years. Then there is the role of something that we call lay referrals; people used to have mums who lived next door, but now they are often much further away. We are socially isolated in an atomised society. We also have a much higher expectation for our health. We cannot fault that, but it means that, for example, people go to the doctor with very minor things. There are also factors such as AI. In my surgery, we use AI, but I believe that creates its own demands. There is also good old Dr Google, who in this country is consulted over 50 million times every year—and those who go to Dr Google usually end up thinking that they have cancer or need an ambulance, so that is clearly driving demand.

There are also doctor factors. If we carry on treating sore throats with antibiotics, people will carry on coming back. Earaches generally get better, and people do not usually need to see a doctor for headaches. We are over-diagnosing and over-medicalising everything. NHS factors includes the algorithms for 111 and litigation. I would also like to talk about health literacy. That means knowing about our health, and understanding that we are not always in totally good health, but we do not have to consult the health service just because we are feeling a little bit low or a little bit tired.

One of my colleagues in Stroud, Dr Hugh van’t Hoff, started Facts4Life, a school-based education service that goes into schools. In the last 10 years, he has worked with over 200 primary schools. He has shown that if we teach young children about health and how it is normal sometimes to feel tired or have a sore throat—stuff like that—we can reduce consultations in the NHS. We can also teach children how to understand information on the internet, so that when they look at statistics, they know what they mean, instead of thinking, “Ooh, my risk of cancer has been doubled by doing this.” That is really important.

We are also over-medicalising patients. In this country, 9 million patients in England alone—one in five adults—are on antidepressants. That is a scandal.

Martin WrigleyOn interpreting statistics, does the hon. Gentleman agree that when it comes to data, GP confidentiality—in respect of the Palantir federated data platform, for example—is critical, certainly when we come to the single patient record, and that the Bill should not reduce confidentiality or data privacy to achieve the single patient record?

Dr OpherI thank the hon. Member for that comment. He is right. NHS and GP data is a massive resource for our scientists in this country, and I agree with him that it should be owned by the UK. It should be a sovereign wealth issue. I would like to ensure that we realise that over time.

I will return to over-medicalisation. I would like to try to divert patients with mild to moderate mental health symptoms to social prescribing, such as access to nature, arts and culture and exercise—and indeed comedy. Let us try to reduce that figure of 9 million on antidepressants, so that people do not have to come back for review. There would be fewer harms, such as suicide, in the first couple of weeks. Let us also look again at neurodivergence, and try to look for a way of not medicalising so many children with the condition.

If we are serious about reducing waiting lists and making the NHS sustainable for the future, we cannot focus only on supply; we must address rising demand, too. Giving people the knowledge and confidence to look after their own health will empower them, free up clinicians to care for those who need them most, and ultimately build a healthier population. That is what new clause 69 seeks to achieve. I urge the Government to accept it.

Edward Morello (West Dorset) (LD)Only half the children in my constituency have seen a dentist in two years. There has been a 20% decrease in NHS dental practices, and some constituents have written to me recently to say that they have been quoted in excess of £7,000 for the most basic of treatments. Amendment 47 would require the Government to establish training hubs in Dorset. It would ensure that dental hubs trained dentists for the future, and would mandate final-year trainees to provide supervised treatment to NHS patients straightaway. Trainees are already providing treatment for free, paid for by the taxpayer, as part of their training. Those appointments should be for the NHS, and not for private patients.

Amendment 48 would ensure that the dental funding underspend is redirected towards additional NHS appointments, shorter waiting times, outreach, and home and school-based services. Amendment 49 would require the dental funding formula to account for rurality, an ageing population, disability, transport costs and recruitment difficulties.

21:15:00

We should also do more to support GPs. Amendment 51, on rural and coastal GP funding, would recognise the additional recruitment and travel costs faced by practices serving dispersed populations with worse economies of scale. Amendment 52, on primary care estate investment, would establish a dedicated capital investment programme for practices whose premises are outdated, unsafe or restricting the delivery of care. Amendment 54 would expand electronic prescribing and mandate greater interoperable records, which would reduce paperwork, avoid delays and give clinicians the information they need when they need it.

The collapse of Jhoots Pharmacy showed us the limits of the current regulatory framework, which was largely designed around independent pharmacies, not large companies controlling extensive pharmacy networks. During my urgent question on Jhoots, there was cross-party support for legislative action, which has not come from the Government. Amendment 55 would give the Secretary of State powers to require an ICB to intervene where there is a serious risk to patient safety or medicine supply—something we did not have to tackle the Jhoots crisis. Amendment 56 would give the ICBs their own stronger powers to require remedial action, suspend arrangements or secure an alternative provider, acting immediately where patient safety is at risk. These are exactly the powers that the Minister told me they needed a year ago in order to act, but the Government have not accepted these amendments.

New clause 74 would ensure that employees were not forgotten when a provider failed. It would protect wages and essential employment rights and help staff transfer to a replacement provider where possible. Amendment 58 would require the Government and ICBs to support new independent pharmacies to open after a large-scale closure and help them secure medicines and supplies quickly. Amendment 59 would mean that funding allocations would reflect rurality, population age, travel costs, recruitment difficulties, economies of scale and unmet need.

All these proposals are designed to improve the Bill, but they will all be rejected and that is a shame. In West Dorset we need a joined-up NHS, accessible NHS dentistry, sustainable GP practices, resilient pharmacies, modern infrastructure and funding systems that recognise the realities of rural Britain and coastal healthcare. I hope the Government will listen.

Ian Byrne (Liverpool West Derby) (Lab)I rise to speak to my new clause 108, because the public rightly expect any company entrusted to operate within our national health service to meet basic standards of ethical conduct, both inside and outside the NHS. In my experience as parliamentary lead on the Hillsborough law, I regularly met members of the public who were shocked that a duty of candour that would compel public officials to tell the truth to the people they served did not already exist. I believe that many of my constituents will be equally shocked that the basic principles of ethical accountability are not already enshrined in Government procurement policy, but they are not.

New clause 108 is not radical. It is a straightforward safeguard requiring the Secretary of State to review the NHS procurement framework and ensure that companies with proven involvement in violations of international law or breaches of internationally accepted standards of business conduct cannot be offered public contracts. Those standards include the UN guiding principles on business and human rights and the OECD guidelines on multinational enterprises. What exactly is there to disagree with? They ask the bare minimum of businesses: that do not contribute to harm, that they carry out proper human rights due diligence and that are transparent about how they handle the data of the people they serve. Yet we currently have a company operating at the heart of our NHS infrastructure, through the federated data platform, that fails to meet that basic standard. I am talking about the US tech firm Palantir.

Palantir has consistently refused to publish a formal human rights impact assessment for its software used in Israel’s assault on Gaza, in violent ICE detentions in America, and in its use of NHS staff and patient data. Such a lack of transparency is not a technicality but a serious failure to meet the standards in the UN and OECD guidelines. I first raised concerns about Palantir’s NHS contract in a letter to the then health Secretary in August 2023, and these concerns have been echoed by many, many others. I am pleased that Parliament has started to push back, with calls from numerous Committees for Palantir to be dropped.

I also fully support new clause 34, tabled by the hon. Member for Newton Abbot (Martin Wrigley). Patients trust the NHS with the most sensitive information they possess.

Martin WrigleyDoes the hon. Member agree that it is a fundamental principle of anything like the SPR that it must have privacy by design at the centre of it, and that therefore a firm such as Palantir—which has a US, slightly cavalier and somewhat casual attitude to how data privacy should be controlled—should not be allowed anywhere near it?

Ian ByrneI fully agree; I have signed the hon. Gentleman’s amendments and we have been in many Committees speaking on this issue.

New clause 108 provides a proportionate and evidence-based mechanism to address this issue. The new clause does not name or target any individual company. It would establish a clear and principled test, rooted in international law and internationally accepted standards, that every contractor must meet. If a company such as Palantir cannot meet that test, it should never hold contracts in our NHS or with Government Departments. I have repeatedly urged the Government to trigger the 2027 break clause in Palantir’s contract to operate the federated data platform. I make that call again tonight.

It is only through a measure such as new clause 108 that we can ensure that companies such as Palantir cannot operate in our public services again. It should be accepted, but the principle behind it should not end with the NHS. It should apply across every Government Department, led by the Cabinet Office. The Cabinet Office’s report on social value and procurement, published last month, was welcome, but it contained a glaring omission: a clear ethical foundation. My clause would provide that crucial and much-needed safeguard, ensuring a legislative framework that prevents companies with records like Palantir’s from securing public contracts in the future.

Last week, I visited the Vatican and spoke with officials about how the United Kingdom could lead the world in the ethical use of artificial intelligence and advanced technologies. Tonight, my Government have a real opportunity to put a marker down and demonstrate that Britain intends to be at the forefront of that global movement. I look forward to helping them achieve that if they adopt my new clause. Let us make it clear that scrutiny, transparency and respect for human rights are not optional extras in public procurement, but conditions of entry for any company seeking to serve NHS workers and patients. That is what new clause 108 calls for, and that is the change that will be welcomed in Liverpool West Derby, across our country and, indeed, in the halls of the Vatican. I look forward to the Government’s response.

David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)I rise to speak in favour of new clauses 133 and 134, which stand in my name. The new clauses would require the Secretary of State to work with Welsh Ministers to update the England and Wales cross-border healthcare statement of values and principles, and to bring forward proposals to place those principles on a formal legal footing.

For many people living along the border, cross-border healthcare is simply a fact of life. In Powys, at least 40% of people depend on hospitals across the border in England. Yet the framework governing how our two healthcare systems work together is based on a voluntary statement of values and principles dating back to 2018. We do not need to look far to see why the current arrangements need reform. Since last July, Powys teaching health board has been asking English hospitals treating Powys residents to treat them more slowly than patients from England as part of cost-cutting measures, despite the fact that they had always previously been treated as equals. The impact of that decision has been devastating. Many patients have had their waiting times increased to up to two years—forced to wait longer in pain, all while their conditions deteriorate.

It is not just me and the Liberal Democrats who have been sounding the alarm; providers on the English side of the border have resisted the arrangements because of concerns about the impact on patients. However, there seems to be little will to resolve the issue from either the Welsh Government or the health boards responsible. Meanwhile, patients are falling through the cracks. My constituents should not have to navigate the administrative boundaries between the NHS in England and NHS Wales simply to get the arrangements and treatment they need. Eight years after the statement of values and principles was introduced, the limitations of relying on a voluntary statement with no formal legal footing are clear.

New clause 134 would require the Secretary of State to work with Welsh Ministers to update that statement, reflecting the problems that cross-border patients face today. Crucially, it would also require the Government to bring forward proposals within two years to place those principles on a statutory footing. The border should never be a barrier to receiving healthcare. It is time to update and strengthen these principles and give cross-border patients the statutory protections they deserve, because I fear that cross-border healthcare will continue to deteriorate over the next couple of years.

Over the summer recess, I held a series of public meetings in response to plans by Powys teaching health board to cut the number of community beds, which will just mean that more people end up stuck in community beds on the English side of the border.

Dr Allison Gardner (Stoke-on-Trent South) (Lab)This Government aim to shift the focus from treatment to prevention, and it is in that spirit that I have tabled new clauses 90 and 91, which would strengthen the frameworks around health inequalities and address the wider determinants of health.

New data from Health Equals reveals a shocking realitythere is a gap of up to 18 years in life expectancy between different parts of the UK, and indeed between nearby neighbourhoods. Health Equal shows that in my constituency just a golf course separates two areas with an average life expectancy gap of eight years and 11 months. Reaching old age is somewhat of an aspiration in my more deprived areas. Indeed, in the most deprived communities people spend an average of just 52 years in good health. The stark inequalities are driven not only by healthcare, but by the wider determinants of health, including poverty, housing, education, employment and the environment.

Within Stoke-on-Trent, healthy life expectancy at birth has fallen by 6.6% for men in the last decade. For women, the picture is even worse, with a 9.6% fall in healthy life expectancy to just 53.5 years over the past 10 years. This Bill represents a real opportunity to enshrine in law a statutory duty for the Secretary of State to go beyond reducing inequalities in NHS access and outcomes, and to reflect wider cross-Government goals for health improvement.

Our health is shaped by the world around us—the food we eat, the money in our pockets, the air we breathe and the home we live in. In other words, every part of Government has an opportunity to influence people’s health. The purpose of new clause 90 is to ensure that the Government take greater responsibility for improving the nation’s health. That includes mitigating any increase in health inequalities, such as those seen in my constituency. The new clause would make improving health a duty, placing prevention on the same footing as treatment.

But a stronger duty alone is not enough. That is why new clause 91 would require the Government to publish a new health improvement and inequality strategy within six months. The strategy would include long-term targets for adults and children, public reporting on progress, a duty on Ministers across Government to have regard to the strategy, and independent accountability arrangements. The Minister, who has worked very hard on the Bill—I commend her for her engagement—has alluded to the fact that pre-existing guidance and processes are in place, and these are designed to tackle health inequalities, and she is right. However, I argue that they are clearly not working, because health inequality has increased. I ask again what the harm would be of embedding this duty in the Bill to tackle the most fundamental issue in health across England: health inequalities.

These amendments have cross-party support, and I note that they are also supported by the Health and Social Care Committee. I thank Health Equals for its work on these amendments. Again, I thank the Minister for her engagement and urge the Government to consider accepting these new clauses.

I will briefly mention new clause 109, which also stands in my name. It was written by myself and Haris Shuaib, with whom I worked on the standard BS 30440 and a validation framework for the use of AI within healthcare. I previously worked with the AI and digital regulations service for NHS England, working with NICE, the MHRA, the CQC and the Health Research Authority. In the interests of time, I will say that in that duty I identified a number of accountability and regulatory gaps that certainly need further addressing. I ask that the Minister responsible for health tech meets me so that we can discuss these further. They partner quite well with new clause 108, which I had not spotted, so I apologise for not signing the amendment of my hon. Friend the Member for Liverpool West Derby (Ian Byrne).

Charlotte Cane (Ely and East Cambridgeshire) (LD)In my constituency, only 40% of adults have seen a dentist in the past two years, and only 54% of children have seen one in the last year. The impact of that is that 12.5% of children in East Cambridgeshire have tooth decay by the age of five. We are in a dental desert, and it is incredibly difficult to get an NHS dentist appointment. When I talk to the dentists, the most frustrating thing is that it is the contract that prevents them from treating people, not their intentions.

The contract is based on units of treatment. For example, dentists tell me that if they do one filling, they just about cover their cost for the unit they get paid for. That unit covers up to three fillings, however, and at three fillings they are making a loss. Even more frustrating is that they get allocated units at the beginning of the year. Once they have used them all, they can get no more; yet they are aware that other local dentists have not used all their units by the end of the year, and they hand them back. Why is there no mechanism whereby those units can be given to dentists who have the capacity to do more work, so that more people can be treated? It is really frustrating to know that my constituents are struggling without a dentist, and that there are dentists in my constituency who are willing to treat them but cannot get funding to do that from the NHS. It is utterly shocking. That is why I support new clause 18 and other amendments that seek to make dentistry more available to people.

21:30:00

I also want to pick up on what Members have said about the NHS in rural areas. It is really important to understand the size of rural areas and the lack of public transport. A few years ago, my constituents in one village nearly lost their GP surgery. The ICB was not particularly worried because apparently people could get to other GPs in the general area. Well, they could not, because there was no public transport. My constituents kicked up enough of a stink that, fortunately, the ICB changed its view and has ensured that they do indeed have a local surgery. We have to understand that it is a much bigger area; it is not like in a town or city where people probably can get a bus to another GP. If someone cannot get to their GP in a rural area, they have a real problem, because their GP cannot get to them either.

A lot of constituents have contacted me about Palantir—both patients and GPs, who are very worried about how the contract works and how Palantir operates. Medical data is hugely sensitive. People have to be confident that it is being managed by a company that they can trust. Palantir does not meet those criteria. It is an incredibly expensive contract, as we have heard, and it does not deliver the value for money that we need. More importantly, people do not trust it, and we are talking about their medical records, so the contract has to be with a company they trust.

Martin WrigleyDoes my hon. Friend agree that that element of trust is even more important when we get the single patient record, and critical to enabling GPs and medical professionals everywhere to use it, and patients to trust it?

Charlotte CaneI absolutely agree. The single patient record is so important to make the NHS work efficiently and effectively, and to help it treat patients better. To achieve that, patients have to trust that the data is being well protected, and I am afraid that a lot of the people I talk to, including GPs—who are obviously critical in convincing patients that Palantir is safe—do not trust it. We have to pull out of the contract with Palantir. Will the Minister please consider that, please consider the issues faced by rural areas, and please, please, please get us some NHS dentists in Ely and East Cambridgeshire?

Apsana Begum (Poplar and Limehouse) (Lab)I rise to speak to new clause 108, tabled by my hon. Friend the Member for Liverpool West Derby (Ian Byrne), and new clause 34, tabled by the hon. Member for Newton Abbot (Martin Wrigley).

Countless numbers of constituents have contacted me about Palantir Technologies, telling me their concerns about the company’s involvement with Israel’s military and Trump’s ICE. Over 35 Members from across the House have signed my early-day motion calling on the Government to activate the break clause in the NHS federated data platform contract. The objection is not just about Palantir’s ethics, but about its operations under that contract. I share the concerns of many, including the National Data Guardian, about whether data identifiable to individual patients may be accessible by Palantir.

The potential success of the proposals on the single patient record and whether it manages to gain the confidence of the British public depends on the Government listening to these concerns, and making sure that issues around data access and limits, patient opt-outs and the data controller are resolved. I note that the hon. Member for Newton Abbot has tabled a number of other amendments related to data safety, which I support.

I also wish to speak in support of amendment 10, in the name of the hon. Member for North Shropshire (Helen Morgan), on ICB financing. I am deeply concerned by the introduction of a duty under clause 48 for each of the constituent bodies of the ICB to achieve financial balance. In east London, we are currently fighting against massive, eight-figure cuts to the East London NHS foundation trust, where workers have been on strike amid cuts to jobs in much-needed mental health services, all of which are being justified by reference to new requirements for financial balance across the trust. Under the provisions of clause 48, matters will be made much worse and the ability to shift and adapt capacity across the system will be rendered impossible. One of the reasons that this is so regrettable, particularly in an area like east London, where the need for mental health services is acute and rising, is that cuts to these services will simply lead to greater costs arising elsewhere. For that reason, I also support amendment 10, tabled by the hon. Member for North Shropshire, to place ICB spending on mental health services on a statutory footing.

I also support amendment 45, tabled by my hon. Friend the Member for York Central (Rachael Maskell), because I am concerned, as others are, about provisions in the Bill for the reorganisation of ICBs. The changes are among many aspects of this Bill that regrettably point towards a revival of marketisation policies from prior decades—policies that have now been largely discredited. To tackle the biggest health challenges that we face, we require partnership working, joined-up decision making between the NHS, local authorities and expert voices—a dialogue between providers and commissioners. Removing the potential for this type of dialogue appears to be a significant misstep, particularly for integrated care.

Turning ICBs into purchasers alone appears to be being done for the benefit of reinforcing a purchaser-provider split—a split that experts have said time and again does not work, and does not deliver improved performance and outcomes, or even value for money. While I am relieved that the Government are tabling their own amendment 60 to reverse the scrapping of local authority ICB membership, I remain in full support of amendment 45 in order to ensure that NHS trusts, and foundation trusts too, retain their voice in commissioning and public health decisions.

To conclude, the fundamental problem in the Bill lies in its adherence to a logic of marketisation. It is deeply regrettable that the Government are returning to the harmful public-private partnership model for capital investment and a rehashing of the private finance initiative disaster, the negative effects of which are still being felt across my east London constituency.

Shockat Adam (Leicester South) (Ind)I refer the House to my entry in the Register of Members’ Financial Interests. I am a practicing optometrist and an officer for the APPG for eye health and visual impairment.

Sight is precious and none of us would like to lose it—but, sadly, 2 million people in this country are living with some form of sight loss today. On the Department’s own projection, that figure will rise to 2.7 million by 2030. Every day, 250 people in the UK start to lose their sight—one person every six minutes. Left unaddressed, that number is set to more than double to over 4 million by 2050. We are witnessing a growing problem, which, sadly, the Bill does not treat with the urgency it deserves.

Tonight, I urge the Government to strengthen this legislation in some specific ways. On governance, clause 21 rightly ensures that ICBs reflect local political accountability, but it says absolutely nothing about clinical accountability. Optometrists have no guaranteed voice in the rooms where commissioning decisions affecting their patients are made. It would be unthinkable to build localised healthcare without GPs at the table. It would be equally unthinkable to do so without pharmacists. I say to the Government plainly: optometrists have the expertise, the infrastructure and the systems already in place to relieve pressure on our hospitals, yet this Bill says nothing about it.

I want to see eyecare—glaucoma monitoring in particular, along with the management of minor eye conditions—commissioned consistently by every ICB in England and not left to a postcode lottery. Optometry already has what I call the TAC effect: it is trusted, accessible and capable. Commissioning it properly would reduce unnecessary demand on emergency departments, freeing them to focus on genuinely specialist cases while improving patients’ access to specialist eyecare where they need it.

A recent report by the Association of Optometrists has found that right now, 780,000 people—the equivalent of the entire population of Greater Nottingham—attend A&E with eye problems annually, at an average cost of £145 to the NHS per A&E presentation. That is £113 million a year. At least seven out of 10 of those people with eye problems could be successfully managed in a community optometry setting with the right service commissioning. Those stats reflect a lived reality for many across our country. If the new Government want to make smarter decisions with public money, they must consider that.

Finally, I turn to the single patient record. Proposed new subsection (7) to clause 51 should be amended so that it explicitly includes optometry in the single patient record framework, ensuring that optometrists have appropriate access to relevant patient information.

This Bill takes real and welcome steps in many areas, but more than 2 million people have already lost their sight—a number that none of us wants to see double to more than 4 million by 2050. Fundamentally, seeing should be a right, not a privilege, so I ask the Government to look again.

Andy McDonald (Middlesbrough and Thornaby East) (Lab)I rise as the chair of the all-party parliamentary group on spinal cord injury to speak to amendments 103 and 104, new clause 160 and amendment 105 in my name. I thank the Minister for meeting me during the passage of the Bill and for her subsequent letter. I also thank the Spinal Injuries Association for its support for the APPG and, crucially, for people living with spinal cord injury. These amendments are not about preventing reform; they are about ensuring that when responsibility for highly specialised services changes, patients continue to receive safe, equitable and nationally consistent care.

Spinal cord injury is a relatively low volume but complex lifelong condition requiring specialist expertise, rehabilitation and long-term follow-up. National commissioning exists to prevent fragmented services and postcode variation. If commissioning moves to integrated care boards, we need confidence that specialist workforce capacity, national standards and the sustainability of specialist centres will be protected. I therefore ask the Minister to clarify how those safeguards will work in practice, particularly around workforce, rehabilitation and geographical variation. I also seek clarity on whether spinal cord injury services will transfer to ICBs and what criteria will determine that decision.

Amendment 104 and new clause 160 would provide national assurance and parliamentary accountability for outcomes, access, workforce and geographical variation. Amendment 105 addresses the single patient record. Specialist charities provide vital practical and peer support after life-changing injury, even where they are not part of the clinical care. That is why this appeal is so resonant. If we can engage with those providers at that early stage, the outcomes will undoubtedly be improved. The amendment would allow referral, with patient consent, to approved condition-specific organisations sharing only necessary information.

I will not press these amendments to a vote today. I hope that the Minister will consider further safeguards and clarification during the Lords stages of the Bill. The care and access to support for patients dependent on specialist services should not depend on where those patients live.

Karin SmythI thank Members across the House for their contributions. As we would expect for a Bill of this size, it has been a wide-ranging debate, and I will not be able to address every single amendment, but I will try to cover them all in the time I have. If necessary, I will get back to people afterwards. As a Government, we know that what we have set out to do through this Bill is ambitious. We do not resile from that; we want to be ambitious. We are determined to make a real and positive change for people up and down the country who use the NHS, and throughout the Bill, we have remained focused on the key objectives. Those are to strengthen democratic accountability, strip back bureaucracy and empower patients.

21:45:00

On integration, this Bill and our wider programme of reform support the further integration of health and care and beyond. I know that this is a matter of considerable interest to Members across the House, including my hon. Friend the Member for Shipley (Anna Dixon), who I have met with, and my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales). I can assure them and all Members that we are committed to supporting joint working between local authorities and the NHS, and that this Bill upholds the existing duties on NHS bodies and local authorities to co-operate. The task on the ground is making it happen, not creating additional legislative requirements. However, as I told my hon. Friend the Member for Shipley, we are very happy to continue working and using her expertise to help make that happen.

Turning to SEND and new clause 85, I pay tribute to the work of my hon. Friend the Member for Thurrock (Jen Craft). I agree with her that we need a much more joined-up approach across education and health, which is one of the reasons why the new Secretary of State for Health and Social Care has made clear to the Department and the NHS that we must give greater priority to maternity and child health. As we have heard, if children have to wait a long time for the treatment or support they need, the problems can last a lifetime. As such, I can tell my hon. Friend that we will strengthen the SEND expectations on ICBs in the new NHS planning framework, including joint commissioning, implementing local SEND reform plans, and the new experts at hand offer.

We are also determined to strengthen accountability, which is another issue that has been raised in the Chamber today. The Department of Health and Social Care will join NHS England and the Department for Education in reviewing this summer’s local SEND reform plans to ensure proper ICB engagement, and the Bill gives the Secretary of State the power to intervene to ensure ICBs are upholding their duties. The framework of requirements on the NHS to provide care across local populations works very differently from the duties on local authorities to support individuals, so this kind of amendment would not be workable for the NHS. However, we share its sentiment, and we want to work with my hon. Friend the Member for Thurrock to ensure ICBs are accountable for their SEND responsibilities.

Karin SmythI am going to move on, because there is a lot to get through.

My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) made a powerful speech, based on his own experience and the terrible experiences of his constituents. I will write to him about what we want to do with ICBs to make that situation better.

I now turn to new clause 56, tabled by the hon. Member for Mid Sussex (Alison Bennett). I also thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for her ongoing work on, and interest in, carers throughout the passage of this Bill. I can assure the House that the Government fully recognise the importance of supporting carers’ health and wellbeing, including ensuring that they can take breaks from their caring responsibilities where needed. The Care Act 2014 already includes duties to assess and address carers’ current and future needs, and of course, we want to ensure that carers get the full benefit of the single patient record. To achieve this, we intend to use our regulation powers, which are already in the Bill.

The topic of inequalities has been highlighted a lot today. We are committed to ensuring that local areas are empowered to make decisions, tackle the specific health challenges they face and make real progress on health inequalities. I want to reassure the House that reducing health inequalities remains a priority for this Government. I know that the Chair of the Health and Social Care Select Committee, and the Committee as a whole, takes a great interest in this issue, and we are committed to working with them. I thank my hon. Friends the Members for Stoke-on-Trent South (Dr Gardner) and for Uxbridge and South Ruislip for their championing of this important issue and for our meeting last week.

I am not, however, convinced about new clause 91. Our focus is, and must remain, on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. We already have a wide range of duties from the 2006 Act, and we have a new duty on combined authorities. There was a duty on ICBs in the Health and Care Act 2022, and there is a duty on foundation trusts. We have the public sector equality duty, as well as our commitment in the 10-year health plan. Again, the issue is making it work and empowering local leaders to do just that.

I commend the work of my hon. Friend the Member for Lewisham East (Janet Daby) on the APPG on sickle cell and thalassaemia, and I will write to her specifically on the issues she raised. She talked about specialised commissioning, a topic that was also raised by my hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald). We know that this is an ongoing concern across many areas, and I commit to keeping in touch with them and with other Members.

Turning to women’s health—including mental health—and maternity services, again, I can assure the House that this is a priority for the Secretary of State. That is why we published the action-focused renewed women’s health strategy. It is why we are undertaking a single national action plan on maternal health, overseen by the national maternity and neonatal taskforce, to drive improvements where it matters to families, clinicians and other experts. I know that many Members of this House are committed to improving mental health, but I take this opportunity to thank my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for all her work in this area as the national maternity adviser.

Opposition Members mentioned the Hughes report, and I assure the House that the Government recognise the importance of providing a response. I do not have time to go into all the ongoing work at the moment, but I commit to doing so at the earliest opportunity. [Interruption.] The Conservatives had a long time. The hon. Member for Sleaford and North Hykeham (Dr Johnson) says that they were about to do it before the election, but that is not what we found when we came into power. The Conservatives left us a lot of work to do in this and many other areas, but we are committed to doing it.

Fertility services and reducing inequalities in maternity services has been raised by my hon. Friend the Member for Stockport (Navendu Mishra) and the right hon. Member for Stone, Great Wyrley and Penkridge (Sir Gavin Williamson), who has been a tireless advocate in this area, as have many others. I have recently written to him. NICE guidelines inform how ICBs should commission in this area, but I know that things are not uniformly implemented. We will continue to work with ICBs to evaluate the next steps.

There was a lot of discussion on primary care, and dental access across the country in particular. We are committed to rebuilding dentistry in England, but actions speak louder than words. We are making great strides in improving access, ensuring an urgent care safety net across the country, reforming the dental contract and developing a 10-year workforce plan. More broadly, we think it is right that under this Bill, primary medical services become the responsibility of ICBs. They have the right knowledge of their areas to make commissioning decisions, and that includes on eye care. They have responsibility for all primary medical services, but rightly they will be accountable to the Secretary of State for their performance.

The right hon. Member for Godalming and Ash (Sir Jeremy Hunt) is right that we will say that he could have dealt with the issues he raises while he was in power, but we do not always say that, and he is absolutely right about continuity of care. I have also visited the practice he talks about in Horfield in Bristol, and not just because I was on the primary care trust board when the 2004 changes happened. Broadly, Bristol does have different standards on some of these issues, and that highlights our point. We do not need to put some of these provisions in legislation. Exactly this sort of good practice can be shared in local systems through neighbourhood care plans, neighbourhood work and the work in primary care networks.

The single patient record is fundamental to the Government’s mission to create a modern, joined-up NHS that puts patients at the centre of their care. On amendments 26, 42 and 43, I assure Members that the overarching purpose of making regulations to create and operate the single patient record is limited to the direct care of patients, and clause 51 is already explicit about that. Crucially, the clause does not create any new data sharing gateways for secondary purposes such as planning and commissioning, so these amendments are not necessary. On data safeguards, the security and privacy of people’s health and social care data are paramount. As Members would expect, we will build the strongest safeguards into the record. On new clause 32, I can assure Members that the SPR will be designed to protect personal data by default, with the highest standards of cyber-security and information governance ensuring that only the right people can access the right information at the right time and only for the right reasons.

Finally, I have heard how important it is that the single patient record is accessible and inclusive. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for amendment 87 and the important work she is doing to publicise this hugely important area. I assure her and Members that we are confident that the Bill is drafted to enable information related to support needs and reasonable accommodations to be included in the SPR. The Department will have regard to the accessible information standard as the SPR is developed.

We are also committed to tackling digital exclusion. We have considered that as part of the single patient record equality impact assessment, and work is already under way to help address barriers around connectivity, skills and confidence. I heard what my hon. Friend the Member for Middlesbrough and Thornaby East said about the need to engage him and others about the single patient record as we go forward.

On the federated data platform, decisions about public contracts must be made through fair, open and non-discriminatory processes. That is governed by UK procurement law, which recognises certain international treaty obligations. NHS England is reviewing the federated data platform contract to determine whether it should continue with standard contract management processes. It will look at evidence of delivery and the impact of the platform, and that should be the basis on which a contract continuation is decided.

Martin WrigleyWill the Minister give way?

Karin SmythI will not. We have heard a lot from the hon. Gentleman, and I want to make some clear points to the House this evening.

We have heard a great deal of discussion about commercial processes, and Members—including the hon. Member for Newton Abbot (Martin Wrigley)—have raised important points about data security, governance and ethical standards of contracts, and support for domestic suppliers and for voluntary, community and social enterprise organisations. Contracts involving NHS data and digital services must be subject to proper scrutiny. The Government’s approach is to assess risks on the basis of the nature of the data, service and supplier access. Crucially, we already have the tools that we need to carry out appropriate due diligence through legal powers and robust contractual provisions.

I agree with the spirit of new clause 108, tabled by my hon. Friend the Member for Liverpool West Derby (Ian Byrne). I fully recognise the importance of ensuring that the NHS does not inadvertently support exploitation or rights abuses. UK legislation already incorporates some international laws: for example, the Human Rights Act 1998 incorporates the European convention on human rights into UK law. Similarly, we can use existing legislation and guidance to exclude suppliers from NHS procurements. Both the Procurement Act 2023 and the provider selection regime allow us to exclude providers when there has been serious misconduct or illegality. For instance, we could exclude a supplier under the Procurement Act for breaches of modern slavery and/or human trafficking laws. We have very high standards and expect all suppliers—including whichever companies go on to provide the single patient record—to meet them.

On a related note, the Chancellor has already written to the Secretary of State to ask that the NHS procurement better support British industry. In the light of that, the Secretary of State has commissioned, within the health family, a review of strategic procurement pipelines to find opportunities for the new social value model to support more British jobs, skills and innovation. The First Secretary of State, my right hon. Friend the Member for Sheffield Heeley (Louise Haigh), who is leading work on procurement across Government, would be happy to meet my hon. Friend the Member for Liverpool West Derby as part of this important work as it progresses, and I can assure him that the actions that we take will be fully in line with the principle of international law.

Steve BarclayWill the Minister give way?

Karin SmythI thank my hon. Friend the Member for Stroud (Dr Opher)—with his example of the sore throat—for his help in driving down demand for healthcare. Indeed, I thank Members in all parts of the House for their contributions to what has been an interesting and helpful discussion. Their expertise and their scrutiny will continue to strengthen the Bill.

Steve BarclayWill the Minister give way?

Rachael Maskell (York Central) (Lab/Co-op)Will my hon. Friend give way?

Karin SmythI will give way to my hon. Friend. [Interruption.]

Rachael MaskellI have listened carefully to the debate. May I refer to my new clause 57? The challenge of the NHS is that so much significant, unaccountable power is being held that we, as Members of Parliament, cannot even deliver for our constituents. Will my hon. Friend look at her my new clause, and work with me to ensure that we get the Bill in the right place with regard to accountability before it goes to the Lords?

Karin SmythAs my hon. Friend knows, I spoke from the Opposition Benches for many years about the lack of accountability of our local systems to local members of Parliament. I think that that was a great loss in the Lansley Bill. It was one of the things that drove me to become a member of Parliament, and in my role as the Minister of State I have endeavoured to make sure that local Members of Parliament have—

Steve BarclayWill the Minister give way?

Karin SmythI will not. The right hon. Member was Secretary of State for Health twice, so he had his chance to put all the right things into legislation. [Interruption.] I am not helping my own sore throat.

As my hon. Friend mentioned, the Bill is about returning that democratic accountability directly to the Secretary of State. We have had a lot of pushback in different places, but that is what this Bill does. It returns accountability to the Secretary of State, it devolves that responsibility for delivering on the ground to NHS organisations, and, crucially, it empowers patients. Our new clause strengthens the Bill, and I commend it to the House.

Question put and agreed to.

New clause 96 accordingly read a Second time, and added to the Bill.

New Clause 97

Care and supportinvolvement of others and visitors

“In section 1 of the Care Act 2014 (promoting individual well-being), in subsection (3)—

(a) after paragraph (e) insert—

“(ea) the importance of the individual being able to involve other people in such decisions and of those people receiving the information and support necessary to facilitate that involvement;”;

(b) after paragraph (f) insert—

“(fa) the importance of the individual having appropriate opportunities to receive visitors;

(fb) in the case of a person who is provided with accommodation in a care home, the importance of them having appropriate opportunities to take trips outside of the care home;”.”—(Karin Smyth.)

Section 1(3) of the Care Act 2014 lists matters to which local authorities must have regard when exercising functions under Part 1 of that Act. The amendments refer to the importance of an individual being able to involve other people in decisions and to receive visitors etc.

Brought up, read the First and Second time, and added to the Bill.

22:00:00

Proceedings interrupted (Programme Order, this day).

The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

New Clause 6

Maternity Safety

“(1) The Secretary of State must ensure that every NHS maternity unit is rated “good” or

“outstanding” by the CQC.

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

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

(b) one-to-one midwifery care,

(d) ringfenced maternity service development funding, and

(e) a dedicated neonatal workforce plan.

This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.

Brought up.

Question put, That the clause be added to the Bill.

66|22:00|77|317| The House divided: | Question accordingly negatived. ||0|0

New Clause 145

Response to the Hughes Reportoptions for redress for those harmed by valproate and pelvic mesh

“The Secretary of State must, within 30 days of the day on which this Act is passed, publish the Government’s response to the Hughes Report.”—(Dr Johnson.)

This new clause would require the Secretary of State to publish the Government’s response to the Hughes Report within 30 days of this Act being passed.

Brought up.

Question put, That the clause be added to the Bill.

67|22:14|170|316| The House divided: | Question accordingly negatived.||0|0

Clause 21

Membership of integrated care boards

Amendments made60, page 15, line 34, at end insert “—

(a) at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board’s area, and

This amendment restores the requirement for integrated care boards to have at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board’s area (as well as any new mayoral nominated member).

Amendment 61, page 16, line 1, leave out from “for” to “as” in line 3 and insert “nominating the ordinary members mentioned in sub-paragraph (2).

(2) A person participating in the process for nominating the ordinary members”.

This is consequential on amendment 60.

Amendment 62, page 16, line 9, at end insert—

““local authority” has the meaning given by section 2B(5);”.—(Karin Smyth.)

This is consequential on amendment 60.

Clause 27

Special Health Authoritiesestablishment and exercise of functions

Amendment made63, page 20, line 13, at end insert—

“(4) In section 271 (territorial limit of exercise of functions), in subsection (3), after paragraph (a) insert—

“(aa) Chapter 4 of Part 2 (Special Health Authorities),”.”.—(Karin Smyth.)

Section 271(1) of the NHS Act 2006 provides that ministerial functions under that Act are generally exercisable only in relation to England. This amendment creates an exception for powers to establish Special Health Authorities etc since they may be used to carry out certain functions beyond England (eg operating information systems).

Clause 39

Joint working and delegation arrangements

Amendment made64, page 29, line 5, leave out subsection (8).—(Karin Smyth.)

This removes an unnecessary amendment to subsections (7B) and (7H) of section 75 of the NHS Act 2006 (those subsections are removed entirely by clause 40(3) of the Bill).

Schedule 1

Conferral of primary care functions on integrated care boards etc

Amendments made70, page 73, line 33, leave out from “for” to end of line and insert—

““NHS England may recognise a committee formed for an area which it is satisfied” substitute “An integrated care board may recognise a committee formed for an area that includes the whole or part of the integrated care board’s area if it is satisfied that the committee”.”.

This amendment makes the geographical extent of a local pharmaceutical committee which can be recognised by an integrated care board consistent with the geographical extent of other, similar committees (for other examples, see paragraphs 12(2), 24(2) and 37(2) of Schedule 1).

Amendment 71, page 74, line 6, leave out sub-paragraph (5).—(Karin Smyth.)

This amendment is consequential on amendment 70.

Bill to be further considered tomorrow.

Document details

Type

Parliamentary Debate

Published

7 Sep 2026

Issue

Health Bill

Provenance

Linked to "Health Bill" via bill_chamber_debate (confidence 1.00) · verified

↗ View on Parliament ↓ Download primary document + Build thread on this ← Back to Health Bill

My list

Save the parent thread "Health Bill" to your list.