Health Bill (Sixth sitting)
House of Commons · Public Bill Committees · 25 Jun 2026 · 97 speeches · Official Report
The Committee consisted of the following Members:
Chairs: Sir Roger Gale, Dr Rupa Huq, † Emma Lewell, Sir Jeremy Wright
† Argar, Edward (Melton and Syston) (Con)
† Brackenridge, Sureena (Wolverhampton North East) (Lab)
† Chambers, Dr Danny (Winchester) (LD)
† Daby, Janet (Lewisham East) (Lab)
† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)
† Irons, Natasha (Croydon East) (Lab)
† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)
† Joseph, Sojan (Ashford) (Lab)
† Kyrke-Smith, Laura (Aylesbury) (Lab)
† Morgan, Helen (North Shropshire) (LD)
† Prinsley, Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
† Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Thursday 25 June 2026
(Morning)
[Emma Lewell in the Chair ]
Health Bill
The Chair
Before we begin, I remind Members to switch all electronic devices to silent. Tea and coffee are not allowed during sittings. As Members will have noticed, I have taken my jacket off, so please feel free to take yours off-it is hot in here. Clause 12 Commissioning functions: responsibility
I beg to move amendment 57, in clause 12, page 10, line 10, at end insert- “(4A) Before making regulations under subsection (1)(b) that would alter the range of services or facilities which the Secretary of State is required to commission nationally, the Secretary of State must- (a) prepare and publish a commissioning transition plan in accordance with subsection (4B), (b) consult in accordance with subsection (4C), and (c) lay the commissioning transition plan before Parliament. (4B) The commissioning transition plan must set out- (a) a description of each service or facility that the Secretary of State proposes to add to, or remove from, national commissioning responsibility under section 3B(1)(b), and the reasons for each proposed change; (b) a description of the body or bodies to which commissioning responsibility for each such service or facility would transfer and the basis on which that body is considered capable of commissioning that service or facility effectively; (c) an assessment of the impact of each proposed change on patients who rely on the affected services or facilities, including- (i) patients with rare diseases or conditions, (ii) patients whose needs cannot be met by a single integrated care board area, and (iii) patients who may face differential impacts on account of a protected characteristic within the meaning of the Equality Act 2010; (d) the transitional arrangements to be put in place to ensure continuity of service for patients during any...
The Chair
With this it will be convenient to discuss the following: Clause stand part. Clause 13 stand part.
In essence, the clause confers the commissioning duties of NHS England on to the Secretary of State, because NHS England is being abolished. In that respect, it is quite straightforward. In the existing National Health Service Act 2006, which is to be amended, section 3 sets out the duties of integrated care boards as to commissioning health services, and section 3A similarly. Section 4 is about NHS England’s responsibility for the provision of high-security psychiatric services. In essence, clause 12 replaces the references to “NHS England” in sections 3 and 3A with “the Secretary of State”. The ICBs now must act consistently with the discharge by the Secretary of State of the section 1 duty to promote a comprehensive health service. That is consistent with the aims of the Bill. I have concerns, which I have expressed previously, about how the Government ensure that the Secretary of State can make those decisions fairly, on the basis of clinical need, rather than because of pressure from a lobby group, a celebrity campaign or such like, but again, that seems consistent. The clause also replaces entirely section 3B of the 2006 Act. Under the previous section 3B, the Secretary of State could direct NHS England to commission the service nationally; the proposed new section 3B confers a regulation-making power to require the Secretary of State to arrange nationally services for members of the armed forces and their families specifically, as well as such services or facilities...
We have heard a few times about Conservative fears about redundancy payments and so on. Why did they not add NHS England to the list of organisations covered by the modification order when they had the opportunity to do so? Is the hon. Lady aware of a reason why that did not happen when the Conservatives were in government?
I am afraid I do not know the answer to that question. The key point is that it is not logical to abolish a three-tier structure and recreate it with taxpayers’ money to do exactly the same thing. If NHS England is replaced by the Secretary of State, the regional NHS England is replaced by the OPICs and the ICBs are at the bottom-the more local tier-what has changed? The middle tier will be doing the same thing.
The modification order is a piece of legislation that is often used in the public sector. It means that when people from a lot of public sector organisations are made redundant and find alternative employment at another state-funded organisation, they are not entitled to a redundancy payment. During their 14 years in power, it would have been entirely possible for the Conservatives to add NHS England to the list of organisations covered by the modification order. That would have prevented the costs that the hon. Lady has mentioned several times. It just seems like they did not take the opportunity to do that, and now they are saying that they should have done that when they were in government.
But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition-the largest that has ever happened in this country. Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.
Amendment 57 essentially seeks to make sure that, if the Government want to do this-there may be good reason on occasion-they have to be reasonable and take advice from experts and consult those who would be affected, and they must have a plan. This Government are fond of saying that they have a plan but not actually having a plan. Before they came into office, they said they had a plan for the NHS; we saw that they did not. They took a year to write their plan and then it was full of messaging about even more plans, such as the workforce plan, which, despite supposedly being “imminent” for most of the last week or so, still has not been published.
As Members think about their vote, I encourage them to think about what the right hon. Member for Makerfield said the last time a Government undertook a reorganisation of such large scale:
“This is a difficult day, but what makes it harder to stomach for people watching is the manner in which things are happening. People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all the facts and all the evidence…How do they begin to justify that to their constituents, to patients who depend on the NHS and to staff who devote their lives to it?” -[ Official Report , 20 March 2012; Vol. 542, c. 655.]
Those comments could be pertinent today, could they not? All we are saying with amendment 57 is, “If you are going to change NHS commissioning from national to local, it could have an effect on patient care, and you need to do it carefully and properly, with a plan that is properly published, and deliver it with timescales and consultations, so that people know what they are doing.”
In summary, clause 12 leaves us an element of uncertainty. Commissioning could move, but it might not; we do not know. Given the chaotic nature of the rest of the changes in much of the Bill, accepting amendment 57 would be an important step to keep patients safe.
Clause 13 introduces the power to confer discretion, which essentially means that if the ICBs are commissioning a service, they can give the provider of that service, which may be NHS or private, the discretion to vary that provision within certain guidelines. To me, that flexibility is a good thing-providers are closer to patients than commissioners, and provided that the limits given by the ICBs are reasonable, the provision seems reasonable to me. Unlike much of the Bill, the provision also aligns with the Government’s stated intent for this legislation, which is more autonomy for local providers. That is a good thing, so I have no particular objection to clause 13.
It is a pleasure to serve with you in the Chair, Ms Lewell. In general, the Liberal Democrats support clauses 12 and 13. We think that local decision making and community empowerment in the NHS, including on commissioning decisions, is the right thing to be doing. However, I echo some of the concerns of the shadow Minister, the hon. Member for Sleaford and North Hykeham, particularly on specialist commissioning. I declare an interest as vice-chair of the spinal cord injury all-party parliamentary group. We are concerned that expertise in low-volume, very specialist concerns will be lost if the commissioning is pushed out to multiple ICBs. My understanding is that specialist commissioning sat with NHS England in the first place because of concern that multiple commissioning groups would struggle to deal with low-volume, complex issues. The president of the Royal College of Psychiatrists warned earlier this month that the new commissioning structure lacks mental health experts, with only one senior mental health lead across the seven new regional commissioning hubs taking specialised services from NHS England. Equally, the chief executive of the Derby and Derbyshire, Lincolnshire, and Nottingham and Nottinghamshire ICB cluster has said that it does not look like there will be a requirement for senior mental health expertise in reorganising ICBs. Will the Minister reassure us that when the Department designs which specialist services will be pushed back down to ICBs and which...
I agree with much of what the hon. Lady has said. Does she therefore support amendment 57, which would ensure that such a consultation takes place?
Yes, we would support the amendment, which is a reasonable way to get there, but an assurance from the Minister that the Department will consider specialist commissioning and really think that through properly before the powers are delegated to ICBs would be sufficient.
It is a pleasure to serve under your chairmanship this morning, Ms Lewell. It is right that Ministers are ultimately responsible to the House for the performance of the health service and subjected to the scrutiny of Parliament for its execution, but there is an important distinction between accountability and operational control, which I fear the clause risks eroding in some cases. The national health service has over many years developed a structure that seeks to balance political accountability with operational independence, and that balance exists for a reason. Decisions on what services are commissioned, where they are delivered and how resources are allocated are not purely political judgments; they are complex, technical decisions that ought to be guided-primarily, in my view-by clinical evidence, patient need and professional expertise. Transferring commissioning functions directly to the Secretary of State, as the clause will do, risks drawing those operational decisions more directly into the political sphere, even if that would not happen in every case. The more that Ministers are involved in determining which services are commissioned nationally and which are not, the greater the risk that over time those decisions will be influenced by short-term considerations and short-term pressures rather than long-term patient outcomes. Even when no such influence is intended, the perception that that could occur will be damaging. As I said in discussions on previous...
I wish to speak on clause 12 in the context of specialised commissioning. In my parliamentary work, I deal with a great number of rare disease communities and other specialised groups. Specialised commissioning is important to them to ensure that they get the service they need and deserve. Will the Minister explain how we can ensure that there is patient involvement in a more dispersed system of commissioning, and that there is national oversight and clinical leadership for all these things? How will she ensure that specialised commissioning groups are monitored and that effective services are being provided to those in the communities who need them?
Clause 12 inserts new section 3B into the National Health Service Act 2006, re-establishing the responsibility of the Secretary of State to commission services. Although we intend ICBs to commission the vast majority of services, as we discussed this morning, we will use this regulation-making power to set out the small number of specialised services that the Secretary of State will be responsible for. That may include, for example, proton beam therapy, alongside a small number of other specialist services not currently suitable for ICB commissioning, such as gender dysphoria services and clinical genomics. By their nature, those are services to which national commissioning is appropriate because, for example, they have fewer patients or providers, greater or changeable costs, or they require specialist clinical expertise and input. Having a regulation-making power allows us to future-proof the system and update the regulations when new services or treatments emerge, or when services become cheaper or mainstream and therefore sit better with ICBs. I now turn to amendment 57, which was tabled in the name of the hon. Member for Sleaford and North Hykeham. I recognise that any change to the way these services are commissioned matters enormously to the patients who depend on them. The hon. Lady used the word “worried”, and I understand that. Any change must be made with the greatest of care. However, the amendment would require the Secretary of State, before any regulations are...
Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another. Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to-mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote. Question put, That the amendment be made.
Clause 12 ordered to stand part of the Bill.
Clause 13 ordered to stand part of the Bill.
Clause 14
Primary care services
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following: Clause stand part. Government amendments 14 to 18. Schedule 1. New clause 2- 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. (2) The scheme should include a right contained in the NHS constitution for a patient to receive a GP appointment within seven days, or 24 hours if urgent. (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.” This new clause requires the Secretary of State to introduce a scheme to ensure that patients have the right to see a GP within seven days. Government new clause 21- Dispensing medical practitioners etc. Government new clause 22- Inadequate provision of pharmaceutical services . Government new clause 23- Pharmaceutical services: appeals etc . New clause 30- General Ophthalmic Services: national 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...
Primary care is the front door to the NHS and is critical to delivering our neighbourhood health agenda. The neighbourhood health service will bring care into local communities, ending fragmentation and preventing unnecessary hospital admissions. To support that, alongside clause 14, which I will discuss shortly, we have tabled new clauses 22 and 23 and new schedule 1, to strengthen action in the event of local pharmacy challenges and streamline the appeals process. On new clause 22, many hon. Members will know how the closure of a local pharmacy can significantly affect a community. Pharmacies close for a range of reasons: voluntary closure, business failure or emergencies affecting the premises or surrounding area. Even where a pharmacy remains open, unforeseen or unexpected events can disrupt access for local people. The NHS Act 2006 sets out how ICBs should commission pharmaceutical services in normal circumstances and what can be done if those arrangements fail. Section 133 of the Act is intended to deal with exceptional situations where standard commissioning processes are too slow and rapid action is needed to restore provision while long-term solutions are put in place, if required. However, the current wording of section 133 is widely interpreted as applying only to large-scale national emergencies, as it refers to inadequate provision affecting a significant number of people. It is unclear whether that would cover more localised situations, such as a village cut...
I have received representations from rural dispensing practices in my constituency about the provision of vaccination services. I understand that dispensing general practitioners are having difficulty securing the funding to provide vaccinations, particularly the new meningitis vaccination for young people. Does the Minister envisage that the change being proposed will have any effect on that arrangement?
The changes here, as I have outlined, are bringing practices in line in terms of the regulation. I think the issue my hon. Friend really addresses is the arrangement between those local practices and the ICB as the commissioner on where the service is provided. Ordinarily a commissioner would seek to make sure that a rural area had provision from somewhere in particular; I am happy to talk to my hon. Friend outside the Committee if there is a problem in his local area.
Finally, I turn to clause 14 and schedule 1. The transfer of responsibilities for primary care services to integrated care boards will deliver on our ambitions to devolve decision making to local systems as part of the 10-year health plan. Since 2022, integrated care boards have had delegated responsibility from NHS England for arranging primary care services, holding contracts and contractual relationships, and making related payments to contractors. That includes the commissioning of primary medical, dental, ophthalmic and pharmaceutical services. However, it is currently a delegated responsibility, with NHS England maintaining oversight and accountability.
Clause 14 and schedule 1 will transfer the statutory responsibility for commissioning services so that ICBs hold the responsibilities in their own right. That relates to my hon. Friend’s question about why the route is through the ICB. This is a key part of giving ICBs the power and responsibilities needed for them to become strategic commissioners of local healthcare services, and allowing them to join up services in the best interests of patients.
I also draw attention to the elements of the clause that give new responsibility to the Secretary of State. In particular, we have been concerned to retain in the centre responsibility for functions that are most appropriately delivered nationally to ensure standardisation, such as setting national contractual and service terms, making regulations and directions, or giving determinations to provide payment terms for primary care contractors.
The Secretary of State will also receive the statutory responsibility for the performers lists from NHS England, along with the power under the Bill to delegate the delivery of functions to appropriate health bodies. The performers list powers allow a practitioner to have conditions placed on them on the grounds of suitability, addressing inappropriate conduct, fraud and the efficiency of the service. The Secretary of State will also receive powers in relation to the removal of a practitioner from the list, including the power to make provision on the grounds for removal. The clause will maintain the framework that upholds patient safety to ensure that practitioners working in primary care are suitable and fit for purpose.
The clause will ensure that stability for contractors and patients is maintained with important safeguards, while further empowering ICBs to create a stronger and more integrated primary care system. I commend the clause and schedule, as amended, to the Committee.
Clause 14 is very straightforward: it states that schedule 1 “confers functions on integrated care boards in relation to commissioning primary care services…transfers related functions from NHS England to the Secretary of State, and”- perhaps most interestingly- “contains other amendments relating to primary care services.” Schedule 1 essentially makes the following changes to the NHS Act 2006: it makes ICBs responsible for commissioning pharmacy services instead of NHS England; it amends section 99 to make ICBs responsible for commissioning dental services instead of NHS England; it amends section 83 to make ICBs responsible for commissioning primary medical services such as general practice instead of NHS England; and it amends section 115 to make ICBs responsible for commissioning ophthalmic services. Largely, this change is formalising existing delegation and the risk of disruption is therefore relatively low. Local commissioners can tailor decisions to local need, and it is better if decisions are taken closer to users. However, there are a few other things in there as well. Paragraph 12(2) amends section 97 of the 2006 Act containing local medical committees, which are statutory committees. The way it is phrased, “the whole or part of the ICB’s area”, does not allow for overlap. Is that the Government’s intention? The Government, in a broader sense, talk about the strategic authorities and having the mayoral authority level involved in the ICB. But in Lincolnshire, for...
Does my hon. Friend agree that this Bill would have been the perfect time to align health commissioning services with local government structures and that the fact that these structures are being created totally without the new local government structures is not just an oversight, but a potential problem with the whole Bill? Does she also agree-I think that she was outlining this already, but I want to ensure that the Minister is clear on it-that the Government still have a chance to amend the Bill to ensure that the commissioning structures and commissioning areas outlined in the Bill neatly map out to the new local government areas? In relation to, for example, the current Hampshire and Isle of Wight ICB, Hampshire is potentially being split up into a number of local government areas. I am against the way it is being split up, but if the Government are pressing ahead with it, this would have been the perfect opportunity to align commissioning with those areas. The problem is that we will now have a situation in which they do not match up, and the problems that my hon. Friend has outlined in her speech thus far will come to the fore.
Of course, my hon. Friend is right. One challenge with the Bill is that although not all the measures are a problem individually, the way they are being brought in is a problem. The planning and organisation that has gone into it has not been coherent. A 50% cut has been made to the budgets of ICBs, which has required many of them to merge, but that has been done before the local government reorganisation has been finished, which means that ICBs have been melded together in a way that is not the same as the local government reorganisation. Let me again give the example of Lincolnshire. Lincolnshire had an excellent ICB, run by chief executive John Turner. That has now merged with Nottinghamshire and Derbyshire. Nottinghamshire and Derbyshire form the East Midlands mayoralty, but Lincolnshire ICB, as was, forms part but not all of the Lincolnshire mayoralty-which, as I said, also includes part of what was the Yorkshire region. Because the cuts were done before the local authority reorganisation, and the left hand does not know what the right hand is doing, we have ended up with an incoherent pattern, which does not help, particularly for social care services that are delivered by local authorities. We will come back to that when we talk about who is on the ICB. The risk is that we end up spending money doing this twice-being forced to do it at short notice, because of the 50% cuts brought in overnight by Government, and then doing it again to try to sort out the mess and...
With permission, I will explain to the shadow Minister our votes on amendment 57, which she pressed to a vote. I was reassured by the commitment the Minister made to consult widely on those commissioning changes, so the Liberal Democrats switched our vote from support to abstain. I move on to new clause 2, our amendment in this group, which the shadow Minister was just discussing. It would require the Secretary of State to introduce a scheme to ensure patients have the right to see a GP or another appropriate clinician within their GP practice within seven days. The NHS constitution currently confers rights on patients when they are considered really important. There are, for example, rights within the NHS constitution around receiving cancer diagnoses and treatment. We felt that there was a gap on access to GPs. Given the Government’s stated aim of transferring more care into the community, which we fully support, and given the observation in the Darzi report that more and more money is being spent on secondary rather than primary care, we think it is really important to confer the right on patients to be able to access primary care when they need to. As the hon. Member for Sleaford and North Hykeham pointed out, this measure would require a large number of additional GPs and would therefore not be achievable overnight, but over the course of a Parliament. The Liberal Democrat plan includes recruiting and retaining an extra 8,000 GPs, relieving pressure on the rest of the...
New clause 2 clearly states that everybody should have a legal right to an appointment with their GP “within seven days”, while the current provision is that patients are entitled to see a GP or other professional within 24 hours or two days for urgent care. Would creating this legal burden on GP practices not reduce their ability to prioritise, meaning that the people who need urgent treatment will be delayed further?
We do not consider the right to achieve a cancer diagnosis and treatment to be burdensome on the secondary care providers of those treatments; we consider that important enough to enshrine that right within the NHS constitution, and this would be a similar level of right. I would not imagine that a GP would be worrying about somebody taking them to court, but it would confer upon the Secretary of State the duty to ensure that primary care is adequately resourced in order to be able to meet that commitment.
I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice-be that any clinically qualified individual within it-or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.
The right hon. Gentleman asks an extremely important question, and I am happy to clarify. It would be an appropriate clinician within the GP practice, and it could obviously be a telephone appointment, because that might be more convenient for the patient. Lots of patients are really happy with telephone appointments and we should be using them wherever that is the patient’s choice, because we want-I think we all do-to see an NHS that is patient-led and not politician-led.
Will the hon. Lady give way?
I am going to make some progress, actually, because I think I am going to be asked the same questions.
I wanted to ask a different question, but okay.
Well, I will just move on a little bit. The important question is: can this be achieved this overnight? Clearly not; we need additional clinicians in the service. The Liberal Democrat view is that the extra-I think 1,000 or 1,500-GPs that the Government have recruited so far is a welcome step forward, but that does not go far enough over the course of a Parliament. As I was saying earlier, when patients cannot access their GP surgery, they end up, more often than not, in accident and emergency departments. That is no good for anybody. It overburdens the A&E department, leaves people who genuinely need urgent care getting a substandard level of care, and costs the NHS far more. We think it is really important that we put the resource in the right place.
Just to reiterate what my hon. Friend is saying, in Winchester we are now putting an urgent treatment centre in front of the A&E, staffed by GPs to do the triage, because so many people who turn up are only there because they cannot get a GP appointment. So we now have hospital trusts paying for GPs to provide same-day GP appointments, and that is coming out of the secondary care budget instead of the primary care budget. That is obviously the most expensive place to treat patients for routine things.
That is exactly what new clause 2 seeks to drive at.
We Conservatives share the hon. Lady’s desire to ensure that patients get their appointments as soon as they need them to be had, but she is talking about a difference between urgent appointments, within 24 hours, and non-urgent appointments, within a week. Who is going to make the decision about whether the appointment is urgent? Will it be the clinician? Will it be the patient themselves? Has she thought about where that responsibility lies?
Yes, I have thought about where that responsibility lies. It clearly lies with the triaging process within the GP surgery. I do not think any of us envisage somebody phoning up about a child with a cold and saying, “I consider this to be urgent,” and getting an appointment within 24 hours, but I would imagine somebody from the surgery saying, “Please describe the symptoms to me,” and then, if they detected something more serious, saying, “That is urgent and you do need to come in within 24 hours.” The point of new clause 2 is to clarify in the NHS constitution that some services require parity with others. We have already established legal rights under the NHS constitution for certain types of treatment, and this puts GP access on the same level. We think that that is important. I am conscious of time, so I will move on to new clause 52, which is about dental deserts. Everyone is horrified by dental deserts and by “DIY dentistry”, a phrase that means-let us face it-people using pliers to extract their teeth and super glue to reattach crowns, and cavities filled with household adhesives. More than 5 million children did not see a dentist at all in 2025. That is a stark failure. Dental care is as important as care for other parts of the body, in particular when most of what goes wrong in dentistry is preventable. We should absolutely focus on prevention, and that is in line with the Government’s aims to move from sickness to prevention. New clause 52 is about our £750 million...
I will start where the Liberal Democrat spokesman, left off, with new clause 52 on dental provision. I have a lot of sympathy for what she is trying to achieve with the new clause. In my own constituency, as far as I can tell, looking earlier today, not a single dental practice is taking new NHS patients for dentistry, whether that be children or adults, and that is extraordinarily concerning. Even more concerning-this somewhat relates to the changes that the Government are making in the clause through bringing the commissioning of dental services to ICBs-I have a fully equipped and fully functional dental surgery in Haslemere hospital in my constituency, but it has remained entirely unused for a number of years, because it sits within the hospital, which is run by the Royal Surrey NHS trust, but is commissioned by the ICB. That seems like an utter waste of resources. That is something that could be clarified through new clause 52 and, I hope, through the clauses tabled by the Government. On new clause 2, about GP practices, I am disappointed that the hon. Member for North Shropshire did not want to take my intervention because she will not be able to answer my questions, unless she intervenes on me now, which I hope she will. Again, I sympathise entirely with what she is trying to achieve. We want to ensure that people have timely access to their GPs. I am sure that, like me, she has constituents who cannot get a GP appointment in any reasonable time. They can wait numerous...
I would like to clarify that point. We envisage that being at the GP with whom the patient is registered. Our broader policy, which is not included in new clause 2, is to have named GPs for people with complex conditions and complex comorbidities. Absolutely, we would envisage that as being a part of the continuity of care, which is so crucial.
That is a helpful clarification, but it raises a number of other questions. I entirely agree with the hon. Lady that named GPs are most appropriate; all the clinical evidence suggests that even for people with non-complex needs, having a named GP whom they can see regularly improves patient outcomes. I therefore support her on that, but does she believe that we currently have sufficient GPs for that to go ahead? Even the six-month lag in her new clause would not be enough time to recruit thousands more GPs. If she does not believe that there are enough GPs at the moment, when does she envisage that they would be in post? How much would that cost? Where would she get the money to fund those extra GPs? Rather than just expressing what I would call “motherhood and apple pie” statements about things that we all want, we in this House have a duty to be honest with our constituents about how we would achieve them-and, if we have to achieve them within six months, what funding and impetus will have to be put in place.
Let me clarify. The new clause is about conferring a duty on the Secretary of State to provide that level of care. It would require a significant number of additional GPs, and that would cost a lot of money. The Liberal Democrats’ 2024 manifesto had a fully costed pledge to recruit and retain an additional 8,000 GPs within the course of a Parliament. I think we can all agree that the world has moved on since then, but the hon. Gentleman will be aware that this week we proposed a significantly closer relationship with the European Union, which would grow our economy, increase our tax base and pay for a number of these things without having to subject people to additional, onerous tax hikes.
I think that clarifies that there is no real concrete plan for how to fund this new clause. I do not mean in any way to demean what the hon. Lady is trying to achieve, because she is trying to achieve something important, and which we all want, but we have to be honest with our constituents about how we can do that, and some ethereal money to come through some ethereal plan at some point in the future-
Will the hon. Gentleman give way again?
Let me finish this point. I am not in the mind of the current Prime Minister, and I am certainly not in the mind of the potential next Prime Minister, but even if the hon. Lady is right my understanding is that he-either is probably a he-is unlikely to have changed our relationship with Europe within six months.
The Chair
Order. We are straying slightly into a debate about European matters. Can we stick to the amendments before us, please?
Thank you, Ms Lewell. You have certainly saved me from myself, if not anybody else. I think I have belaboured the point; I will leave it there. I sympathise with and indeed support the ambition of new clause 2, but I have a real problem with the lack of detail on how it would be achieved. I turn quickly to clause 14. As my hon. Friend the Member for Sleaford and North Hykeham said, it has bits that we welcome, but there are some concerns about how the ICB structures fit over the local government structures, and cutting ICB administrative budgets by 50%, while asking them to take on more power and responsibility for commissioning services and many other things, is a real problem. Likewise, we have welcomed, and I think both sides of the Committee agree, having neighbourhood health-however we want to describe it-and care closer to home, and having commissioning closer to home. It is therefore strange that my best performing ICB, Frimley ICB, has been abolished or merged with a number of other ICBs that have been performing far less well. If the Government want to have the principle of place-based, locally responsive commissioning, they have to have a real focus on, actually look at, what fits with the current structures and to ensure that those ICBs that are performing best are encouraged and kept and that those that are not are dealt with. I have real concerns about, for example, the superstructure of the new Surrey and Sussex ICB. It is huge and, essentially, entirely...
One thing that my hon. Friend mentions is the Government’s stated intention to bring things closer to home, as opposed to the reality of the Bill as drafted. Does he agree with me that the document that explains what will happen to the commissioning of specialist services, and that talks about seven regions and how ICBs could collaborate within those regions, might imply that the Government are looking forward to having seven areas in which most commissioning takes place? These are even larger areas than have been described in the mergers so far.
It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed. I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.
It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised. The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned. I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical...
I am sure the right hon. Member has enjoyed reading the Liberal Democrat website. If he had delved a little further into the policy paper that sits behind that manifesto commitment, he would see that that is with an appropriate clinician and not with a GP. I appreciate that the wording of the new clause says a GP, but it does indicate a GP practice, and would require the Secretary of State to establish a scheme that would achieve that. I expect that clarification could be made at that point.
I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation. My concern is how this measure would be paid for-8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.
I am happy to clarify. Clearly, the world has moved on since July 2024 when we put together our manifesto, but this was a fully costed plan with a number of different changes to tax regimes, including a tweak to capital gains tax and changes to the way that banks were taxed and digital services tax. Since then, we have proposed a number of other alternatives, but the principle of changes to capital gains tax, to the way that windfall profits of the big banks are taxed and to digital services taxes still stands. Plus, we also have a fully fleshed-out plan to actually grow our economy and deal with this problem in the long term.
I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion. We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.
Even when the right hon. Gentleman criticises, he does so in a charming way. None of this is moving the discussion to how we keep people healthy and treat them early. He may criticise our funding models and challenge the detail for achieving this measure, but if we flip that round, the previous Government promised 40 new hospitals, which were not hospitals and did not materialise. The entire focus of healthcare has been on treating people once they are sick, while people cannot get GP appointments. I hope that the right hon. Gentleman would agree that the thrust of the argument is to try to keep people healthy and treat them early, before they end up needing hospital treatment, and that that is what we should all be focusing on. If he wants to help with the details in order to get 8,000 GPs by the end of this Parliament, he can submit his suggestions to the Liberal Democrat website.
The hon. Gentleman makes his point in a typically reasonable way. Of course, he is right to talk about the need to shift, where we can, from acute settings to either community settings or, ideally, a preventive setting or focus. The Minister may well disagree with me, but I think that is a desire or thread that, however well implemented or otherwise, runs consistently through Governments. It ran through the Blair-Brown Government, the previous Liberal Democrat and Conservative coalition, the Conservative Government and into what the previous Secretary of State announced and what the Minister today is seeking to achieve. I do not think that anyone would disagree with that. We will always need those acute settings for particular treatments and cases, as well as for those very specialist pieces of work or for people with significant illnesses. There has always been a desire to push the care into the local community. GPS are a central part of that, as are-to address the points raised by my hon. Friends earlier-our community pharmacists and other pharmacists. Pharmacies remain an improving but underused resource as part of that preventive picture. I do not disagree with the hon. Member for Winchester in that, but one can agree with the objective, but nonetheless gently push a little on the detail. As we know, the devil is in the detail, and people will want to see a deliverable plan. That is one of the challenges that I have had in Melton Mowbray, where the ICB says it will do...
I have enjoyed the “back to the good old days” of the Lib Dem-Tories. They tell us we live in fractured political parties, but I quite like the old days. On new clause 2, I understand the intention that GP provision is important to us all and to our constituents. We have recruited over 2,000 more GPs since 2024-the highest number of qualified GPs since 2015-and there is provision to ringfence money for even more. We all know the importance of timely access to general practice, and patients need to be confident that they can get that care urgently and receive it promptly. We are seeing improving signs. According to the ONS, the number of people who say it is now easy to contact their GP practice is up 14% since 2024, and that satisfaction is rising. Importantly, 69% of patients are seen within seven days and 44% are seen within the one day that they have requested an appointment, irrespective of urgency. That is the progress that we are encouraging, but we are not complacent; we recognise that there is more to do. We also recognise that not everyone not seen within seven days is experiencing an unnecessary delay. Not every patient requires an appointment within seven days, and many people book appointments in advance for routine reviews, medication checks, to ensure that they see their preferred clinician or to fit around work and other life responsibilities. The new clause would cut across that flexibility by imposing a more rigid approach to appointment allocation,...
Adjourned till this day at Two o’clock.