Health Bill (Fifth sitting)
House of Commons · Public Bill Committees · 23 Jun 2026 · 140 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
Tuesday 23 June 2026
[Sir Roger Gale in the Chair ]
Health Bill
The Chair
Good afternoon, ladies and gentlemen. Members may remove their jackets and, because of the health warning-exceptionally-if Members or civil servants wish to remove their ties, they may do that as well. Please understand that that is not a precedent. Clause 7 Education and training Amendment proposed (this day) : 33, in clause 7, page 4, line 31, at end insert- “(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.”- (Peter Prinsley.) This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco. Question again proposed, That the amendment be made.
The Chair
I remind the Committee that with this we are discussing the following: Amendment 50, in clause 7, page 4, line 32, at end insert- “(4) After subsection (2) insert- ‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’” This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years. Amendment 54, in clause 7, page 4, line 32, at end insert- “(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care. (5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.” This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care. Clause stand part. New clause 44- Medical training places - “The Secretary of State must double the number of medical school training places to 15,000 by 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 45- Data collection: clinically trained staff - “(1) The Secretary of State must collect and publish...
Before the lunch break I was saying that, in essence, clause 7 states what the Secretary of State’s job is. It moves the function of planning the workforce from NHS England to the Secretary of State, which is a reasonable thing to do. I talked about the previous Government’s record on opening new medical schools and how that has helped with the number of clinical staff. We also talked about workforce planning. The Government are due to produce a workforce plan, but it is not clear when it is due to come out. It was due to come out at the end of last year, but it did not; it was then due to come out in the spring, but now it is the summer. Given the Prime Minister’s resignation, it is not at all clear when it will come out. Will the Minister let us know whether it will come out before the summer recess, this week or whenever? I quoted some of the concerns of the Royal College of Nursing, the British Medical Association, of which I am a member, and others. Those concerns include the workforce plan. Those organisations have seen what we have not seen, so they have been asked to comment on something that we have yet to see. That brings me to new clause 44, which is in my name. Before the general election, Labour promised that it would double the number of medical school places. The now Chancellor of the Exchequer promised to double the number of medical school training places, as did the now Secretary of State for Science, Innovation and Technology. Once the general election had...
Does the shadow Minister agree that if we doubled the number of medical students, we would simply not be able to accommodate those people as young doctors unless we also doubled the number of training places? After five or six years, those medical students become young doctors. If we are to correct any problem with the medical workforce, it is insufficient to simply state that we will double the number of medical students.
The hon. Gentleman is right. When all the new doctors that the Government have promised have been trained, they will need jobs and postgraduate medical training, and there are issues with that. Nevertheless, the Government asked the public to vote for them on the basis that they would double the number of medical school places. Many of the hon. Gentleman’s colleagues produced little videos to that effect, which can be viewed on Twitter. They toured the newsrooms saying, “Please vote for us, we’re going to double the number of medical school places.” They suggested that there would be a revolution in Government to make sure that there were enough doctors. This is important-more doctors would help. All new clause 44 does is ask the Government to commit to doing what they have said that they will do-or to say that they will not. Either way, we have had the Secretary of State saying one thing and a Minister saying the opposite and then correcting it, so we need clarity. The public deserve that. The Minister herself said that they would double the number of medical school places so that we have the doctors that our NHS needs. If they do not double the number of medical school places, it follows that they will not have the number of doctors that the NHS needs. Presumably that is in their workforce plan, but it needs to be cleared up. Amendment 50 would put a duty on the Secretary of State to publish independently audited forecasts of the NHS workforce every five years. The logic...
I strongly support the argument that clinical staff, even if they progress into a senior role, should carry out some sort of clinical practice. Does the hon. Lady agree that that is what went wrong over the past few years, especially when NHS England was created? Many senior clinicians who were moved into management posts had no contact with clinical areas. That is what this Government are trying to fix by abolishing NHS England.
I am talking predominantly about clinicians working in trusts who are trained and very experienced, but then move to work in the same trust but in a more managerial role that does not involve clinical care. I am not saying that every single person needs to be delivering clinical care-there may be exceptions, of course; people do have career changes-but I encourage the Government to reflect on the number of posts being created that take people away from the clinical arena, and on the effect that that has. When the Minister is presented with the number of nursing or midwifery-qualified staff working in a particular department, that may not reflect the number who are delivering clinical care and, by their own admission, the Government do not know which is which. Amendment 33 would place a duty on the Secretary of State to ensure that the workforce is trained on the wider determinants of health, such as housing standards, air pollution and the use of harmful substances. In my many years as a paediatrician, I have yet to meet a nurse, doctor, surgeon, porter or care co-ordinator who does not know that damp and mould are bad for people’s health, and I have yet to meet a fellow employee who does not know that air pollution causes asthma, or that tobacco use increases the risk of chronic obstructive pulmonary disease, cancer and a whole host of other ailments. Considering the many pressures on NHS workers, I do not believe that mandating a new programme on health determinants is a...
It is a pleasure to serve under your chairmanship, Sir Roger. Clause 7 says-I abbreviate: “The Secretary of State must exercise functions…with a view to ensuring that…there are sufficient people with appropriate education and training to meet the workforce needs of the health service, and…there is an effective system in place for the planning and delivery of education and training of people to meet those needs.” That is all very nice-who couldn’t agree with that?-but amendment 50, tabled by the shadow Minister, would add a means by which the public, in the interests of transparency, could make an assessment of that by requiring the Secretary of State to publish independently audited forecasts of the NHS’s workforce needs every five years. That seems entirely sensible, it is something that I am sure any Government would want to do anyway, and it would add meaning, assessment and transparency to what is already in the Bill. New clauses 44 and 45 would do something similar in relation to the number of medical school places. As the shadow Minister said in response to an intervention, new clause 44 seeks to do only what the Government have already said they want to do. Hopefully, the Minister can give us some clarity on whether that is still the Government’s intention and, if it is, what aversion she has to including it in the Bill. Separately, new clause 45 seeks to establish a benchmark of data collection. Of course, duties and requirements placed on a Secretary of State, such...
I thank hon. Members for bringing this discussion before the Committee. The Government are committed to ensuring that the NHS has the right people in the right place and with the right skills to care for patients when they need it. We will be publishing our 10-year workforce plan imminently. I cannot give the shadow Minister any more details on that at the moment, but it will set out the action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan. High-quality education and training for the NHS workforce will be fundamental to that, and clause 7 is in keeping with that commitment. Before turning to the clause, I will address some of the issues raised during the debate and in the amendments. I understand the intention behind amendment 50, but I cannot accept it. The 10-year workforce plan will set out the staffing needs of the NHS for the next 10 years. That goes further than the amendment calls for and will be updated every two years in line with our manifesto commitment to publish regular, independent workforce planning. It is only because the Government have set such a clear direction for the service through the 10-year health plan that we can credibly set out a sustainable approach to staffing the NHS over the long term. As hon. Members will understand, workforce planning is a complex topic. It is closely related to the wider service planning, which is why we have engaged so widely with independent experts to develop...
I am happy with those assurances, so I beg to ask leave to withdraw amendment 33. Amendment, by leave, withdrawn. Amendment proposed : 50, in clause 7, page 4, line 32, at end insert- “(4) After subsection (2) insert- ‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’”- (Dr Caroline Johnson.) This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years. Question put, That the amendment be made.
Clause 7 ordered to stand part of the Bill.
Clause 8
Directions to exercise Secretary of State’s functions
Question proposed, That the clause stand part of the Bill.
Clause 8 will give the Secretary of State the power to direct integrated care boards to exercise his or her functions. This power, similar to that currently employed by NHS England, will promote subsidiarity by enabling such functions to be delivered at the lowest appropriate level. The clause builds on the existing section 7B of the National Health Service Act 2006, which allows the Secretary of State to direct ICBs but only in respect of public health functions. With our plans to abolish NHS England, the Secretary of State will again have broad powers and responsibility relating to the health service, and so this power encompasses a wider range of functions. Unlike the delegated frameworks set out under sections 65Z5 and 75 of the 2006 Act, which are entered into voluntarily, any integrated care board directed under this power would be obliged to carry out the stated functions. I reassure the Committee that, while the ICB will be legally responsible for how it discharges a function, overall accountability will remain with the Secretary of State. Furthermore, the Secretary of State might also use directions to place restrictions on the onward delegation of any functions, preventing delegation where it may be inappropriate. Finally, any directions must be published, ensuring transparency and allowing proper accountability. This measure will empower the Secretary of State to assign functions to ICBs where most appropriate. It aligns with and facilitates our broader direction...
Clause 8 is essentially about the control that the Secretary of State has over ICBs. When we discussed the clause abolishing NHS England, we talked a lot about the balance between democratic accountability on the one hand and independence from political interference on the other. The Government suggest that the Bill is a decentralising Bill. What this clause does is essentially to recentralise by default. As the Minister has just said, the Secretary of State can change what the ICB is doing if they think that it is inappropriate. What does “inappropriate” mean exactly, and how will that power be used? It may be used very infrequently-perhaps the current and previous Secretaries of State think that the power would be used infrequently-but equally it could be used in response to considerable pressure from MPs, lobbyists and campaign groups. Instead of issuing directions sparingly, we may end up in a position where the Secretary of State is issuing day-to-day instructions. The Government want ICBs to take greater responsibility for commissioning decisions, but then they want to be able to undermine them by direction from the Health Secretary. The Health Secretary will never have as good a grasp of the situation in the local geographic area as local leaders, but he has the power to tell them what to do and issue blanket instructions with different characteristics. That will be inherently inefficient. ICB leaders will be under pressure, knowing that if they make a particular...
It is a pleasure to serve under your chairmanship, Sir Roger. I agree heartily with the shadow Minister, and a couple of other things concern me about clause 8. On the one hand, the clause appears to bring more centralisation, but on the other hand it pushes things down to an ICB level at the same time. I am worried that if we have individualisation of ICBs, we will only exacerbate the disparity of services across regions. I would be interested to understand from the Minister how the Secretary of State’s functions will allow the independence of ICBs and, where an ICB understands its local population well, ensure that patients do not end up in a postcode lottery based on which ICB area they happen to live in. The danger here is that if the Bill does not deal with those problems and close regional gaps, it is not immediately clear from the clause how the Secretary of State could intervene to ensure that ICBs have the autonomy to make decisions based on their local populations and ensure at the same time that patients do not receive a worse service just because they happen to live in one ICB area rather than another.
I recognise that this is a subject of some debate; we may discuss it further when we come to the part of the Bill on ICBs. The abolition of NHS England and transferring all its functions to one body has a consequence, which is that the Secretary of State retains that accountability and power. We are keen to have that power clear but flexible in order to empower local systems. That remains the intent. The power is necessary for the Secretary of State to update national commissioning standards, for example. The ICBs will have wider roles as strategic commissioners. We expect them to take on formal responsibility for a number of services delegated by NHS England. That allows us to issue a common set of commissioning standards, on the point made by the hon. Member for Farnham and Bordon about variability in different places. There need to be common standards across the piece: eligibility criteria, the treatments the provider should use, and national reporting requirements. ICBs having those standards means that there will be a reduction in unwarranted variation in some of these events. The shadow Minister raised the timetable. The Opposition will recognise that there needs to be flexibility for the Secretary of State and Ministers to respond to unforeseen or changing events. That is why it is purposely broad, because the range of events that can impact the NHS is clearly very broad. We cannot predict the future. The hon. Member for Farnham and Bordon said that the Bill needs to...
The Minister is talking about flexibility. I understand that if a Minister is responding to an unforeseen circumstance, he or she may be very busy, but where a direction has been made, it should not take very long for a member of staff to publish it, because it will already have been written and sent. I understand that a Minister might take a day or so to sign it off because they are so busy, but it should not take months. The addition of a deadline is therefore not an unreasonable request.
With due respect to the hon. Lady, it is not a matter of the Minister being busy, whether that is me or anybody else. It is about the operational running of a £200 billion organisation with 1.5 million staff treating millions of people every day. I am sure we all remember from our own experience incidents and unforeseen events that have happened in the local system, and sometimes very tragic events that have required the Secretary of State to take action. We are trying not to increase the number of reports and documentation and to rid the system of bureaucracy by putting something out in that timeline.
Will the Minister give way on that point?
No, I have finished. Question put and agreed to. Clause 8 accordingly ordered to stand part of the Bill. Clause 9 Secretary of State’s power to provide assistance Question proposed, That the clause stand part of the Bill.
Clause 9, which will insert new section 12DA into the National Health Service Act 2006, will give the Secretary of State a clear statutory duty to provide financial, staffing or other practical assistance in connection with the health service. The power may be used to support persons providing, or proposing to provide, services as part of the health service or which are beneficial to the interests of the health service. It may also be used to support public authorities where the assistance relates to education or training for people employed, or considering becoming employed, in activities connected with the provision of health services. The assistance may include financial assistance, the services of civil servants or other resources of the Secretary of State, and it may be provided on agreed terms, including terms about payments by or to the Secretary of State. The clause will support the wider purpose of the Bill by enabling a small centre to act in a supportive and enabling way towards the wider system. Where appropriate, the Secretary of State will be able to provide assistance directly to those delivering or supporting health service activity. The clause is needed because the existing statutory framework does not include a clear power that enables the Secretary of State to provide practical support across the full range of health service activity. Relevant support may be financial, practical, staffing-related or connected with education and training. Without this clear...
In a system as large as the NHS, covering an area as diverse as England, it is necessary that the Government be able to deal with unexpected situations. The pandemic may be half a decade behind us already, but the Committee will remember that the previous Government had to act quickly and part with a lot of money in a short time. In such instances, it is essential that Ministers have the power to provide financial assistance. It is not only about crises, however; ordinarily, there are occasions when a Government will want to roll out a new prevention programme or address deficiencies in care in particular areas. I know that health policy is always evolving, and the case for flexibility is clear. The Health Secretary may need to be able to provide financial assistance in pursuit of supporting the health service. I am sure that hon. Members are familiar with the existing legislation. Section 12D of the National Health Service Act 2006 gives the Secretary of State, NHS England, an ICB or the local authority the ability to make direct financial payments as an assistance to persons or bodies. Clause 9 would new section 12DA of the Act, under which the Secretary of State would be empowered to provide assistance to any person or body carrying out, or proposing to carry out, activities that they deem beneficial to the service. This is where semantics are important. The existing legislation allows the Secretary of State to make payments, but clause 9 is different: it would allow the...
I endorse the comments made by my hon. Friend the Member for Sleaford and North Hykeham. I am particularly concerned about subsection (2)(a) of proposed new section 12DA. On examination, this provision raises significant concerns about the control of public expenditure and the efficient use of resources within the health service, and I find it rather vague. There is no definition of the terms used, no indication of scope and no express limitation on how the power is to be exercised. When read together with subsection (1) of proposed new section 12DA, the effect, as I read it, is to allow the Secretary of State to provide funding to an extremely wide category of recipients. That includes not only public bodies and established NHS providers but, as my hon. Friend the Member for Sleaford and North Hykeham has said, private entities, charities, individuals and any person engaged in activities that the Secretary of State considers to be beneficial to the health service. That breadth is not accompanied by a corresponding statutory safeguard. The clause does not set out criteria for eligibility, priorities for funding or principles to guide decision making. It does not impose limits on the sums that may be disbursed, nor does it require any structured process for allocating funds. There is no express provision for transparency, such as publication of decisions or reporting obligations to another body such as Parliament. That absence is significant. Control over public expenditure...
There is also a risk that such a provision will contribute to systemic pressures. The health service already absorbs a substantial proportion of public spending, and there are long-standing concerns about whether additional funding consistently produces the corresponding gains in efficiency or performance. A broadly defined power to provide financial assistance, unconstrained by detailed statutory controls, will reinforce that pattern, and may enable the continued allocation of funds without sufficient assurance that those funds are used in a disciplined and effective manner.
The clause’s reliance on what the Secretary of State, and I quote, “considers to be beneficial” further amplifies my concern, because that is an inherently subjective test. Without defined criteria, decisions may lack consistency and be even more difficult to scrutinise. Even where decisions are taken conscientiously-I would never suggest that the current Minister would do anything otherwise-the absence of clear standards will increase the risk of perceived unfairness or imbalance in the allocation of public resources.
There are also implications for existing funding and procurement frameworks. The health service operates through established mechanisms designed to promote fairness, competition and value for money. The broad power in this clause to provide direct financial assistance could cut across those arrangements by enabling selective support outside those structures. That may create inconsistencies between providers and reduce confidence in the integrity of any allocation process.
In concluding the debate on this part of the Bill, the Opposition have helpfully made most of my arguments for me. The hon. Member for Sleaford and North Hykeham opened with reference to the pandemic and the unusual circumstances in which we have found ourselves. It is obviously important that this Government learn the lessons from that pandemic in the round, that we are prepared and that, as NHS England is abolished, those powers come back to the Secretary of State so that we can respond to any eventuality that comes before us. As the hon. Member for Farnham and Bordon said, there are existing standards and rules of procurement. Any spending that happens through the Department and the NHS will be publicly recorded and published in the Department of Health’s consolidated accounts. Those come before Parliament, so there is direct transparency through the parliamentary process in the usual way and, as we all know and as the hon. Member for Farnham and Bordon said, Treasury rules apply. The point about the use of civil servants has been made. Again, it is really important that we recognise that we are bringing together NHS England, NHS staff and civil servants in the Department. It is right that the Secretary of State, in whatever eventuality comes before him or her, is able to deploy the right person for the right job, be they a civil servant or someone currently under NHS staff terms and conditions, to support that work going forward. The clause is necessarily flexible and...
I beg to move amendment 53, in clause 10, page 6, line 21, leave out from “interests” to end of line and insert “of patients”. This amendment would only allow the Secretary of State to vary the balance between the public and private sectors in the NHS where it is in the interests of patients to do so.
The Chair
With this it will be convenient to consider clause stand part.
This is perhaps the oddest provision in the Bill. Since time immemorial, the Labour party has accused its political rivals of wanting to privatise the health service. In the early 2010s, the then shadow Ministers indulged the idea that the Health and Social Care Act 2012 was a Trojan horse for privatisation. Several years later, after the Minister had herself joined the House, claims continued. The then leader of the Labour party urged the previous Government to “undo the very damaging privatisation of so much of our NHS”. -[ Official Report , 23 October 2019; Vol. 666, c. 960.] In the 2019 election, the public were even presented with a dodgy dossier-not Labour’s first-that purported to show that the NHS was on the table in negotiations for a trade deal. We now have a trade deal and the NHS is still intact. Even though Members know full well that no sensible opposition party is advocating for abandoning our NHS system, they keep saying that Governments have been selling off the health service through the back door. Today, private providers deliver only about 10% of NHS care and the system continues to be free at the point of use. That brings us to the deep irony of today’s debate. After years of peddling the NHS privatisation myth, the Labour party has introduced legislation to make privatisation possible. The Health and Social Care Act 2012 inserted a safeguard against privatisation, section 12E, into the NHS Act 2006. That section prohibits the Secretary of State from...
The shadow Minister has outlined a couple of hypotheticals for the future, when we have a different Prime Minister and a different Secretary of State. One might go down a route of more privatisation, another down a route of removing the private sector from health service provision. My concern is more practical and for the here and now: if the clause stands part of the Bill, it must be because the Government have some desire to do one of those two things now. Would it not be a good idea to hear from the Minister which of those two options it is?
It does raise questions about the point of new section 12E. That provision was not there before; there must be a reason for adding it. Either the Government want ideologically to reduce the amount of private provision in the NHS, or they want to increase it. The clause gives them the power to do both. Labour politicians very often tell the public that the NHS is being privatised. Data has shown that that is not happening, but that did not matter; they found the myth politically advantageous and repeated it ad nauseam. Now, the Minister and her colleagues are in office-they have the levers of power-and are proposing to change the law to make it easier to change the provider mix. That is not only ironic but deeply misguided. I tabled amendment 53 to require any changes to the provider mix to be in the interests of patients. If the Minister is unwilling to support that, will she offer a compelling explanation why? Clause 10 has alarmed stakeholders across the health sector and the political spectrum. That really ought to tell us something. I look forward to her response.
It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason. As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences-a bit like the deregulation of buses. In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers-that has worked well to bring down elective waiting lists, for example-the provisions to protect the mix are important. I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.
It is true that the situation in ophthalmology is now quite serious, but is the hon. Lady aware of the problems in radiology and pathology? Some hospitals are unable to recruit histopathologists or significant numbers of radiologists, who provide key services, because the personnel necessary to run those services have been attracted into a private system, although they are contracted to the NHS. That jeopardises the ongoing services for urgent and emergency care.
The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence. Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?
I will respond to that question before picking up the other comments. If I do not address all the Committee’s comments, I will come back to Members. Everyone would expect this, but let me be clear: this Government are absolutely committed to a free-at-the-point-of-use, taxpayer-funded service. We also think that unless it is reformed and changed, it is an existential problem for the British public, who will not continue to support the service. As Members know, one Parliament can never bind another one, so I cannot predict what a future Government will do. There is talk from some of our Reform colleagues about an insurance-based system. There are people who were in the Conservative party but have moved over who think that, so obviously I cannot-
Will the Minister give way on that point?
I will make some points, and then I will be happy take the hon. Lady’s intervention if I do not address what she was going to say. The hon. Member for North Shropshire outlined some of the history. This clause seeks to strike a balance. The governing principle behind it is that the decisions of the Secretary of State must not vary the proportion of providers by the type of legal entity that they are. Decisions must be taken according to what serves the health service and the people who depend on it. The clause permits, by way of exception, the balance between sectors to be varied purposefully, but only where doing so would be in the interests of the health service. That would, for example, prevent the Secretary of State from deliberately choosing to grow the proportion of NHS services delivered by private providers for solely ideological reasons. I understand the concern that drives the amendment. It is that the exception might be relied on to support the convenience of those already providing the service, without taking into account what is best for patients, as the hon. Member for Sleaford and North Hykeham said. That is not the Government’s position, and the clause does not lead to that outcome. The test that it creates is whether the interests of the health services are served. As the hon. Member for Sleaford and North Hykeham also said, the definition of the health service-as defined under section 1 of the National Health Service Act 2006-is not separate from the people...
I want to take the Minister back to her rejection of the amendment of my hon. Friend the Member for Sleaford and North Hykeham on the basis that-I paraphrase-she felt the definition of “patients” was too limiting because it would not count people who had not entered the health system at that point. The clause itself, however, refers to the benefit for the health service. Is the Minister suggesting that the health service, as defined in the Bill, includes what happens before people enter what I would describe as the health service? Is it something before that point? She seems to be saying that our definition is too narrow, but her definition in the Bill must apply to those who have entered some kind of formal setting. Or is the health service wider than that?
I refer the hon. Gentleman back to my comments. The health service is defined under section 1 of the NHS Act 2006 as not being separate from the people it exists to serve. It is defined as “a comprehensive health service” for “the people of England”, directed at improving their health and at the “prevention, diagnosis and treatment” of illness-so, yes. At this juncture, I will explain a number of other features of the clause. In particular, I draw the Committee’s attention to the fact that it builds on section 12E of the 2006 Act to cover the Secretary of State’s health functions, powers and duties. It recognises that, with the abolition of NHS England, the Secretary of State has a far more substantial role to play-as a commissioner of services, for example-than previously. I also put on the record that whenever the Secretary of State takes a decision in this space, the general NHS procurement requirements and other statutory duties will continue to apply. Finally, the NHS relies on privately owned providers, as well as charities and community organisations, to provide a range of important NHS-funded services across the country. As such, it is important to ensure that, where there is a mixed-market provision between public and private for providers of a particular service, the Government’s powers are not used to distort the provision and potentially discourage important investment from outside the NHS. Conversely, they should not be used purposefully to favour independent...
If I heard the Minister right, she said that the clause did not provide for changes on the basis of ideology. However, it says that changes are not to be made “unless the Secretary of State considers that to do so is in the interests of the health service.” A Secretary of State whose ideology is that the private sector is bad, good or whatever else could well believe that it is in the interests of the health service to be private or not private. How does the clause prevent an ideologically driven Secretary of State from changing the health service on the basis simply of his ideology, rather than of patient or clinical need?
The hon. Lady tempts me to delve into the politics of future Secretaries of State. They will respond according to the manifesto on which they are elected by the British public. That is the point of a democratically accountable public service. I think that the clause strikes that balance, as I have said. For those reasons, I hope that the hon. Lady will withdraw her amendment. I commend the clause to the Committee. Question put, That the amendment be made.
Clause 10 ordered to stand part of the Bill.
Clause 11
General power to direct integrated care boards
I beg to move amendment 47, in clause 11, page 8, leave out lines 15 to 30. This amendment prevents the Secretary of State from removing the Chief Executive of an integrated care board.
The Chair
With this it will be convenient to discuss clause stand part.
Clause 11 is particularly interesting. In August 2025, Alan Milburn was asked about the abolition of NHS England on the Health Foundation podcast. He said that the Government wanted to see a model that was “more delegated…more devolved” and “more diverse”, which necessitated the centre being smaller. Considering that he is a former Labour Health Secretary and a non-executive director at the Department of Health and Social Care, I do not doubt his understanding of what the Government wanted to achieve. When the former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), announced the 10-year plan to the House, he also talked about dissolving power. He spoke of a “brave new world of devolution of power, resources and control”. -[ Official Report , 3 July 2025; Vol. 770, c. 469.] That was repeated in the Government publications that accompanied the Bill: “Empowering ICBs as strategic commissioners will support putting patients at the centre of care by devolving decisions to a local level where different services can better integrate… Reforms to the NHS FT model will give providers more flexibility to design and deliver healthcare around local needs.” Between the announcement of the abolition of NHS England and the publication of the Bill, Ministers articulated a vision for a more decentralised system. There is expert consensus that decentralisation boosts performance, reduces health disparities and fosters innovation. After listening to remarks this...
Currently, ICBs are accountable to NHS England. Under sections 14Z61 and 14Z62 of the National Health Service Act 2006, NHS England is able to direct an ICB when it has failed to carry out its functions, is failing, or is at risk of failure. If failure were to occur, NHS England can, among other things, direct another ICB to assume its functions. It can direct the ICB or its chief executive to carry out a function in a particular way or within a particular timeframe, or it can fire the ICB’s chief executive and direct the board on their replacement.
Clause 11 would replace those sections of the 2006 Act with new powers exclusively for the Secretary of State. It is important to note that those new powers are broader in scope. Not only does the Secretary of State gain the power to direct ICBs that are failing or at risk of failure, but, through a new general power, they will be able to direct ICBs to carry out their functions. The explanatory notes point to several benefits of that power. The Health Secretary will be able to exercise “oversight of ICBs” and could
“set standards that ICBs must meet when exercising their commissioning functions… Directions can capture a level of detail that could not be included in primary or secondary legislation”.
That is pertinent to clinical pathways for particular services. Directions could also reduce “unwarranted variation”, including by “ensuring nationally consistent standards”.
These changes could bring material benefits. If the Secretary of State-rather than an arm’s length body-has oversight, the Government could be more responsive to issues that emerge in the health system. The Department said in its memorandum to the Lords Delegated Powers and Regulatory Reform Committee that the new general power for the Health Secretary to direct ICBs is “necessary to ensure” that they are carrying out their functions correctly.
As we heard in the evidence session, there is variation in the system that leaves some patients in an unenviable position. James Cooper from Together for Short Lives said that
“19% of ICBs currently commission end-of-life care for children at home 24/7, provided by nurses and specialist consultants.”
What about the other 81%? Mr Cooper also said that ICBs were
“not taking on their full functions and implementing national guidance”, -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 44, Q72.]
and he was clear that he wanted more. I am curious to know why NHS England has failed on that, given that it does have some powers over ICBs. Is the issue that NHS England has been asleep at the wheel, or that its powers are not strong enough? Will the Minister share her thoughts on that?
I return to the philosophical contradiction in the Bill. This reorganisation was meant to be about devolving power away from the centre, yet power at the centre-with the Secretary of State-is being strengthened, because ICBs, which are the devolved units in the system, are deemed to be underdelivering. From the Department’s perspective, is there such a thing as good and bad variation? It may be troubling to see that waiting times are better in some ICBs than in others, or that some ICBs commission around-the-clock end-of-life care for children when others do not, but is that not inevitable in a system in which commissioners are empowered to allocate resources based on an assessment of the needs of their own population? A decentralised system without variation surely cannot exist in the real world.
In their policy paper, “ICBs as strategic commissioners”, the Government are clear that they want to encourage ICBs to innovate and
“design new models of care”.
However, that will also create new variations across the health system. Those are not always bad, but I am not sure how the Government can achieve greater autonomy for ICBs, lower health inequalities and reduced variation across the system simultaneously, especially when the Secretary of State has strong powers to intervene. There is a lack of coherence, and at least one objective will surely have to give. There is a difference between taking back control and taking control of absolutely everything.
I recognise that there are safeguards in clause 11 against the Health Secretary making directions relating to the employment or treatment of a particular individual. Likewise, the Secretary of State will not be able to issue directions that contravene National Institute for Health and Care Excellence guidance. Those are sensible guardrails, but they do not go far enough.
Clause 11 gives the Secretary of State power to fire and hire ICB leaders as he sees fit. Should a political office holder be able to wield such power? NHS England was operationally independent, but the Secretary of State is not. This Government have shown themselves to be highly political on health, not least by not taking any reorganisation advice from Lord Darzi, but also on clinical matters such as puberty blocker trials and their shambolic handling and delaying of the RSV vaccinations. The Secretary of State must be able to act if an ICB is failing, but should the power to fire and hire healthcare leaders be in the hands of politicians?
I remind Members what Jon Restall of Managers in Partnership said in our evidence session. His verdict on the Bill was:
“On the whole, it is probably more of a centralising measure.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 79, Q122.]
When we discussed clause 8, I highlighted the risk of a chilling effect. If ICBs are operating under the spectre of political intervention, they are less likely to engage in the innovation and risk taking that Ministers seem to want. If ICB leaders step out of line by doing something that the Government dislike, they do not just face interference or micromanagement; they are staring at a P45. We have sought to address that by tabling amendment 47, which would amend clause 11 so that the Secretary of State did not have the power to remove the chief executive of an ICB.
The former Health Secretary, my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), said that the health system has too many targets. In our evidence session, he said that abolishing NHS England makes sense only if the intention is not to increase control and impose more targets. The centre is responsible for 18 monthly operational targets for hospitals and 44 quality and outcomes frameworks for GPs. My right hon. Friend wrote yesterday in a newspaper:
“Every new health secretary is told by No 10 to ‘grip’ the service. Every time, the response is a new target.
The result is learned helplessness… They are micro-managed to deliver ‘improvement trajectories’, leaving them little time for the innovations that boost productivity.”
That is a sobering assessment. It is why Members should be concerned that clause 11 paves the way for more command and control issued from Whitehall.
Once organisations are judged by certain metrics, they, not the broader quality of service provided, become the primary objective. As is often said, when a measure becomes a target, it may cease to be a good measure. Could the Minister reassure Members that the Health Secretary’s new powers of direction will not be used to lay additional targets upon additional targets on providers?
The powers in the Bill for taking control of everything risk the creation of a politicised service in which those who shout the loudest get preferential treatment. Several groups have indicated their desire for the Secretary of State to issue directions to reduce variation in service, but what about those we have not heard from? We have debates in the House about screening for some conditions and treatment of others. What about all the conditions we do not hear about-the ones that do not have a celebrity campaign behind them?
How many Members on the Government Benches have heard of corticobasal degeneration, Wiskott-Aldrich syndrome, Lafora body disease, Friedreich’s ataxia or maple syrup urine disease? Are ICBs failing to deliver appropriate care for people with those conditions? Who is publishing the data for us to know? How will we ensure that celebrity campaign groups to the Secretary of State do not distort the priorities of the health service, which should be clinical need, not the ability to pay or have a celebrity shout for you? If the Minister is not able to answer the question today, would she be willing to write to me on that matter?
The Government set about abolishing NHS England with a vision to devolve power away from the centre. It was a laudable vision that the Opposition were willing to row in behind, but the legislation before us is far from that vision. The Government are giving more responsibility to ICBs and expecting more from them, while at the same time giving the Health Secretary more powers to micromanage them, all while under immense pressure to cut their running costs by 50%.
In a report published on 1 May, the NHS Alliance said:
“Trust and ICB respondents indicated that we are likely to see an increase in services being reduced or closed this year. More than a third (35 per cent) stated that their organisation cut services in 2025/26, with 64 per cent saying they expect to do this in 2026/27.”
The Government are cooking up a disaster. More responsibilities, more micromanagement, less money and cuts to frontline services-that is not what the Government promised, nor the vision they described, but it appears to be what they have achieved.
I am sure this will elicit a smile from the Minister, but once again I remind her of past comments. During the passage of the Health and Social Care Act, she said:
“Politically we might disagree with the centralisation of the NHS and the diktat as opposed to the permissiveness. I am definitely on the more localised, permissive side.” -[ Official Report , 14 September 2021; Vol. 700, c. 223.]
On another occasion, speaking again on the legislation, the Minister said:
“As I said in Committee, this is fundamentally another NHS reorganisation Bill. It is a restructuring of the NHS and a centralisation of power within the NHS. It does not nothing to achieve integration and nothing to improve accountability to the public, to patients and to communities… It is clear that centralising control in the NHS is very much the wrong approach. Local representatives need much more power over local services, and accountability needs to be much better at a local level.” -[ Official Report , 30 March 2022; Vol. 711, c. 941.]
I appreciate that Ministers may be frustrated after the election, pulling levers only to find that they are not attached where they thought they were, or even to anything at all, but I find it hard to reconcile what Ministers previously said, given the strength and universality of those comments, with what they have sought to do in this Bill.
I understand the Government’s intention in clause 11, but it is unnecessarily sweeping. Ministers promised to let go of the steering wheel, but in practice they have installed a larger one. The hon. Member for North Shropshire hit the nail on the head when speaking during the Bill’s Second Reading:
“This Bill focuses on shuffling responsibility around Whitehall and gives the Secretary of State the role of chief micromanager.” -[ Official Report, 1 June 2026; Vol. 786, c. 909.]
The gap between what was promised and what is being offered has left the British public wondering: did the Labour Government really believe that power was too concentrated, or that power was concentrated in the wrong hands? I hope the Minister will enlighten us.
I mentioned in Committee last Thursday that the Liberal Democrats are worried about the risk in the Bill of political capture and the Secretary of State’s ability to meddle in day-to-day operations. As I am sure the Minister is aware, speaking at the NHS ConfedExpo this month, Sir Jim Mackey, the chief executive officer of NHS England, warned that the Bill may give Ministers too much control and that there has to be operational freedom; otherwise we will grind to a halt. I want to probe the process by which we got to this point. Originally, there was discussion about whether the seven NHS regional teams should become independent arm’s length bodies to mitigate such a risk. NHS leaders argued that this would mitigate the risk of direct political control of the service and pointed out that the 10 regional strategic health authorities had played a useful role in running the service efficiently before the creation of NHSE. That proposal was rejected by Ministers, and it is not entirely clear why. I am interested to hear the Minister’s view on that. It is now being reported that a fresh attempt is being made to argue that regional teams should be hosted by an NHS organisation-probably an ICB-to protect their employment terms and, as staff would remain public rather than civil servants, provide some brake on political control. Can the Minister shed any light on all this? Does she recognise the importance of maintaining operational freedom in NHS decision making? We have discussed...
I rise to support amendment 47, tabled by my hon. Friend the Member for Sleaford and North Hykeham, and to ask a few questions about clause 11. I completely understand the thinking behind the clause. The Secretary of State for Health and Social Care is probably the most politically impotent of all Secretaries of State: as my hon. Friend said, they pull levers and not much seems to happen, because they do not have the control over the health service that the public think they do-or indeed, that Members of Parliament think they do, judging by the number of us who stand up and demand that the Secretary of State do things in our local areas. I understand the Government and the Secretary of State’s desire to change some of that, but there is concern about the potential politicisation of NHS leadership. Integrated care boards were established in various forms under the Health and Social Care Act 2012 precisely to remove politicisation to ensure that decisions in our healthcare service were made for the benefit of patients on the basis of clinical evidence and the needs of the local population, not on the whim of any Secretary of State or Minister. More importantly, ICBs were brought in to make sure that local health systems, local authorities, clinicians and communities made decisions based on local need. Those politically independent ICB chief executives were expected to exercise professional judgment, make difficult decisions about priorities and resources and sometimes deliver...
We have a clear political and-as I think the hon. Member for Sleaford and North Hykeham said-philosophical division here. This Government believe in democratic accountability, in politics and in good government. I understand that both Opposition parties were architects of the 2012 Act, which created this huge, independent body to run what has become a £200 billion service that clearly has not worked, and that they want to hold on to some of that, despite not opposing the Bill on Second Reading and, actually, not really opposing the abolition of NHS England-I think we will keep returning to that-but we believe that, ultimately, the Secretary of State needs to be accountable for the service, which is not working as the British public deserve or expect. The hon. Lady asked me to go into good variation and bad variation. Our drive has been to understand the variation. I know from Members of Parliament who have come to me in the past two years, and we understand from looking in detail at the variation across the service, that there is often no rationale for the variation. Local people do not understand why services work better in one part of their county, even, than in another. The hon. Member for Farnham and Bordon alluded to that when he mentioned some places in his area that are working better than others. That is why-and I personally wanted to drive this very strongly-we are getting more information out, releasing the outcomes framework and releasing information to all...
I could not agree more with the Minister that when there is an obvious failure, either in a local system or in a trust, we would hope that the Secretary of State will intervene. She will know from our experience in Shropshire that, when a system is failing or underperforming, that intervention is welcome. But the Bill gives the Secretary of State power to intervene even when things are going well, which is quite an extension of power. Will the Minister comment on that?
I thank the hon. Lady for that intervention, and I will come on to the power. As hon. Members are aware, NHS England currently holds similar powers, so it makes sense for these powers to be held by the Secretary of State once NHS England is abolished. I want to be clear-I hope that this will address the hon. Lady’s point-that our intention is to use these significant failure powers rarely and not as a first port of call. It is far better to work closely with ICBs and their leaders to spot issues and work collaboratively to resolve them before they have the opportunity to become significant, but it would be irresponsible not to have the power to intervene as a last resort. I want to address the other elements of clause 11. The first part of the clause establishes a general power for the Secretary of State to direct integrated care boards about the exercise of their functions. Using that power, the Secretary of State could direct a singular ICB, a group of ICBs or all ICBs, depending on the scope of the direction. This power is a necessary step in restoring democratic control over the NHS. The public rightly expect Ministers to be able to set priorities, drive improvements and set out how they expect the NHS to operate. For example, we expect to use the power to set up and update national commissioning standards. The power is particularly relevant given the wider commissioning responsibilities ICBs will have in their role as strategic commissioners following the abolition of...
Clause 11 ordered to stand part of the Bill.
Ordered, That further consideration be now adjourned. - (Emma Foody.)
Adjourned till Thursday 25 June at half-past Eleven o’clock.
Written evidence reported to the House
HB61 Just Fair
HB62 Provider Public Health Network
HB63 Nuffield Trust
HB64 Dr Mary Guy, Research Fellow, Trinity College Dublin
HB65 Association of Anaesthetists
HB66 Sickle Cell Society
HB67 Healthwatch England (supplementary submission)
HB68 Henry Burkitt, Managing Director, Oxygen Strategy (re: clause 58 (NICE compliance period))
HB69 A coalition of six homelessness charities: St. Mungo’s, Homeless Link, Groundswell, Single Homeless Project, Crisis and Pathway
HB70 Healthwatch York
HB71 Patient Experience Library
HB72 Association of Optometrists
HB73 Care Quality Commission (CQC)
HB74 Healthwatch Redbridge
HB75 Royal College of Paediatrics and Child Health
HB76 National Children’s Bureau on behalf of the Health Policy Influencing Group (HPIG)
HB77 Specialised Healthcare Alliance (SHCA)
HB78 The College of Optometrists