Health Bill (Thirteenth sitting)
House of Commons · Public Bill Committees · 7 Jul 2026 · 331 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, Dr Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
† Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
† Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Tuesday 7 July 2026
(Afternoon)
[Emma Lewell in the Chair ]
Health Bill
Clause 59
Transfer of HSSIB’s functions to CQC
Question (this day) again proposed, That the clause stand part of the Bill.
The Chair
I remind the Committee that with this we are discussing the following: Amendment 55, in schedule 8, page 110, line 23, at end insert - “(10) If the Secretary of State certifies that it is in the interests of national security that the powers conferred by subsection (1)- (a) should not be exercisable in relation to certain premises in which there is a Crown interest, or (b) should not be exercisable in relation to certain specified premises for other purposes, those powers are not exercisable in relation to those specified premises. (7) In this section, “Crown interest” means- (a) an interest belonging to a government department or held in trust for His Majesty for the purposes of a government department; (b) an interest belonging to His Majesty in right of the Crown; (c) an interest belonging to His Majesty in right of the Duchy of Lancaster; (d) an interest belonging to the Duchy of Cornwall.”. This amendment makes provision for the Secretary of State to disapply investigation powers under subsection 51J(1) to the Health and Social Care Act 2008, inserted by Schedule 8 of this Bill. Amendment 56, in schedule 8, page 116, line 8, leave out subsection (9). This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance. Amendment 5, in schedule 8, page 120, line 16, at end insert- “(2A) After paragraph 6(8) insert- “(9) A committee of the Commission is to be appointed in accordance with regulations. (10) The purpose of the...
My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.
The shadow Minister is absolutely right. Perception is a problem, but the reality on the ground is perhaps an even greater problem. Both are issues here with what the Government plan. There could be a reason why this merger, or the abolition of the Health Services Safety Investigations Body, needs to happen, but we have not seen that compelling argument. We have seen some attempts at justification, but they seem to be incredibly thin-and that is being generous. The principal argument seems to be that there is a busy and confusing landscape when it comes to investigatory and regulatory bodies. The figure Dr Dash put forward was something like 150 different organisations; she was asked to review just six of those. Even if she were to have abolished all six, it clearly does nothing to reduce the busy and confusing landscape. My hon. Friend the Member for Farnham and Bordon made that point well. A busy and confusing regulatory landscape should not be a justification for getting rid of an essential investigatory body and disincentivising the investigation process and whistleblowing and disclosures, by tying it up with the regulator, which itself may be at fault. Streamlining and dealing with a busy and confusing landscape are objectively good reasons to do something, but not this. That is the central point. As my hon. Friend the Member for Farnham and Bordon referred to, the question was put to Dr Dash, the author of the recommendations, when she gave evidence: what happens if...
It is a pleasure to serve under your chairship, Ms Lewell. The question is what will make patients more safe. Does incorporating the department that looks at safety into the organisation that inspects the services help? It might. Safety is not an add-on; safety must be at the heart of absolutely everything that we do. Safety is not a separate matter; it depends on those who work in our NHS and all of us all the time. That must be the culture. Let us not rely so much on inspections and litigations. At a time when we are unable to find jobs for newly qualified midwives, we spend more on obstetric litigation and compensation than we spend on obstetrics. I applaud what our Government are trying to do and their intention to improve things.
It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB. Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety-in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here-and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully. For people here and those reading our deliberations, what is difficult about the Bill-we understand this as legislators-is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us. Among all the discussions, there are a couple of key questions that I want to address,...
Will the Minister give way?
I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it. To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report. The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six...
I listened carefully to what the Minister said about a change of culture. A change of culture can certainly happen. In the surgical world, we used to bring patients into the operating theatre, check that the patient was on the operating table and do the operation. Sometimes, we operated on the wrong patient and on the wrong part of the body. We then introduced the World Health Organisation checklist, which checked absolutely everything before we started. It was a complete change of culture in the operating department. We made sure that we had the right prosthesis, the right patient and that we were operating on the right part of the patient. Now, the WHO checklist is a universally adopted process. I am absolutely sure that the culture in the health service can change.
I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.
Will the Minister give way?
I want to make some points first. I will pick up any outstanding points I do not cover. The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action. Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said: “by bringing HSSIB into the CQC, you can align the work of the two. For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB-that team of people with specific expertise-‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.] to enable best action. These organisations can learn better from each other. Transferring investigation powers...
The safe space issue is really important. I have said it before, and I will say it again: the Bill protects safe spaces. Safe space protections will continue to apply following the transfer of the investigation powers to the CQC. Sensitive information obtained by the CQC during the course of an investigation may not be disclosed to a third party by the CQC or its investigators, as is currently the case for the Health Services Safety Investigations Body.
The Bill sets a high bar for exceptions to this prohibition on disclosure. The Opposition raised that issue, so I wanted to address it. The limited circumstances in which disclosure may be permitted are set out in the Bill, and the CQC will appoint a designated responsible person-we envisage it being the chief executive-who will be responsible for decisions relating to the disclosure of protected information, ensuring that any such decisions are made consistently and in accordance with the statutory framework. The CQC has provided assurance that the high bar for decisions to disclose in exceptional circumstances will be upheld. That will ensure that disclosure to the regulatory function may only occur when a statutory exception is met, providing confidence to stakeholders that safe space is maintained at the same level and strength as under HSSIB and that it will continue to be an integral principle to investigations.
The other issue that was raised by Opposition Members concerned the CQC looking into itself. I reassure the Committee that the CQC’s investigatory function will be empowered to do that if necessary. The investigations function within the CQC will have autonomy to launch investigations into any part of the health system, including other parts of the CQC if required, and make recommendations to any part of the system, just as HSSIB does now.
On that point, will the Minister briefly give way?
No. There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that. I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.
Will the Minister give way?
I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership. I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that. The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit. Amendment 56 would...
My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?
I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction. The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies. New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose. Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That...
The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?
We are probably not going to agree on this point. I have made the point several times-and we made it in the Dash review-about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp. Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change. I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the...
Clause 59 ordered to stand part of the Bill.
The Chair
Does any Member wish to press amendment 55 to a Division?
The Minister has reassured us that, although it has not been lifted and shifted from the original, the amendment is a duplication of another clause. Therefore, we believe the Committee-
The Chair
Order. The Member just needs to say whether she is pressing it to a Division.
No, I am not. Schedule 8 Transfer of HSSIB’s Functions to CQC
Amendment proposed : 56, in schedule 8, page 116, line 8, leave out subsection (9).- (Dr Caroline Johnson.)
This amendment would allow the Commission to recoup charges in excess of the costs incurred in providing assistance.
Question put, That the amendment be made.
Schedule 8 agreed to.
Clause 60
Transfer schemes in connection with abolition of HSSIB
Question put, That the clause stand part of the Bill.
Clause 60 ordered to stand part of the Bill.
Clause 61
Transfer schemes under section 60: taxation
Question put, That the clause stand part of the Bill.
Clause 61 ordered to stand part of the Bill.
Clause 62
Reviews and investigations of commissioning
Question proposed , That the clause stand part of the Bill.
Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State. On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48. NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the...
I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?
My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong. Question put and agreed to. Clause 62 accordingly ordered to stand part of the Bill. Clause 63 Time limit for bringing proceedings Question proposed , That the clause stand part of the Bill.
The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help. Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action. The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal...
As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.
Apologies-I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?
The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question. The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent. The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?
Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention. Question put and agreed to. Clause 63 accordingly ordered to stand part of the Bill. Clause 64 Abolition of Healthwatch England Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss the following: Schedule 9. New Clause 74- Report on the abolition of Healthwatch England - “(1) Within 12 months of the passage of this Act, the Secretary of State must lay a report before both Houses of Parliament on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs. (2) The report must consider- (a) the effectiveness of escalation routes for complaints, (b) the ability to receive responses to complaints from the relevant ICB officer, (c) accountability of ICB CEOs for delivering new functions arising from the abolition of Healthwatch; (d) independence in the delivery of patient surveys, and (e) ability to investigate organisations from which the ICB commissions services. (3) The report must make recommendations about how any issues identified under subsection (2) may be mitigated.” This new clause would require the Secretary of State to publish a report within 12 months of the passage of this Act on the impact of the abolition of Healthwatch England and transfer of Healthwatch England's functions to ICBs. New clause 78- Healthwatch funding - “(1) The Secretary of State, must within 12 months of the passing of this act, enact a scheme to fund Healthwatch England and local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14. (2) The Secretary of State must consider uprating this funding with...
The Chair
I call the Minister.
This is a popular clause, Ms Lewell-and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.
Taken together, the clause and schedule provide for the abolition of Healthwatch England, which is a step that we are not taking lightly. I want to pay tribute to everybody involved in this work. In some areas, Healthwatch has played a really important role in amplifying the experiences of patients, families and carers, and those insights have helped shape services over many years, but the system for capturing feedback has become fragmented, with multiple routes for producing large volumes of information without clear ownership or, crucially, the action and impact to make the necessary changes.
The arrangements we have divorce those listening to patients from those with the power to make change. The patient voice was left on the outside lobbying in, too far from where local commissioning and national policymaking decisions take place. As set out in the 10-year health plan, we are simplifying the landscape so that listening to patients and users is not something done at arm’s length and not something that has to be done as part of the commissioning process as a box to tick, but fundamental to the commissioning process and the work of these organisations-a core responsibility at the heart of Government and across the NHS and local authorities. That is why we are bringing patient voice in house to give it a greater profile at the national level within the reformed Department of Health and Social Care.
That will lead to a step change in how the Department considers patient experience as an ongoing part of national policymaking. We will appoint a director of patient experience within the Department, who will be responsible for overseeing a more coherent approach. That will include stronger national surveys to collect feedback, a reformed complaints process that is easier to navigate, and clearer local arrangements so that concerns are heard early and resolved quickly.
The creation of the new patient experience directorate does not need legislation. However, the requirements in the Bill for the Secretary of State to oversee and have the ability to issue guidance to ICBs and local authorities on best practice for obtaining user views will ensure that the Department plays a central role in strengthening patient voice and holding the system to account. The patient experience directorate will also ensure that the experience of diverse communities and seldom-heard groups feed into the design and delivery of services. This will in turn help improve experiences and outcomes and reduce inequalities.
I know that some across the House and the Committee are worried that the abolition of Healthwatch England could weaken the patient and user voice. I cannot stress more clearly that that is absolutely not our intent. Our intent is the exact opposite. We want to make feedback easier to give and, crucially, harder to ignore and more directly linked to improvement. Patients and users should not have to work out which organisation to tell. The Government should be accountable for listening and taking action.
I remind hon. Members that there is no shortage of independent outside scrutiny of Government and the NHS, from the Parliamentary and Health Service Ombudsman to the Patient Safety Commissioner, now sitting within the Medicines and Healthcare products Regulatory Agency, along with a wide number of voluntary, community and social enterprise sector organisations, which we will all know well from our local communities. We have not lacked recommendations; rather, as we have heard in recent debates, we have lacked the actions to fix the issues that they address. That is why this clause, to bring patient voice in house at the Department, is vital. It will ensure that patient and user insight informs policy and decision making at the highest level, where it cannot be ignored. I therefore commend the clause to the Committee.
Clause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England. Members may be familiar with the term “nothing about us without us”-the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change. Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out...
For over 50 years, there has been a statutory independent patient voice in the health and care system. The creation of Healthwatch was, in part, a direct response to the issues raised by the Francis inquiry into Mid Staffs. In a 2024 Healthwatch poll, almost a quarter of NHS patients said that they had experienced poor care in the past year, but 56% of them-more than half-took no action. Of that 56%, 20% said that that was because they were scared that giving negative feedback directly to NHS services would affect their ongoing treatment. Women, people living in areas of greater deprivation, disabled people and unpaid carers were significantly more likely to give the fear of retribution as a reason for not speaking up. The Government are stripping patients of their voice in our NHS. Rather than being able to go to an independent body and express how the NHS can work better for them, patients will now be able only to give feedback to the same organisation that might have failed them. I have had experience of that in the past few weeks. My partner Emma has endometriosis, which has been an ongoing condition. She was worried that speaking to the local hospital trust specifically about the treatment she received might affect her treatment going forward. The Government have argued that the changes will bring patient insight closer to decision making, making it much more effective at securing change. The former Health Secretary, the right hon. Member for Ilford North (Wes...
I am a member of the Health and Social Care Committee, and the hon. Member is absolutely right to say that Healthwatch England raises issues with us. When the Department assumes those roles and functions, I very much doubt that it will be as keen to disclose such issues to the Committee.
The hon. Gentleman must have read the next line of my speech. We are concerned that a DHSC employee appearing before that Committee will not clearly and openly state whether DHSC is failing. New clause 78 “would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care” in 2013-14. We do not just want to protect Healthwatch; we want to strengthen it. As I mentioned, it receives almost £26 million a year, which is spread over 153 organisations. In real terms, that is about 60% less than the £43.5 million that DHSC originally estimated would be needed to fund the network. The Healthwatch network does such amazing work-I will not go through it all again-despite being underfunded compared with those original estimates. Imagine the work it could do if it was adequately funded. Even more worryingly, there is still no clarity on how Healthwatch’s functions will be funded once they have been transferred to the new system. Given the ongoing constraints and cuts to ICB running costs, there is a real risk that the funding for Healthwatch will simply end up being incorporated into wider ICB budgets, and money for the patient experience infrastructure could end up being cut entirely. The new clause aims to ensure that the Healthwatch network is properly funded, but it also raises the point that, if this change is to go through, funding for patient experience infrastructure must be protected....
It is, as ever, a pleasure to see you in the Chair, Ms Lewell. Healthwatch was established, at least in part, as a response to the Mid Staffs scandal. Mid Staffs came up three times in our evidence sessions, and the hon. Member for Winchester mentioned it just now. That scandal matters to everyone, but it has a particular resonance for my role in Parliament. Many of my constituents were harmed by the failing at Mid Staffs. I was born in that hospital, and I speak as a Staffordshire MP. None of us should ever forget what happened or allow it to be swept aside without examining it. There were a great many failings at Mid Staffs over a long period. Oversight was just not in the room when decisions were being made. Staffordshire county council’s health and care overview and scrutiny committee clearly did not do that job. The Francis report stated: “The arrangements for public and patient involvement, and for local government scrutiny in Stafford, were a conspicuous failure.” The report recommended some changes to ensure that Healthwatch, which was in the process of being set up at the time, was funded properly. In that light, the framing of this debate is important and timely. Healthwatch has been going for well over a decade. It is right that we now examine its impact, as it is a significant part of patient voice within the NHS. Despite the very best efforts of a great many hard-working staff and an army of committed volunteers across the country, the quality of local...
We heard in evidence that the reason for that variability was a lack of funding. Would the hon. Gentleman support our new clause 78, which tries to deal with the lack of funding and ensure a consistent service from Healthwatch across the country?
Funding Healthwatch is really important, but to address the issue properly, we must make sure that Healthwatch is in the rooms it needs to be in. Funding needs to be part of the process that ICBs follow. I will touch on that later, so the hon. Member will hear further thoughts on the matter. Local healthwatch organisations across all our constituencies have an important role. At the local level, they are geographically bound to counties. In constituencies like mine and that of the hon. Member for North Shropshire, those geographical areas are huge. The health disparities within my constituency, with two towns that are 4 miles apart, one with a significant mining-
I hesitate to intervene on the hon. Gentleman, because he seems to be straying into the next grouping and I do not want to encourage him down that route, but now that he has raised it, I share his concern. I do not know what it is like in his area, but the ICB areas that local branches of healthwatch will be absorbed into are even larger than counties. In my area, Surrey and Sussex make up three administrative counties. That is an even larger area. The provisions are clearly not the solution to the problem that the hon. Gentleman is outlining.
In isolation, that criticism would be legitimate, but, alongside other changes being introduced, there are ways to mitigate that problem. I am concerned that local healthwatch branches are not truly local. The healthwatch in Staffordshire has not held an event in my constituency for a number of years. I think its last three events were just volunteer fairs to get more volunteers involved. That is not to say that there are not significant numbers of people there who work very hard to support people in their engagement with the health service, but geographic changeability is real. On a national scale, Healthwatch England has a huge role to play.
I will use the example of maternity services to assess the impact of Healthwatch-despite the best efforts of those involved, those services show that it is not working particularly well. After the Mid Staffordshire scandal, there were issues with a large part of the Staffs trust, but it was particularly pronounced in maternity.
Healthwatch was set up in 2013; two years later, the Morecambe Bay report came out. A lot of what that report addressed was historical and happened before 2013, but there was very little mention of things starting to change in the intervening two periods. One of the recommendations in the Morecambe Bay report was that
“The Trust should increase public and patient involvement in resolving complaints”.
The report also concluded:
“The NHS complaints system in the University Hospitals of Morecambe Bay NHS Foundation Trust failed relatives at almost every turn. Although it was not within our remit to examine the operation of the NHS complaints system nationally, both the nature of the failures and persistent comment from elsewhere lead us to suppose that this is not unique to this Trust. We believe that a fundamental review of the NHS complaints system is required, with particular reference to strengthening local resolution and improving its timeliness”.
It does not sound like patient voice was particularly close to decision makers in the situation at Morecambe Bay.
Six years later in 2021, the East Kent report stated that
“The Trust...used high-level information inappropriately as reassurance, taking comfort from the grouping that at least there were other trusts in the same boat. At times, it has used this false reassurance as a bolster against the plethora of evidence from other sources that there were very significant problems in its maternity services.”
It seems that decision makers were bound by the directorates in the NHS-by their bosses and the structures that exist to hold them to account. Healthwatch’s independence-or, in this case, remoteness-meant that decision makers were not hearing patient voice as they should have been, which had disastrous consequences for huge numbers of families.
Five years on from that, Baroness Amos’s report on maternity and neonatal care, which was published just last week, repeatedly mentions that mothers were not listened to. One recommendation in the report is for maternity services to
“Engage meaningfully with women, birthing people, families, and representative groups to inform priorities and decision-making, and champion approaches to listening to women and families that lead to visible action and change.”
The final part of that recommendation-“lead to visible action and change”-is so important. I was taken by the point that the hon. Member for Winchester made about Healthwatch publishing research. That is great and valuable, and that research will obviously be helpful, but if Healthwatch is not in the room with the commissioners and decision makers, will any of it lead to visible action and change?
I am not in any way down on the hard-working Healthwatch staff and committed volunteers. They work hard to achieve things for their communities, but they are not given the structures needed for visible action and change. Yes, changes to Healthwatch will come, which will be a challenge and come with risks, but I am impressed that, by moving the responsibility for patient voice to the room with the commissioners, so that one of their key responsibilities is to listen to patient voice, the Bill gets over the barrier of remoteness. It puts patient voice in the heart of the room and in front of the people making decisions. As we have seen for more than a decade, there are many hard-working people, and thousands of recommendations are not necessarily being acted on-as Opposition Members said in long speeches this morning. We need to get patient voice into the room with the decision makers.
Will the hon. Gentleman give way?
I will make some progress. There are concerns that if we roll some responsibilities into ICBs or councils, the Department needs to make sure that the issue does not get pushed to the side and that the funding does genuinely remain for patient voice. I am reassured that there will be a patient experience directorate within the Department. That will bring decision making and the patient voice into the Department while also keeping an eye on what is happening with those ICBs and ensuring that they have standards to hit. The Department needs to ensure that it is sharing good practice and keeping oversight of local authority commissioning of social care. The CQC is starting to do that, and there are some positive indicators. There is obviously more work to do, and we need to stay on top of it because, as I said earlier, there are risks whenever there are changes to healthcare. I am reassured that bringing the patient voice into the room with decision makers is the right way to enact change.
Will the hon. Gentleman give way?
I am just about to conclude, so I will allow the hon. Lady to come back when she makes her speech shortly. The final point I want to make is about local government. I hope the Secretary of State will issue guidance on how local government will commission adult social care services. I also hope we will get annual reporting from ICBs and local councils on how they are using the patient voice. I know that the Secretary of State will have the ability to intervene, and I would expect him to do so should those reports show that the patient voice is not being used, is not finding its way into the room or is not leading to the meaningful change that the Amos report suggests.
I will confine my remarks to group 47, conscious that the next group will give us an opportunity to discuss local arrangements, so I will stick to the national ones. We are all aware of the significant role that Healthwatch England plays, as well as its popularity and the trust that many people place in it. As a former Minister in the Department, I was on the receiving end, on occasion, of some sharp-or firm-suggestions from Healthwatch England, but that is what it was there for. It was there to be the grit in the oyster. It often made useful suggestions, and its independence meant that it could put reports not only to me but to the public-it published them. It could give them, for example, to my hon. Friends who served on the Health and Social Care Committee and, if it wished, go to the media to make sure that that voice was heard. That is where, for me, the challenge with what is proposed comes in, because a new directorate in the Department, staffed by civil servants, will simply not be able to do that. We all know that those who work in a Department, however excellent they are, report upwards ultimately to the permanent secretary and to Ministers. They are answerable to the political leadership of the Department. Would they be able to decide that something was coming through regularly from patient feedback and publish it independently, without ministerial approval or that of the permanent secretary, or hand it to the media? Would that director be able to champion the...
I rise to speak to new clause 74 on behalf of my hon. Friend the Member for Rugby (John Slinger), who is in the Gallery, and also to some extent on behalf of my predecessor, Jo Churchill, who was the Member of Parliament for Bury St Edmunds and Stowmarket before me, and was also a Health Minister. This is about Healthwatch and the patient voice. The amendment tabled by my hon. Friend the Member for Rugby suggests that the Secretary of State create an impact report within 12 months of the Bill passing through Parliament to assess what the impact of the amalgamation or integration of the functions of Healthwatch into the ICB would in fact be, and in particular look at the effectiveness of the complaints procedure and the way in which complaints were responded to. The theme is also that which we spoke about this morning on whether an organisation can successfully interrogate itself. I believe that with the appropriate safeguards it probably could, but I do think that the suggestion that there ought to be a formal report on the impact within 12 months is something worth considering.
It is a pleasure to serve under your chairmanship again, Ms Lewell. I think right hon. and hon. Members will be disappointed to know I am not going to speak too long on this, but they need not worry: in the next grouping, usual service will resume. I want to pick up a few points on the abolition of national Healthwatch. When we took evidence from Sarah Woolnough of the King’s Fund, I asked her a fairly open-ended question about when she gave evidence at the Health and Social Care Select Committee. I put it to her that she “seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 15, Q23.] She gave me an answer that essentially said it could all be done without the need for the reorganisation that is in the current NHS Bill. I then asked Mr Jacob Lant, a representative from National Voices, whether he would agree with that and, unprompted, because I did not mention Healthwatch in my question, he replied: “Yes. I kind of think, as the debate goes on, that-with the changes to Healthwatch in particular-you could achieve so much without legislation. You could beef up the internal functions for listening to a patient and engaging with them without legislation-there is no requirement for that. You could invest more resource in that, and you could do the same with Healthwatch.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 16,...
New clause 74 was tabled by the hon. Member for Rugby, and the hon. Member for Bury St Edmunds and Stowmarket spoke to it. I have a lot of sympathy for what the hon. Member for Rugby is trying to achieve here. Clearly-I hope that I am not putting words in his mouth-he tabled it because he has similar scepticism about the effectiveness of what the Government are proposing; otherwise, why review it?
There are some problems. The new clause mentions complaints but, although I fell into this trap when talking a moment ago, Healthwatch does not really deal with complaints; it raises issues and systemic failures that can be brought up through the system. Likewise, I am concerned that nothing in the new clause covers what happens once the Government have done their impact assessment. Even if the impact assessment comes back and says, “Actually, this has been a terrible idea,” the Government cannot do anything and, to be honest, once they have abolished these things it will be extraordinarily hard to pull them back. I have a lot of sympathy for the new clause, but unfortunately it will probably not achieve what the hon. Member for Rugby and I want.
It is a pleasure to serve with you in the Chair, Ms Lewell. This is another example of the Government seeking to abolish an independent voice and merge its functions into an organisation that, frankly, will probably benefit to some extent from not having that independent scrutiny, but it is not for the betterment of patients or indeed the system. Healthwatch England is effective specifically because it is an independent voice for patients. We have not heard any compelling arguments for why, just because the system is not perfect, this change is better than leaving it alone. The argument has been advanced that this brings patient voice closer to decision making, but I would hope that the directly elected Ministers who represent people are what bring the voice of the people closer to decision making in the Department of Health. They should be the ones bringing patient voice to the heart of decision making-I am sure that they do, of course-and there are other means by which the Department formulates policies and decisions; it does not need to remove an independent patient voice through Healthwatch England, which serves a different purpose, to enhance that. That different purpose is this: some of the things that Healthwatch England advocates for and shines a light on are uncomfortable truths for decision makers and the Department of Health. It looks far too cosy to now bring that function into the decision-making process. Some of these issues need the light shedding on them that...
I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell. I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously. I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the...
I was flattered to hear my comments on Second Reading quoted by the hon. Member for Sleaford and North Hykeham, but I think she has misunderstood me. My question to the Minister was and still is about how we maintain within the new arrangements the ability to speak up on behalf of others. Could the Minister comment on that?
I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important. At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable. I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding...
For the record, I tabled amendments to delete those clauses, so there was consistency of intention.
I am just computing that in my brain. Can I seek clarification on that?
I tabled amendments to delete the clauses that will remove Healthwatch, but they have not been chosen for debate, because we can just vote against those clauses standing part. New clause 78, which would ensure that Healthwatch is funded properly, was tabled alongside amendments to ensure that Healthwatch is retained.
I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.
Currently, local authorities are responsible for commissioning local healthwatches and deciding how best to deploy resources locally. This means that setting a fixed national funding level in legislation would not guarantee an increase in what the local healthwatch ultimately receives. It would remain up to local authorities to determine how much is ultimately spent on the local healthwatch, now or in future, while undertaking their new user involvement responsibilities. It is right that local authorities are in charge of determining, on a local level, how best to deploy their resources in their areas. I should be clear that although local authorities have a statutory duty to provide a local healthwatch, we will continue to provide funding to support those duties.
The Department provides approximately £3.3 million in funding each year to Healthwatch England, as a statutory committee of CQC, and we will continue to fund Healthwatch England as long it stays in place. For those reasons, I ask the hon. Member for North Shropshire not to press her new clause 78.
My hon. Friend the Member for Bury St Edmunds and Stowmarket spoke to new clause 74, which was tabled by my hon. Friend the Member for Rugby. That new clause raises some important issues around transparency, which I am passionate about and have often spoken about. The new patient experience directorate within the reformed Department of Health and Social Care is about directly informing commissioning. Indeed, NHS-commissioned patient services already sit within Government-linked structures and achieve strong participation by actively building trust. We know that for the new arrangements to work effectively, we need to continue to grow that work. At a local level, we want those who commission services to hear directly from patients and the public. That means clearer accountability, with commissioners responsible not just for what services are delivered but for listening to people, and acting on and implementing what they say.
To ensure that these new arrangements are a success, effective oversight and transparency will be critical. That is already a key consideration in establishing the patient experience directorate, and the Bill includes additional key safeguards. First, integrated care boards will be required to publish an annual statement on how they have gathered feedback and-this is crucial-what actions they have taken as a result of that feedback. That is a vital role: it will make their behaviour more transparent and public. It may also provide a link for local Members of Parliament, local people and ICBs across the patch in the same way that people use public forums, for example, at a local authority level. ICBs will be required to publish an annual statement.
At a national level, as part of the regulatory function of local authority adult social care commissioning, the CQC will also look at whether the statutory functions of local authorities are being met. Additionally, the Secretary of State will have a new power to direct ICBs on the exercise of their functions if that is felt necessary to set consistent standards in this area. Local Members of Parliament and other bodies will have a key role in raising those issues.
The existing complaints regulations allow people to make a formal complaint to providers of services or to a commissioner of services, and ultimately to the appropriate ombudsman. Healthwatch has no statutory role in relation to complaints, so the abolition of Healthwatch services will therefore not affect the complaints procedure.
Finally, following its passage, we will undertake an evaluation of the Bill to provide objective and robust evidence for both learning and accountability. The learning element will feed directly into the development of services and the creation of an evidence base, and the accountability element will support further decisions and approaches to implementing services. The new clause would therefore duplicate our wider plans and would add unnecessary complexity to the legislation without delivering any other practical benefit. The Government consider that the current approach strikes the right balance. For those reasons, I ask hon. Members not to press their new clauses and I commend clause 64 and schedule 9 to the Committee.
Question put, That the clause stand part of the Bill.
Clause 64 ordered to stand part of the Bill.
Schedule 9 agreed to.
Clause 65
Abolition of arrangements with Local Healthwatch organisations
Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss schedule 10.
Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities. At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers. This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in...
As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape. There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening? The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change? The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will...
I am very grateful to serve under your chairship, Ms Lewell. My hon. Friend the Member for Winchester has made some general points about Healthwatch and the importance of an independent patient voice; I will not reiterate them, because he made them very well, but I want to speak specifically about local healthwatches and the benefits that they bring. I find it quite difficult to hear in this room, so I hope the hon. Member for Lichfield will correct me if I have misunderstood the gist of his speech, but I was frankly astonished by the suggestion that if local managers had heard about the problems at Mid Staffs or at Shrewsbury and Telford hospital NHS trust, the concerns raised in those extremely serious scandals would have been addressed. The reality is that the management of both providers knew exactly about the concerns in those trusts, and they did not address them. That is why we have Healthwatch. The hon. Member for Lichfield may be aware that my parents live in Stone, which was in the Mid Staffordshire constituency at the time. My mum was a clerk to Staffordshire county council, and I recollect very strongly that the health scrutiny committee at that council questioned the trust about its appalling mortality rate and was constantly reassured that there was nothing to see here. It absolutely failed to mark its own homework. The suggestion that my constituents Kayleigh and Colin Griffiths, who fought for the Ockenden report on Shrewsbury and Telford, did not first try...
Is it the hon. Member’s belief that that is something that Healthwatch would have been able to deal with, support and prevent?
The hon. Member will know that Healthwatch was introduced almost as a direct consequence of the Francis review of Mid Staffordshire, so that was certainly the intention. I have discussed the variability of healthwatch organisations across the country and the fact that they are not as well funded as was originally intended. Although I take the point that they have not effectively delivered that alarm-raising service in every case, if they were properly funded and used in the way that they were envisaged to operate, they would be able to spot such issues.
rose -
I am going to go on and give some examples. Central to the value and success of the Healthwatch network is its local focus and the fact it is centred in communities. Where it has worked well, that has allowed Healthwatch to earn trust and build relationships, especially with harder-to-reach communities, as we have discussed. I take the Minister’s point that we know about those harder-to-reach communities, but the reality is that we are not engaging with them, and that is important.
I have a list of examples from Lib Dem colleagues from constituencies across the country that show where Healthwatch works well. My hon. Friend the Member for Torbay (Steve Darling) notes that his local healthwatch identified and investigated failures by care providers. After Healthwatch exposed the problems, the provider was put under special measures and no longer exists. Without Healthwatch, the provider would still be providing substandard care. There were even concerns about abuse. Central to exposing the issue was that Healthwatch was trusted by care workers to anonymously share their experience.
Moving on to Cromer in north Norfolk, my hon. Friend the Member for North Norfolk (Steff Aquarone) got in touch with me to note that in 2023 the Conservative-led county council decided to close the Benjamin Court reablement centre with no proper public consultation. Healthwatch Norfolk stepped in to carry out an extensive engagement process with the local community and found overwhelming support for and need for the centre. It also exposed a lack of communication from the county council and ICB as a common thread during the closure process. Without the intervention of Healthwatch and without-as I will obviously say-campaigning by local Lib Dems, the local community would have had no route to meaningfully share its desire for the centre to remain open, and it would likely have been shut. We are hopeful that at least some form of NHS services or care services will return to Benjamin Court.
Finally, my hon. Friend the Member for Stratford-on-Avon (Manuela Perteghella) notes that the surveys and data of Warwickshire Healthwatch have helped to reveal that her constituency is a dental desert. That problem is now being addressed by the ICB, which is trying to deal with it.
Healthwatch organisations shape services as well as report problems. As the Minister pointed out, they do not have a statutory complaint process role but they can alert to systemic problems within the local system. Without Healthwatch, the ICB and county council in Norfolk would have continued to ignore local residents by simply refusing to ask the question that they did not want the answer to: “Does the local community need this service?” Healthwatch was valuable due to its ability to go out and ask questions that the ICB did not want the answers to. In Torbay, care workers made it clear that the independence of Healthwatch made them feel comfortable sharing their concerns about the failing care provider. We must ask: would they have felt comfortable doing that internally, into the system that was commissioning that provider?
I also remind hon. Members-as the shadow Minister, the hon. Member for Sleaford and North Hykeham, has already-of our potential future Prime Minister’s support for his local healthwatch. In November, the right hon. Member for Makerfield praised his local healthwatch organisations for their impartiality, deep relationships with communities and role in bringing lived experience into system improvement. The Liberal Democrats agree with him wholeheartedly on those points.
I return to a point I made earlier in the debate. Local healthwatch responsibilities are set to be split between the ICB and the local authority, looking at the social care and the health elements separately. Although local authorities will be funded to continue the social care element of local healthwatch, it is not clear that ICBs will be able to. That gives us two concerns: first, that there will not be sufficient resourcing for service-shaping on the NHS side, from the ICB; secondly, that such work will become increasingly divorced from the shaping of social care services.
Is there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?
The hon. Lady raises a good point. I do not want to revisit an earlier part of the debate, but it is certainly relevant that where there is not a local authority representative on the ICB and there is not a mayor in place, and the ICB’s area is not coterminous with the local authority boundary, that adds another element to the issue of the separation out of Healthwatch. Does the Minister agree that the independent and locally rooted Healthwatch cannot be replaced by processes that sit within the NHS system? Will she please reconsider the change? There is concern on all sides of the House, given the value that Healthwatch brings to the service.
Clause 65 and schedule 10 focus on local healthwatch arrangements. As I said when speaking to the previous group of amendments, Healthwatch is respected and trusted at a national level, and that is even more the case at a local level. I fear that the Government seek to remove something that works, that is effective and that ensures a strong patient voice in the system. It simply does not work to have integrated care boards take on those responsibilities, as they will be marking their own homework rather than being the independent patient voice. It is a little like the discussion the Committee had during the previous grouping on HSSIB, in which it turned out that the CQC will be able to investigate itself, but the chief executive of the CQC would decide whether any protected disclosures could be published during that investigation. That measure brings things entirely within the system and removes the independent voice, which is exactly what this clause also does. The ICB is the voice of the NHS system, not the voice of the patient. We need the grit in the oyster that is provided by an independent voice talking to the ICB. Being in the room with an ICB will not mean that the patient voice is heard more loudly or clearly, or that it will be acted on-it is probably more likely to mean that it is not. As an example from my constituency, the ICB did conduct a consultation exercise on the proposed closure of St Mary’s birth centre in Melton Mowbray, the response to which was...
I want to address this clause because I believe that the Government are making a significant mistake by abolishing Healthwatch England, as they have just done with the group of amendments, and local healthwatch organisations. The Government have sought to reassure the Committee that the functions currently carried out by Healthwatch will continue; however, that is not the question before us. The question is whether those functions can continue with the same degree of independence, credibility and public confidence once they are absorbed into the organisations that they currently scrutinise. Having listened carefully to the witnesses who appeared before the Committee, and having reflected on the debate on Second Reading, I do not believe that the Government have demonstrated that they care. Once again, the Government’s case rests largely on the recommendations of Dr Penny Dash. Dr Dash argued that patient engagement should sit much closer to those responsible for planning and delivering services, that providers and commissioners gather and respond to patient experience themselves, that integrated care boards already possess engagement functions capable of undertaking that work, and that the variation between local healthwatch organisations means that the current statutory model is no longer justified. Those are interesting arguments, but they were examined by this Committee and, in my view, were not sustained by the evidence that we subsequently heard. Indeed, what struck me...
The concern has not come solely from Opposition Benches. On Second Reading, the hon. Member for Hornsey and Friern Barnet (Catherine West) intervened on the Secretary of State:
“Healthwatch Haringey plays an enormously important role in being a champion for the ecosystem within a locality. The Local Government Association is very concerned about some of the discussions.”
That intervention deserves attention, because it did not come from an Opposition Member seeking to frustrate the Bill; it came from a Member on the Government Benches, recognising the contribution made by Healthwatch in her own community and the concerns expressed by local government about the proposals before us. The Secretary of State did not dispute her assessment of Healthwatch’s value. Instead, he argued that the Bill sought
“to bring the voice of patients closer to the people who plan and deliver services.” -[ Official Report , 1 June 2026; Vol. 786, c. 887.]
The Minister today has done something similar. With respect, again that answers a different question. Bringing patient voices closer to decision makers is not the same as ensuring that those voices remain independent of the decision makers. Integration and independence are not synonymous. Indeed, the evidence we have heard suggests that independence is precisely what gives Healthwatch its authority. That distinction is not just theoretical, but reflected in the evidence submitted by those who work in the health and care system itself.
Healthwatch Surrey, which covers part of my constituency, including the town of Haslemere, has provided statements from NHS leaders and from Surrey county council. Those are not organisations resistant to partnership working; they are organisations that work with Healthwatch every day. The chief executive of NHS Surrey and Sussex told me that Healthwatch’s
“independent role in gathering this insight and acting as a voice for the community is essential in ensuring that the needs of all residents are heard-especially those who may otherwise go unheard or are at risk of health inequalities.”
The chair of NHS Surrey and Sussex stated:
“I would wish for an independent service to enable resident and patient voices to be heard to remain in place going forward.”
The chief nursing officer described Healthwatch simply as “a third eye”. Councillor Tim Oliver, leader of Surrey county council, explained:
“Healthwatch has operated as an impartial champion...built a trusted brand within local communities where individuals can feel ‘safe’ in sharing their experiences and concerns...Their independence has been central to this.”
He went further, observing that healthwatches are
“trusted because they are outside the system”.
Such evidence is particularly important because it comes from the organisations that will inherit those responsibilities should the Bill proceed. Far from arguing that independence is unnecessary, they describe it as essential to the effectiveness of the existing arrangements. Surrey county council also highlighted another practical reality, that
“many individuals do not feel confident using these formal mechanisms.”
That is precisely why Parliament has repeatedly concluded that an independent patient advocate is required.
Independent bodies exist because some people are unwilling to raise concerns directly with the institutions about which they are concerned. That is not a criticism of those institutions; it is simply a recognition of human behaviour. The evidence from Surrey therefore reinforces what many of the witnesses subsequently told this Committee. Trust is not created simply because responsibilities are transferred from one organisation to another; trust depends on independence.
Professor David Croisdale-Appleby, the chair of Healthwatch England, reminded the Committee that that is not a new constitutional principle. He said:
“we have had 52 years of independent organisations representing the patient voice, as well as that of the carer.”
That is not simply an historical observation; it reflects Parliament’s long-standing judgment that patients should have access to an advocate who is institutionally separate from those providing and commissioning care.
Professor Croisdale-Appleby also explained why Healthwatch cannot be understood simply as another engagement function. He told us:
“it is about independence and holding organisations to account...we are not only the ears of the patient and the carer; at times, we hold feet to the flames over whether something sensible is being done. We do not give up on this; we pursue it down the rabbit hole.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]
I found that one of the most important pieces of evidence heard during our proceedings. It defines the distinction between engagement and accountability. Engagement teams collect views; Healthwatch collects evidence, investigates concerns, challenges organisations, follows up recommendations and persists until action has been taken. Those are fundamentally different responsibilities.
Indeed, Professor Croisdale-Appleby’s evidence exposes what I regard as the principal weakness in the Government’s case. If Healthwatch exists to hold organisations to account, how can that responsibility be transferred to the very organisations being held to account? That is not a political question but a structural one. How does an integrated care board investigate itself independently? How does it scrutinise its own decisions? How does it, in Professor Croisdale-Appleby’s words, hold feet to the flames when the feet are its own?
That question was put to Ministers on Second Reading. The hon. Member for Bicester and Woodstock (Calum Miller) asked the Secretary of State:
“can he reassure the House that bringing the scrutiny of local voices up to the level of the Secretary of State will not diminish the independence of the local healthwatch organisations that…do so much to promote the patient voice and to hold the NHS to account for its services?” -[ Official Report , 1 June 2026; Vol. 786, c. 888.]
That was a perfectly reasonable question, but the Secretary of State did not explain how independence will be preserved. Instead, he returned to the argument that patient voices will be brought closer to those planning and delivering services. Again, that is a different proposition. Closer does not mean more independent, and nor does it necessarily mean more effective.
The evidence presented to this Committee points consistently in the opposite direction. Witness after witness argued that Healthwatch’s effectiveness derives precisely from the fact that it sits outside the organisations whose decisions it scrutinises. That institutional separation is not an administrative inconvenience, but the foundation upon which public confidence has been built. If that independence is removed, the burden falls on the Government to explain how the same confidence, the same willingness to come forward and the same capacity to challenge will be maintained. Having listened carefully to the evidence and the Minister’s comments today, I do not believe that explanation has yet been provided.
The question of independence was reinforced by Sarah Tilsed, speaking on behalf of the Patients Association. Her evidence was notable because it came from an organisation whose sole concern is the interests of patients, rather than the preservation of any particular institutional structure. She told the Committee:
“we need a truly independent patient voice”-
not simply a patient voice, but a truly independent voice. She went on to warn:
“Abolishing healthwatches creates a fragmentation of patient engagement responsibilities across ICBs and local authorities.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]
The Government have presented these proposals as a simplification of the landscape. One of the country’s leading patient organisations has described them rather differently. It suggested that responsibility would become fragmented, rather than simplified. That is a material difference of opinion, and one that Ministers have not adequately addressed.
Perhaps the most significant aspect of Ms Tilsed’s evidence concerned public confidence. She told the Committee:
“patients trust independent organisations. I feel that that trust might be lost in local communities.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]
That observation goes to the heart of this clause. Trust cannot simply be transferred from one statutory body to another, and nor can it be created by legislation. It is earned over time through experience.
Many of the people Healthwatch represents have had poor experiences of health and care services. Some have experienced unsafe care, and some have struggled for months-sometimes years-to have their concerns recognised. For those individuals, approaching an independent organisation is qualitatively different from approaching the organisation about which they wish to complain. The Government assume that patient engagement will continue because the statutory function will continue, but the witnesses asked a different question: will patients continue to come forward if they no longer believe the organisation hearing their concerns is independent of the system that they are challenging? That is a practical question about behaviour.
The Committee has heard evidence suggesting that independence is itself one of the principal reasons that patients are willing to engage. That concern was echoed on Second Reading: the hon. Member for Strangford (Jim Shannon) warned that abolishing independent patient bodies risked weakening the patient voice. In the oral evidence to this Committee, I found it striking how often witnesses representing very different organisations returned to precisely the same issue: not bureaucracy, organisational charts or governance arrangements, but independence. That consistency deserves considerable weight.
Professor Croisdale-Appleby challenged another important assumption underpinning Dr Dash’s recommendations. Dr Dash argued that patient engagement functions could largely be absorbed into NHS organisations. Professor Croisdale-Appleby explained why meaningful engagement is considerably more demanding than that description suggests. He told the Committee that Healthwatch
“has been very successful in reaching out to those communities often referred to as ‘difficult to reach’…where we all know the health inequalities are often the deepest.”
He then explained how that work is undertaken, saying that
“there is quite often an investment of some six months for one of our people to go into a particular community…and win the confidence of the people so that they actually talk to us about the problems. I have to ask how that depth and focus is to be replicated under the arrangements suggested in the Bill.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]
It is not a rhetorical question, but it has remained unanswered.
Building trust with communities experiencing the greatest health inequalities cannot be achieved through an organisational redesign alone; it requires sustained engagement and relationships built over time. More importantly, it requires confidence that those listening are independent of the institution whose performance is being discussed. Communities that already distrust public institutions are unlikely to become more willing to engage simply because the engagement function has been transferred into those institutions.
The Government have not explained how those relationships will be maintained, nor have they explained how the expertise accumulated by local healthwatch organisations over many years will be preserved. The Committee is being asked to assume that a statutory function can simply be relocated without affecting the way it is discharged. The evidence clearly suggests otherwise.
The Government have relied heavily on another element of Dr Dash’s review-namely, that the performance of local healthwatch organisations is too variable to justify retaining the present statutory model. At first sight, that seems to be a reasonable criticism. If there is significant inconsistency across England, reform is an entirely legitimate subject for discussion.
Indeed, Professor Croisdale-Appleby accepted that there is variation across the 153 local healthwatch organisations. He did not seek to deny it, but he challenged the Government’s explanation for why that variation exists. He told the Committee:
“One of the reasons there is a difference or variation among the 153 is that the amount of funding is very different. Some of them get 10 times the funding of others”.
That evidence is significant because it changes the diagnosis. The Government appear to argue that variation demonstrates a flaw in the Healthwatch model itself. Professor Croisdale-Appleby suggested something rather different: that much of the variation is the predictable consequence of unequal investment. He went on to say that
“if the funding were more equitable, some of that variation would disappear”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 48, Q78.]
That is, in my view, one of the most important pieces of evidence heard by the Committee. If inconsistency is principally the product of funding disparities rather than organisational design, the logical response is to address the funding disparities. It is not to abolish the organisation altogether.
Professor Croisdale-Appleby drew another important distinction. He told us:
“What it does not allow…is a change in the quality of the way in which the research is done.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 48, Q78.]
That deserves careful attention. Differences in organisational capacity do not necessarily imply differences in professional standards. A smaller organisation with fewer resources may produce fewer reports than a larger one. That is not the same as suggesting that its work is less rigorous. The evidence therefore points towards a funding issue rather than a structural failure.
That conclusion is reinforced by the evidence submitted by Healthwatch Surrey. The chief nursing officer described Healthwatch as a “third eye”. The chair of NHS Surrey and Sussex said:
“I would wish for an independent service to enable resident and patient voices to be heard to remain in place going forward.”
The chief executive described Healthwatch’s independent role as “essential”. Surrey county council explained that Healthwatch is
“trusted because they are outside the system.”
Taken together, those statements are striking. They come not from campaign organisations or from political parties, but from organisations working within the health and care system itself. Far from arguing that independence has become unnecessary, they argue that it remains fundamental to the effectiveness of patient representation.
That brings us back to the Government’s central proposition. Ministers ask us to conclude that because there is variation between local healthwatch organisations, the independent model should be abolished. The evidence heard by the Committee points to a different conclusion. Where funding is unequal, funding should be made fairer. Where consistency can be improved, consistency should be improved. Where good practice can be shared more effectively, it should be shared. Those are the arguments for reform. They are not, on the evidence we heard, arguments for abolition.
Indeed, the abolition of Healthwatch does not answer the question posed by Professor Croisdale-Appleby-it does not explain how long-established relationships with “seldom-heard communities” can be replicated. It does not explain how institutional trust will be preserved, or how an independent voice becomes stronger by becoming part of the system it is expected to scrutinise. On those central questions, I respectfully suggest that the Committee has heard considerably more evidence than it has heard answers.
One further aspect of Professor Croisdale-Appleby’s evidence deserves attention. Throughout our debates, much has been said about ensuring that patients are heard, but Healthwatch does considerably more than just listen. Professor Croisdale-Appleby reminded the Committee of the scale of its work, saying:
“We have produced over 20,000 reports”.
That is an extraordinary body of evidence built over many years from the lived experience of patients and carers across England.
More importantly, Healthwatch does not simply publish reports before moving on to the next issue. As Professor Croisdale-Appleby went on to explain:
“When we produce reports…we always follow up on those recommendations and ask, ‘Are they being implemented? Are they being listened to?’ Each year, we produce a report that says, ‘What change has occurred as a result of the recommendations that we make?’” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]
That is the language of accountability. It is not simply consultation and it is not merely engagement; it is independent scrutiny followed by persistent follow-up until change has either occurred or been shown not to have occurred. That is a very different function from just gathering patient feedback.
I come back to the central question: who performs that role if Healthwatch disappears? Will integrated care boards publish reports criticising their own decisions? Will they systematically monitor whether recommendations directed at them have been implemented? Will they publicly report on the effectiveness of their own response? The Government have said that the function will continue, but the witnesses clearly stated that the effectiveness of that function depends on its institutional independence.
The Committee also heard important evidence from Sir Ciarán Devane, whose evidence was particularly valuable because he did not approach the question from the perspective that no change should ever be made. Indeed, he accepted that the reform of patient engagement arrangements may be appropriate. Yet even he identified independence as something that must not be lost. He told us:
“This function has been slightly outside and independent, playing back into decisions; we have to ensure that the level of independence remains somehow in how this is constructed”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40, Q67.]
That is a significant concession: a witness prepared to contemplate structural reform who nevertheless regarded independence as indispensable.
Sir Ciarán continued by saying that we have to
“make sure that what was good about healthwatches is preserved”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40-41, Q67.]
I agree entirely. Ultimately, that is the question before the Committee: does the Bill preserve what was good about Healthwatch? Or, as I contend is more likely, does it remove the very characteristic that has enabled Healthwatch to command public confidence for more than a decade?
Sir Ciarán identified another practical concern, warning that
“there is a risk because of that pressure.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 41, Q67.]
The pressure to which he referred was the operational and financial pressure that already faces integrated care boards. That brings me to one of the unanswered practical questions arising from the Government’s proposals. Throughout our consideration of the Bill, Ministers have spoken about reducing bureaucracy, simplifying structures and improving efficiency. Integrated care boards are expected to operate within substantially reduced running costs yet, at precisely the same time, they are expected to assume the statutory responsibility that is currently exercised by independent healthwatch organisations.
When questioned about that change, Sir Ciarán accepted that the responsibilities represented
“an additional duty”
and acknowledged that
“if there is no extra money coming…it will be pressured.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40, Q67.]
That observation seems self-evident. If organisations are expected simultaneously to reduce expenditure while assuming additional statutory responsibilities, something must inevitably give.
The Committee has not been told how the new responsibility will be resourced. Will additional funding accompany the duties? Will specialist staff transfer? Will the expertise and local relationships built over many years be maintained? Or are we simply expected to assume that patient representation can somehow improve while independent organisations disappear and resources remain constrained? The evidence has not answered those questions.
There is also a broader constitutional principle at stake. Across public life, we recognise that effective scrutiny requires institutional independence. As I mentioned when we were speaking about HSSIB, the Government are scrutinised by independent regulators, public expenditure is examined by the National Audit Office, and citizens may complain to independent organisations. Parliament has long recognised that patients deserve the same protection. As Professor Croisdale-Appleby reminded us,
“we have had 52 years of independent organisations representing the patient voice”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 45, Q74.]
Successive Governments have reorganised the NHS many times, sometimes for the better and sometimes not, but they have consistently preserved an independent patient voice. This Bill breaks with that principle. The burden of proof therefore rests with the Government, and I do not believe that they have discharged that burden.
What struck me both on Second Reading and during the Committee’s evidence sessions is that Ministers and witnesses have been answering very different questions. Ministers have spoken about integration and organisational efficiency; witnesses have spoken about independence, trust and accountability. That evidence has been remarkably consistent. Professor Croisdale-Appleby told us that Healthwatch exists to hold “feet to the flames” and to pursue concerns “down the rabbit hole”. Sarah Tilsed warned that
“patients trust independent organisations. I feel that that trust might be lost in local communities.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 46, Q75.]
Sir Ciarán Devane told us that we have to
“make sure that what was good about healthwatches is preserved”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 40-41, Q67.]
And the chief executive of NHS Surrey and Sussex described Healthwatch’s independent role as “essential”.
Those witnesses came from different organisations and different perspectives, but they reached the same conclusion. None argued that Healthwatch should remain unchanged. They argued that where there are weaknesses, they should be reformed, where there are inconsistencies, they should be addressed, and where the funding is unequal, it should be made fairer. What they did not argue for was the abolition of independence. That is why I cannot support this clause.
The Government have relied heavily on one review. The Committee has heard from those who work with patients, represent patients and speak for patients, and their message has been clear: “Preserve independence.” If Ministers believe that Healthwatch can be improved, please improve it. If they believe consistency can be strengthened, strengthen it. But let us not abolish the only statutory body whose sole purpose is to represent patients independently of those who commission and provide NHS services, because once that independence is lost, it cannot be recreated. For those reasons, I hope that the Minister will reconsider.
The Government’s proposal to abolish the independent voice of patients is a mistake. It is a backward step, and I have seen no compelling reason why it should happen. Apparently, the voice of patients is going to be realised through integrated care boards and local authorities themselves, but that is not an independent patient voice. The very point of independence is that that voice is represented through an organisation that has no other function-no other skin in the game other than to represent that voice. It is remarkable that the Government are taking this step. I suspect the Minister will say-she has already given a number of reasons-that this is happening in order to bring the voice of patients closer to those who make decisions, but that is not the function of Healthwatch. If she wants to achieve those things, she can achieve them while maintaining Healthwatch as an independent patient voice. That independent voice ensures not only better decision making, but more effective scrutiny of decisions that have been made, and it does it by ensuring there is no blending or conflict of interest within a certain organisation-the decision maker. It does it by ensuring that light is cast on the critique, the scrutiny and the voice of patients, and that that process takes place outside the closed doors of, in this case, the integrated care board, not behind them. I suspect that the Minister will say that the system is not working, because there are too many good reports by...
We have too often seen the ICB making decisions without due regard for the fact that while the journey from, for example, Ryde to a hospital in Portsmouth may be three or four miles as the crow flies, and may in theory be covered by public transport via a ferry and a bus, the disruption of having to make that journey for, in some cases, reasonably routine procedures is unique to an island community. It does not bear equivalence to travelling three, four or five miles without a stretch of water in the way.
I am using my own patch as an example, and it is fairly unique, but there are many areas across the country, particularly coastal and rural ones, with their own unique challenges. At the moment, those are well-represented through small, independent local healthwatches. That uniqueness will be lost, not only because of the lack of independence of the patient voice that will result from merging healthwatches with ICBs, but because the patient voice will be merged with others, since ICBs cover far wider areas. Given the values that Labour says it stands by and gets elected on-patient choice, patient voice, improving healthcare outcomes-it surprises me that a Labour Government want to abolish that independent patient voice. No matter how much they want to make space for that voice within an ICB, they cannot argue that that voice is independent once it becomes part and parcel of the ICB.
Again, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape-well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do. I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure. I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”-that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience?...
Clause 65 ordered to stand part of the Bill.
Schedule 10 agreed to.
Sitting suspended.
On resuming-
Clause 66
Civil contingencies: category 1 responders
Question proposed, That the clause stand part of the Bill.
As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004-the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response. Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee. Question put and agreed to....
The Chair
With this it will be convenient to discuss the following: Government amendments 20 to 24 and 83. Schedule 11.
These are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act. Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others-primarily the Secretary of State and integrated care boards-and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67...
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following: Government new clause 92- Medical Devices Regulations 2002: mutual recognition agreements . Government new clause 93- Consultation about medicines and medical devices regulations . Government new clause 94- Medicines and medical devices regulations: parliamentary procedure . Government new clause 95- Medical devices etc: parliamentary procedure for certain fees regulations . Government amendments 80 to 82. New clause 67- Secretary of State directions relating to early access to medicines - “(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the implementation of a scheme providing early access to medicines to people with life-threatening or seriously debilitating conditions. (2) The bodies are- (a) integrated care board, (b) NHS Trusts, (c) NHS Foundation Trusts, (d) NHS Advanced Foundation Trusts, and (e) other health and social care bodies.” This new clause would give the Secretary of State power to direct integrated care boards, NHS Trusts, NHS Foundation Trusts, and NHS Advanced Foundation Trusts to implement a scheme to provide early access to medicines to people with life-threatening or seriously debilitating conditions. New clause 68- Review of the Early Access to Medicines Scheme - “(1) The Secretary of State must, within six months of the passing of this Act, commission a review of the regime for early and accelerated access to medicines in England and Wales....
I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises. These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly. New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is...
New clause 91 would amend the Medicines and Medical Devices Act to enable regulations “to refer to both international agreements and standards and standards developed in the United Kingdom” and enable the Secretary of State “to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.” New clause 92 would amend the definition of “mutual recognition agreement” so that “agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.” New clause 93 “amends the duty to consult in relation to regulations about human medicines and medical devices.” That means that instead of a public consultation, it “gives the option of consulting such persons as the relevant authority considers appropriate”. I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody. New clause 94 “changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.” That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes. Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I...
I thank the hon. Lady for her comments. The purpose of the new clauses is to support our life sciences and medicine sector, in order to make that more streamlined. She will be aware of the proposals about the negative and affirmative procedure. If there were particular issues of scrutiny, normal parliamentary rules and processes would apply if Members wanted to raise any particular issue. Question put and agreed to. New clause 91 accordingly read a Second time, and added to the Bill. New Clause 92 Medical Devices Regulations 2002: mutual recognition agreements “(1) The Medical Devices Regulations 2002 (S.I. 2002/618) are amended as follows. (2) For regulation 1A (Schedules) substitute- ‘ 1A Schedule Schedule 2A has effect.’ (3) In regulation 2 (interpretation), in paragraph (1)- (a) in the definition of ‘mutual recognition agreement’, in paragraph (a), for ‘country listed in Schedule 2’ substitute ‘country specified in a list published by the Secretary of State from time to time’; (b) in the definition of ‘third country conformity assessment body’, for ‘established in a country which is listed in Schedule 2 and designated in accordance with a relevant’ substitute ‘designated in accordance with a’. (4) Omit Schedule 2 (mutual recognition agreements).”- (Karin Smyth.) This new clause would amend the definition of “mutual recognition agreement” in the Medical Devices Regulations 2002 (as it has effect in England and Wales, and Scotland) so that agreements are defined by a list...
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss new clause 13- Maternity Safety - “(1) The Secretary of State must ensure that every NHS maternity unit is rated ‘good’ or ‘outstanding’ by the CQC. (2) The Secretary of State must, within 6 months of the passage of this Act, establish a scheme to support NHS trusts to deliver the requirement under subsection (1), which includes- (a) 24/7 consultant obstetrician cover on every labour ward, (b) one-to-one midwifery care, (c) a Director of Midwifery in every maternity service, (d) ringfenced maternity service development funding, and (e) a dedicated neonatal workforce plan. (3) Within 12 months of the commencement of the scheme under subsection (2), and every 12 months thereafter, an annual report should be laid before both Houses of Parliament on the effectiveness of the scheme.” This new clause would place a duty on the Secretary of State to create a scheme to ensure that every maternity unit in the country achieves a “good” or “outstanding” rating by the CQC.
New clause 1, which I tabled, would require the Secretary of State to appoint a maternity commissioner within the Department of Health and Social Care to oversee national maternity services. This person should be someone with experience and expertise in maternity services, and not a political appointment. It is important to start by saying that I tabled the new clause before we had the report from Donna Ockenden on the Nottingham review, and last week’s report from Baroness Amos on her national review, both of which recommended the appointment of a maternity commissioner. Obviously, since then, the Secretary of State has announced that he will appoint a maternity commissioner. None the less, I will state the arguments for having one, and if the Minister can give us some assurances today, I will not press the new clause to a vote. Just to set the scene, which I think we all know too well, maternity services in England have suffered a series of high-profile scandals. The cost of political neglect has been paid by families in terms of trauma, injury and lost lives. We have known for a long time that maternity services in this country have been failing. Numerous recommendations have been made over that period, but they have not been effectively acted on in a consistent way, and Baroness Amos’s inquiry finally confirms that. It is important to say that the vast majority of births take place safely, successfully and happily. However, where things go wrong, having a baby safely has...
As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner. New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012, early 2013. I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words. The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity. My...
I am grateful to the hon. Member for North Shropshire for bringing this discussion before the Committee. I put on record our thanks for the work she has done in this area and for her engagement with me, and indeed with officials at the Department, to help us understand it more clearly, particularly in the light of the new clause. Hon. Members across the Committee are committed, as are the Government, to ensuring that women, families and babies receive the care and support they need. We know that the vast majority of births are safe and that there are outstanding examples of care in the NHS. However, where things do go wrong, it can have a devastating impact on women and their families. That is why the Government launched the national investigation into NHS maternity and neonatal care, chaired by the noble Lady Baroness Amos. Baroness Amos brought the findings from past reviews, local rapid reviews and new evidence from families and staff together into one clear national set of recommendations, which as we heard was published last week. The Government also launched the maternity and neonatal taskforce, chaired personally by the Secretary of State, which will translate Baroness Amos’s recommendations into action. As we heard, Baroness Amos recommended the appointment of a statutory maternity and neonatal commissioner. We have accepted that recommendation, and I know there is support for it across the House. To be clear, the Secretary of State stated last week that we are...
We talked about clause 1-on the abolition of NHS England-at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?
I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as-I think the hon. Lady said this herself-the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce. I hope that addresses the comments the hon. Lady made. On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.
However, we recognise the importance of driving improvements in maternity and neonatal care so that ratings can improve over time. We acknowledge that we must reset maternity and neonatal services, which is why we commissioned the national investigation and have introduced a maternity commissioner. It is also why we are investing £10.6 million to fund 1,000 additional temporary roles for newly qualified midwives to join the NHS.
Baroness Amos made specific recommendations relating to the maternity and neonatal workforce, including the introduction of a modern service framework for those services to set out consistent safety, workforce and operational standards. That will be considered in detail by the taskforce personally chaired by the Secretary of State, which will oversee the development of an action plan by the end of the year. The plan will translate Baroness Amos’s recommendations into action, along with those of Donna Ockenden from the investigation into Nottingham, and drive systemic and sustained improvements across maternity and neonatal care.
We will also shortly publish a 10-year workforce plan, which will put the NHS workforce on a sustainable footing so that it can deliver the service model set out in the 10-year health plan. The Government think that the focus should now be on developing the action plan. Now is not the time to legislate for a new approach, so I hope that the hon. Member for North Shropshire will withdraw the new clause.
I thank the Minister for her response. Given the commitments that she has made, I do not intend to press the new clauses, but I hope she will be able to come back to us on Report with some more concrete progress. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 3 Assessment of risks posed by contracts with non-UK based suppliers “(1) Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK. (2) In conducting an assessment under this section the Secretary of State must- (a) pay particular regard to contracts which provide technology companies with access to confidential patient data; (b) consult national security experts on the risks posed to UK sovereignty by such contracts; (c) consider risks associated with the sharing of confidential patient data with organisations based outside of the UK; (d) assess public and NHS staff attitudes to relevant suppliers and any implications such attitudes may have on the use and effectiveness of products or services provided under the contract; and (e) consider the background of relevant suppliers, known contracts with other states and organisations, and any relevant ethical considerations. (3) Where any significant risk is identified, the Secretary of State must set out the Government’s intentions to manage and mitigate such risks, including its intention to...
I beg to move, That the clause be read a Second time.
The Chair
With this it will be convenient to discuss the following: New clause 4- Duty on the Secretary of State to prioritise domestic suppliers - “In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert- ‘1CD Duty to prioritise domestic suppliers (1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom. (2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a viable domestic alternative does not exist. (3) Before signing any contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must consult with- (a) patient groups, (b) national security experts, and (c) staff unions, on the proposed contract and lay a report on such a consultation before Parliament. (4) Where it is proposed to sign a contract for the procurement of technology and information systems which will handle NHS patient data with a supplier based outside of the United Kingdom, the Secretary of State must arrange for a motion agreeing to the signing of such a contract to be tabled in each House of Parliament, and no such contract may be signed where a motion for...
New clauses 3 to 5 are related to the publication of risk assessments of contracts between NHS organisations and suppliers based outside the UK. They would place a duty on the Secretary of State to prioritise domestic, UK-based suppliers in the case of technology systems and contracts involving the handling of NHS patient data, and place restrictions on the signing of such contracts with non-UK-based suppliers. New clause 5 would require the Government to publish an NHS digital sovereignty strategy setting out how they intend to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies. We had a Westminster Hall debate on this subject recently. The lack of transparency in how some contracts are awarded is one of the central concerns about Palantir’s involvement with the NHS. We are particularly concerned about the national security considerations of offshoring the whole of our nation’s health data to any foreign company, which makes us vulnerable to political and economic changes in other countries, but especially to companies of questionable integrity in an increasingly authoritarian jurisdiction with little respect for privacy and sovereignty. We should all be worried that our health data has been so closely linked with such an organisation, which has shown itself all too eager to work closely with Donald Trump’s Administration. We know that his Immigration and...
Obviously, I have sympathy for what the hon. Member is trying to achieve-ensuring that our data systems are free from potential hacking by either state or non-state actors is very important-but I cannot see anything in new clause 4 about the size of contracts. Does his suggestion relate to any contract, however small, that was given to a non-UK-based company? It is not clear what he means by a non-United Kingdom company. Is that one that is headquartered here, one that is listed on our stock exchange, or one that has a CEO who is a British citizen? I am not quite sure what he means by a UK-based company, but if we can define an outside-based one, is he saying that any contract of any size given to such a company will have to come to Parliament?
The size of the contract would be pretty much irrelevant; what matters is the implications arising from the contract being signed. Does a contract potentially compromise our data sovereignty? Alternatively, if a contract failed for any reason, whether it was because of the action of a state actor or a non-state actor, would the service continue to function?
I am grateful to the hon. Member for taking my intervention and I am sorry that it is late in the afternoon. The question we are faced with is this: what is the best system to serve our patients? If the best system turns out to be a system that is procured from another country, would he in principle always object to that?
I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly. There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty. I have a few questions for the Minister,...
I rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however. New clause 3 says: “Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.” That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be...
This is not about closing off markets or shutting off the potential to use foreign companies if they are most appropriate. It is about prioritising and investing in UK technology and our economy to solve some of our domestic problems while also providing security. Saying that we are closing off domestic markets is misunderstanding the thrust of the new clause.
I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe. New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.
My questions will be very brief. I am conscious that, given that these are mostly Liberal Democrat new clauses, for once I will be asking the hon. Member for Winchester for a response, not the Minister. New clause 4 would require that contracts be laid before Parliament. I would be grateful if the hon. Gentleman can tell the Committee how many such contracts he thinks would end up being laid before the House in any given year, based on historical data, and therefore how much parliamentary time that would take up. Does he envisage that being handled by an affirmative or negative statutory instrument? What will the process be? I can see what the hon. Gentleman is trying to do, but I have a certain wariness, along the lines of that expressed by the hon. Member for Bury St Edmunds and Stowmarket. Although it is important that we have appropriate protections and scrutiny, when we are procuring services and technology for the NHS we should be looking for the most effective and best tools that have those safeguards but can do the job that eminent surgeons and clinicians need them to do in order to do their work for patients.
I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work. I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience. I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value-we heard a little about that from the Opposition-and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the...
I appreciate the Minister’s response and the comments of other Members, which were insightful as usual. When we discussed whether carers could access parts of the single patient record, Members made very good points about privacy and historical health issues that a patient might not want a carer to know about. Those are very sensible concerns, but someone watching these proceedings or looking back over the record would think that there had been a lot more agonising over whether someone caring for a patient could access relevant information than over the potential systemic misuse of health information facilitated by private companies. A lot of people are worried about that when it comes to procurement, trust and sovereignty. I thank the Minister for her comments on new clause 3. I beg to ask leave to withdraw the motion. Clause, by leave, withdrawn. New Clause 4 Duty on the Secretary of State to prioritise domestic suppliers “In the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert- ‘1CD Duty to prioritise domestic suppliers (1) In exercising functions in relation to the health and care service, the Secretary of State must prioritise the awarding of any contract that will involve the handling of NHS patient data to suppliers based in the United Kingdom. (2) The Secretary of State may only seek to procure technology and information systems which will handle NHS patient data from suppliers based outside of the United Kingdom where a...
New Clause 5
NHS Digital Sovereignty Strategy
“(1) The Secretary of State must, within 12 months of the passing of this Act, publish a strategy (‘an NHS Digital Sovereignty Strategy’) which sets out the Government's approach to maintaining the security and resilience of relevant NHS information systems by-
(a) assessing, managing and mitigating risks-
(i) associated with foreign interference,
(ii) arising from reliance on foreign-supplied technologies, and
(b) preventing over-reliance on foreign providers by building domestic capacity.
(2) For the purposes of this section, a ‘relevant information system’ is an information system with access to NHS patient data.
(3) An NHS Digital Sovereignty Strategy published under this section must-
(a) include risks associated with-
(i) hardware,
(ii) software,
(iii) supply chains, and
(iv) procurement processes;
(b) include a specific focus on security and resilience in digital procurement processes, detailing how the Government intends to reduce strategic dependencies on foreign-owned service providers to mitigate the risk of systemic disruption;
(c) include a commitment to prioritise the use of technologies developed in the UK by UK organisations in relevant information systems to reduce reliance on foreign technologies;
(d) recommend steps to support and develop sufficient domestic capability where it does not currently exist;
(e) where risks are identified, state how the Government intends to address these risks by supporting the use or development of domestic technologies or systems.”- (Dr Chambers.)
This new clause would require the Government to publish an NHS Digital Sovereignty Strategy setting out how it intends to address risks to relevant information systems posed by foreign interference and reliance on foreign technologies, including by supporting the use of domestic technologies.
Brought up, and read the First time.
Question put, That the clause be read a Second time.
Ordered, That further consideration be now adjourned.- (Emma Foody.)
Adjourned till Thursday 9 July at half-past Eleven o’clock.
Written evidence reported to the House
HB110 Alzheimer’s Society
HB111 British Dental Association (BDA)
HB112 Iron Mountain
HB113 Adam Cooper, Independent Researcher and Healthcare Campaigner (further submission)
HB114 National Care Association (NCA)
HB115 The NHS Alliance (supplementary)
HB116 Cystic Fibrosis Trust
HB117 Carers UK (supplementary)
HB118 Shockwave Medical, part of Johnson & Johnson MedTech
HB119 Coalition for Responsible Digital Health (CoRDH)
HB120 Pernicious Anaemia Society (PAS) and the B-12Alliance (joint submission)
HB121 National AIDS Trust
HB122 Parkinson’s UK