Health Bill (Twelfth sitting)
House of Commons · Public Bill Committees · 7 Jul 2026 · 137 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
(Morning)
[Sir Roger Gale in the Chair ]
Health Bill
The Chair
Good morning, ladies and gentlemen. Electronic devices switched off, please, and no teas or coffee in the Committee Room. Members may remove their jackets if they wish to do so and, exceptionally, if any Members wish to remove ties, because of the weather I am prepared to permit that as well. Clause 58 NICE recommendations: decisions about time for compliance
I beg to move amendment 78, in clause 58, page 43, line 40, at end insert- “1. (8B) Regulations under subsection (8A) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with. 2. (8D) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.” The amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England.
The Chair
With this it will be convenient to discuss clause stand part.
The amendment was tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) on behalf of the approximately 1.2 million people in England who live with myalgic encephalomyelitis, because five years after the introduction of National Institute for Health and Care Excellence guideline NG206, little has changed. Service provision according to NG206 remains patchy and poor, with many patients having traumatic experiences. The amendment would require a period to be set in which integrated care boards and other health bodies must comply with the guideline, and the Secretary of State must publish an annual statement on compliance with NG206 across the NHS in England. The introduction of the guideline after sustained campaigning represented a major reform after years in which ME was treated as a psychiatric condition and patients were pushed to follow graduated exercise therapy. Often, GET had disastrous consequences, precipitating serious deteriorations that patients never recovered from. Credit is due to the hon. Member for Washington and Gateshead South (Mrs Hodgson), the current Minister for Public Health and Prevention, for her determination when in opposition to bring about the change. In a written answer published last week, the Minister for Public Health and Prevention confirmed that all ICBs have a statutory obligation to ensure sufficient care provision for their population, but the experience of those with ME is that that obligation is far from being...
I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals. In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website. The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short...
On a point of order, Sir Roger. I am a parliamentary patron and champion of Action on ME. I feel I ought to put that on the record, as we have an amendment on ME.
The Chair
Thank you. That is a matter of record. Any other takers? No.
Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State. NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment. That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals. I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive...
I thank the Minister for her words, particularly on amendment 78. As I said, I will not press the amendment to a vote, but I hope that the Minister will continue to bear in mind that provision for people with ME is extremely patchy and that a number of our constituents are suffering in the long term. I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Clause 58 ordered to stand part of the Bill. Clause 59 Transfer of HSSIB’s functions to CQC Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to discuss 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 committee is to...
Clause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission. Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services. With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it...
The Minister will recall that in evidence, Dr Rosie Benneyworth, interim chief executive officer of HSSIB, spoke about the vital work of the organisation, especially with regard to investigations where vulnerable staff and workers do not feel confident about coming forward for fear of reprisal. HSSIB did great work in that area, and I am wondering whether the CQC will carry it on and take on board that learning.
I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.
What we are talking about is not so much the safety of staff when they come forward, but the safety of patients, and whether we genuinely believe that the proposed modification to the arrangement will improve patient safety. That is the underlying point. Although the safety of staff is important, it is the safety of patients that we must bear in mind.
Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents-either patients or staff-through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change. My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body. The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system....
These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician. When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed-Members will be pleased to know that I will not go through the whole presentation-was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues. Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error-that we design processes that limit the opportunities for error-use technology to limit...
I was at the Adjournment debate on patient safety yesterday evening, in which my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) highlighted that 1,400 recommendations have been issued across the last few years from 30 public inquiries across England and Wales, but HSSIB has issued only 56 recommendations, and does so cost-effectively: its budget is much lower than the budget for an individual public inquiry. If HSSIB accounts for less than 3% of all recommendations issued in the last 30 years and its investigations are cost-effective, what are the Government trying to achieve by folding it into the CQC? It just does not make sense. The recommendations given have been specific, relatively low in number, targeted and effective; why would we not want that?
Another question is: how will this work in practice? The Minister told the House that combining the functions of HSSIB and the CQC will be
“to the benefit of both.” -[ Official Report , 1 June 2026; Vol. 786, c. 958.]
The impact assessment speaks of
“a more strategic approach to the commissioning of safety investigations”
and “economies of scale savings”, so it sounds as though the benefit may be financial and not operational, but I think we have demonstrated that that does not really make sense either. The impact assessment also makes it clear that the national quality board will provide
“clear direction to the new investigation unit”.
Considering that the national quality board is tied directly to the NHS, how does direction from the NQB square with the independence of the new investigation unit? On top of that, as the Minister will be aware, the impact assessment says that the topics of “the vast majority” of investigations are expected to be directed by the Secretary of State. Again, that will have an effect on independence. There is currently a power to direct, but it has been seldom used, whereas the Government seemingly intend to use it more frequently.
The other question is more fundamental: if HSSIB is rolled into the CQC, what happens if the HSSIB unit finds a problem with healthcare that is caused by the CQC failing to properly regulate or properly inspect? In the Committee’s first oral evidence session, I asked the chief executive of HSSIB how that would work in practice. She said:
“If we were a directorate in the CQC, as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also concern about our ability to make effective recommendations to the CQC if we are a directorate within it.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 23, Q38.]
There is a serious risk of a chilling effect if the Committee just waves these clauses through. The impact assessment indicates that Ministers want to preserve HSSIB’s safe space, but I do not see how that is feasible. In its submission the King’s Fund wrote:
“The transfer of the functions of HSSIB into the Care Quality Commission (CQC) also raises questions around people being able to trust the system and come forward with their concerns and issues.”
How sure will people be that they are responding in a safe space? How willing will they be to speak when they know that in the same breath they are also reporting to the regulator?
This subject is of particular interest to me. For quite a few years I was a trustee of a charity that supported evidence-based medicine and quality improvement. The hon. Lady talked about a no-blame culture. We now tend to use the term “just culture” but it is the same kind of thing: we must have a safe space for people to come forward, like in the airline industry. We want to encourage reporting not only of mistakes but of near misses so that improvements can be delivered without tragic incidents having to take place. If we are to create a culture in which people will come forward to admit even potential mistakes and near misses, they cannot in any way fear punitive punishment under regulations. Does the hon. Lady agree that folding HSSIB into the CQC will make it difficult to create a culture in which people feel confident enough to want to come forward with and overtly discuss mistakes and errors?
The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear. Dr Benneyworth made it clear to the Committee that “we are still working in a culture of fear” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.] and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that “people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for-the perception is everything”. -[ Official Report , 1 June 2026; Vol. 786, c. 915.]
As my hon. Friend said earlier, the problem comes when this new body within the CQC has to investigate the CQC. In the oral evidence session, I asked Dr Dash what would happen if the problem was CQC, and she gave what is probably the most extraordinary answer out of the many extraordinary answers she gave. It is worth repeating: “Well, we then have to deal with that as a problem. That is the same as saying, ‘What happens if the problem is this organisation or that one?’…What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 8, Q9.] She did not answer my question at all. In fact, she entirely sidestepped it. How can we have confidence in the Government’s proposal if the architect of the procedure cannot answer the most basic questions about the investigatory framework?
My hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer. It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”-according to the impact assessment-of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State. The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the...
The point about patient safety is absolutely important, as every Bill Committee member would agree. The number of patient safety incidents has been going up for the last 10 years. Between 2015 and 2022, there was a 62% increase in patient safety incidents in this country, and since the creation of HSSIB, the number of incidents has again gone up. Does the hon. Member agree that the CQC, which has access to all patient records and all documentation in any healthcare settings in real time, would be able to monitor the improvement and progress that each provider is making following the learning from each incident? That would be important and helpful, as the HSSIB has limited ability to look into documentation and clinical notes.
I thank the hon. Gentleman for that intervention, but I think this comes to part of the problem. When producing a list of faults-of things that are wrong with the service-and saying, “We need to improve the culture; it needs to be better”, we need to ask, “Okay, but how? What will be the deliverable, measurable way of doing that? How will we go about improving things?” For example, let us say that there is a problem with patients with aortic dissection, so how will we prevent that? The benefit of HSSIB is that it produces a plan, the plan is implemented and patients are safer. Part of this is about the delivery plan. As for the other part, the hon. Member talked about monitoring progress, but that is not the job of HSSIB. If a mistake or an event happens, it is investigated by HSSIB-HSSIB produces a set of investigations based on understanding how and why it happened, because of the safe space-and then those recommendations are put forward to the Government. The Government then, ideally, implement those changes. The Minister is there to ensure that those are implemented. It will be her job to ensure, having decided which recommendations are to be implemented, that that is done fully and properly. It is a separate function. The CQC is a regulator, HSSIB is an investigator, and the Minister is there to ensure that things are delivered properly. Going back to patient safety, at the end of my interview, I essentially told the panel, “I cannot tell you that anything is 100%...
Decluttering a landscape does not make patients any safer. Rolling HSSIB into the CQC does not make anything safer. In fact, one of the fundamental things I do not understand about this is that the Government say, “Don’t worry, it’s okay-we’re basically recreating HSSIB within the CQC,” in which case they have not decluttered the landscape; they have just hidden it and sort of pushed it out of the way within the CQC. They have not removed it. Either they have decluttered the landscape and removed it, or they have not. It does not seem clear which the Government think they have done. I would be grateful if, when the Minister wraps up her comments, she could explain why she thinks this move will improve patient safety for us all across the NHS.
I declare an interest as a member of the all-party parliamentary group on patient safety, which is opposed to the changes to HSSIB proposed in the Bill. Over the last couple of weeks, we have been reminded why we need an appropriate safety landscape when things go wrong. We have had the Donna Ockenden review into Nottingham maternity services. We have had Baroness Amos’s national review into the picture following a range of maternity scandals across the country. Yesterday evening, I attended the debate on the regulations to compensate victims of the infected blood scandal. Safety is at the top of all our minds at the moment, as it should always be. Something that has come across very strongly from Members of all parties, on both sides of the House, is that culture is critical to ensuring that those types of issues-the huge scandals-never happen again. Indeed, smaller scandals must never happen again, because people need to be free. Staff in particular need to have the confidence that, if they report concerns about the way they operate, they will be safe to do so without jeopardising the rest of their career, and that those concerns will be acted on and the lessons learned. Everybody here wants to achieve that. I do not think anybody is arguing about the fundamental principle that, when there are concerns, they need to be raised in a safe place and that the lessons from those concerns need to be learned. That is why I share the lack of understanding of the shadow Minister,...
Before I address the clauses, I say for the record that 21 years ago this morning, 52 people were murdered and 784 injured by Islamist terrorists in London. I pay tribute to all the medical professionals who treated those people in such difficult circumstances. I will speak to clauses 59 to 63 together because they all concern one of the most significant structural changes proposed in the Bill: the abolition of the Health Services Safety Investigations Body as an independent statutory organisation, and the transfer of its functions to the Care Quality Commission. At first glance, that may appear a relatively modest machinery-of-government change. The Minister argues that HSSIB’s functions will continue, its statutory safe-space protections will remain and operational independence will somehow be preserved. However, when one examines the evidence presented to the Committee, and that given to the Health and Social Care Committee, of which I am a member, it becomes increasingly difficult to identify the problem that this merger is intended to solve. Instead, what emerges is a remarkable degree of consensus among those with the greatest expertise in patient safety that this proposal carries significant risks while offering little measurable benefit. The question before us is therefore not whether HSSIB’s statutory functions can be transferred to another organisation, but whether Parliament should abolish an institution that it deliberately created to be independent. That...
Nobody disputes that unnecessary bureaucracy should be reduced, or that duplication should be removed where it genuinely exists. Nor, I think, would anyone argue against simplifying an over-complex landscape, if doing so allowed frontline clinicians to spend more time caring for patients. The question, however, is whether HSSIB is the problem-and when one examines the evidence, the Government have not demonstrated that it is. Indeed, HSSIB represents only a tiny proportion of that landscape. In its first 30 months of operation, it produced just 38 recommendations. Its annual budget is around £6 million. By comparison, more than £160 million is spent each year across patient safety activities. The overwhelming majority of recommendations within the system do not originate from HSSIB at all, but from regulators, public inquiries, royal colleges, NHS England and many other organisations.
I ask the Minister again: if the concern is excessive bureaucracy across more than 150 organisations, why have the Government chosen to abolish one of the smallest, most focused and arguably most cost-effective organisations within that landscape? How does removing one body, responsible for just a handful of carefully targeted, systematic investigations, simplify the wider system in any meaningful way? Where is the evidence that HSSIB is responsible for the duplication identified in the Dash review?
These are important questions because, during her evidence, Dr Dash repeatedly referred to simplification and alignment. She explained that:
“The point of bringing it into the CQC…is that we are trying to simplify this landscape…The hope…is that by bringing HSSIB into the CQC, you can align the work of the two.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]
But alignment is not, in itself, an argument for abolition. Many organisations work alongside one another, but that does not mean they should be merged. Indeed, through public administration, we deliberately maintain institutional separation precisely because organisations fulfil different constitutional functions: investigators are different from regulators, auditors from departments, and ombudsmen from the bodies about which complaints are made. That separation is not duplication-it is a safeguard.
As my hon. Friend the Member for Harwich and North Essex said, the Dash review gets some basic facts wrong. It claims that HSSIB could not retain maternity investigations because the Health and Care Act 2022 made no provision for them. In his words, that is
“wrong in fact and law.” -[ Official Report , 6 July 2026; Vol. 789, c. 143.]
The problem was not powers; it was safe space protections. Why have Ministers accepted that assertion and many others that are simply untrue?
The review then claims that HSSIB has extended beyond its remit by “making…systemic recommendations”. My hon. Friend called that “complete nonsense”; HSSIB was created to do exactly that. Like the AAIB, the marine accident investigation branch and the rail accident investigation branch, it exists to identify system failures and recommend change. That was Parliament’s intent from the outset. My hon. Friend speaks with particular authority because he chaired the Select Committee that proposed HSSIB and the Committee that scrutinised the legislation. Why are Ministers relying on a review that misstates both the law and Parliament’s intent?
Most concerning is recommendation 3 in that report-as my hon. Friend calls it, the “fundamental flaw in Dash”-which proposes that most safety investigations remain with provider organisations. Yet, as the hon. Member for North Shropshire has pointed out, Ockenden and Amos exposed the weaknesses of trusts investigating themselves. Families do not trust organisations to mark their own homework, and neither do clinicians and patient safety groups. Amos was clear: when families lose confidence in a local investigation, they should have access to an independent one. If not HSSIB, then who? That is the question Ministers have yet to answer.
During our evidence session, my hon. Friend the Member for Sleaford and North Hykeham asked Dr Dash directly about the obvious conflict created by merging HSSIB into CQC. Dr Dash’s response was strikingly brief. She said,
“I do not see a conflict. I think they are complementary”. -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 5, Q3.]
With respect to Dr Dash, that assertion does not answer the concern. Two organisations may be complementary; that does not mean they should become one. The police and the Crown Prosecution Service are complementary, as are the National Audit Office and the Treasury, and the air accidents investigation branch and the Civil Aviation Authority, yet Parliament deliberately keeps those institutions separate, because each performs a fundamentally different role.
I therefore put a series of questions directly to Dr Dash during our evidence session. I reminded her that the King’s Fund, Nuffield Trust and the Health Foundation appeared before the Health and Social Care Committee, and all three advised against bringing HSSIB into the CQC. I observed that no one apart from her and the Department thought it was a good idea, and I think that observation remains true today. Concerns have been raised by former Health Secretaries, patient safety organisations, the professional bodies, people working within HSSIB, academics specialising in patient safety and even the Care Quality Commission. That breadth of concern must give Ministers pause.
I then asked Dr Dash what I believe is the central question before this Committee:
“if…the safe space element would be retained and HSSIB would operate as an independent organisation, how can you square the fact that it would remain independent and yet be part of the CQC? If it does remain independent, what is the need to bring it into the CQC?” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.]
I have reflected carefully on her answer. She returned once again to simplification. She spoke about aligning work and reducing duplication, but did not explain why abolishing the independent statutory body was necessary if, as the Government repeatedly assure us, operational independence, safe space protections and investigative independence will all remain exactly as before.
That contradiction runs throughout the Government’s case. On the one hand, Ministers tell us that nothing of substance will change. On the other, they ask Parliament to dismantle the very institutional framework that Parliament itself established only a few years ago. Those two positions cannot comfortably co-exist. If institutional independence is essential to maintaining confidence, it should remain institutional. If institutional independence is unnecessary, Ministers should explain why Parliament was right to legislate for it in the first place. The Government cannot simultaneously argue that HSSIB’s independence is indispensable while abolishing the independent institution itself.
Nor is this simply an academic debate about organisational charts. This goes directly to confidence. Patients, families and clinicians do not read statutory drafting before deciding whether to speak openly. They judge organisations by what they are. Today, HSSIB is clearly understood to be an independent safety investigator, but if this Bill became law tomorrow, it would sit within the Care Quality Commission-the body responsible for regulating, inspecting and assessing providers.
However carefully the internal governance arrangements are drafted, public perception will inevitably change. Once confidence in independence is weakened, rebuilding it may take many years, which is why I remain unconvinced that the Government have demonstrated either the necessity or the proportionality of these clauses. They have identified a real challenge across the wider patient safety landscape, but they have yet to demonstrate that abolishing one of the few internationally respected independent safety investigation bodies is the appropriate solution.
If the Government’s argument is one of administrative efficiency, the evidence we have heard from those who have spent years improving patient safety demonstrates why efficiency cannot come at the expense of independence. Perhaps no witness was better placed to address that than my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt). As the longest-serving Health Secretary in recent history and the Minister who championed a new approach to patient safety following a number of tragic failures in the NHS, he reminded the Committee why HSSIB was established in the first place. He told us that
“the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned.”
That comparison is fundamental. The Government present this merger as though it were merely an organisational restructuring, but it is not. It represents a departure from a principle that has underpinned accident investigation in every major safety-critical industry for decades. Those functions are deliberately separated because investigators must earn the confidence of those whose evidence they seek. The objective is not to establish blame, to prosecute or even primarily to determine liability; it is to understand why the system failed so that the same tragedy does not occur again.
My right hon. Friend explained exactly why the model was adopted for healthcare. He said:
“The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn.”
That sentence captures the entire philosophy behind HSSIB. Safe space is not a procedural convenience; it is the mechanism through which investigators obtain the evidence that would otherwise remain hidden. People speak honestly because they trust the institution. They trust that investigators are there to understand, not to punish. That trust cannot simply be written into legislation.; it has to be actually earned. It must be protected, for once it is lost, it is extraordinarily difficult to rebuild.
My right hon. Friend went on to a very clear conclusion:
“I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 29-30, Q52.]
That is a remarkable piece of evidence. The architect of this approach to patient safety is telling us that the feature of HSSIB that has proved most successful is the very feature that these clauses place at risk. He is not arguing that safe space will disappear overnight; he is making a more subtle and, I would suggest, more important point. Safe space depends upon confidence, confidence depends upon independence, and independence depends not only upon statutory wording, but upon institutional identity. Patients, clinicians and families know today that HSSIB is separate from the regulator. However carefully Ministers draft governance arrangements, that perception will inevitably change.
The Government repeatedly assure us that operational independence will remain, but operational independence is not the same as institutional independence. Indeed, that distinction was brought into sharp focus during our evidence sessions. Dr Rosie Benneyworth, the chief executive of HSSIB, explained why safe space matters in practical terms rather than in legal theory. She said:
“Safe space…means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs.”
She went on to describe the reality within today’s NHS:
“We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns…we are still working in a culture of fear.”
That evidence should concern every one of us on the Committee. The success of HSSIB was never based on an assumption that the NHS already possessed an open speaking-up culture-quite the opposite. It was created precisely because too many staff still fear the consequences of speaking openly.
Dr Benneyworth continued by explaining that the HSSIB’s independence gives confidence not only to staff, but to patients. She said:
“This enables staff working in the service and patients to talk to us freely…Patients sometimes worry that they will be treated differently…This enables patients to talk to us in the knowledge that they will not be named.”
Perhaps most tellingly of all, she described the trust that HSSIB has spent years building. She said:
“We are now in a stage where we are growing that trust…When we launch an investigation, organisations right across the country say, ‘Please come and see what’s happening here.’…I worry that that might be impacted by the changes ahead.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]
Those are not the words of an organisation resisting change for its own sake. They are the considered concerns of the organisation that Parliament established specifically to investigate patient safety without fear or favour.
The Government argue that statutory protections will remain. I do not doubt the sincerity of Ministers in making that commitment, but we cannot legislate for trust. Legislation cannot compel confidence, and it cannot guarantee that a frightened junior doctor, an agency nurse or a bereaved family member will feel the exactly the same about approaching an investigator housed within the regulator as they do about approaching an entirely independent statutory body. It is not a legal question; it is a human one.
Dr Benneyworth recognised that if Parliament proceeds with the proposal as outlined in these clauses, the legislation must go further than it currently does. She told us that there needed to be
“much more clarity about governance…to protect independence”
and that
“it is vital that there is a legal duty for the CQC to protect safe space.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 26, Q44.]
Even the organisation being abolished is telling Parliament that the safeguards in the Bill are insufficient.
I therefore return to the central question. If the Government’s objective is to improve patient safety, why jeopardise one of the very few organisations that has successfully built trust among clinicians, patients and families? Why weaken confidence in the one institution specifically designed to investigate systematic failure, independent of regulation and enforcement? Why abandon a model that aviation, rail and every other major safety-critical industry continues to regard as essential? Those questions remain unanswered.
Dr Dash sought to challenge the comparison with aviation. She accepted that she was aware that the air accidents investigation branch and the Civil Aviation Authority are two separate organisations. She argued, however, that healthcare was somehow different. She told the Committee:
“the more I have looked into it, the more I think there are limits to that analogy.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 9, Q11.]
She suggested that aviation investigations were more focused on identifying specific technical failures such as a faulty component, and that healthcare safety issues were broader questions about the quality of care.
With respect, I do not think that argument addresses the fundamental point. The lesson from the aviation industry is not whether a safety failure involves a bolt on an aircraft, a medication error in a hospital or a failure in a clinical pathway. The lesson is about how high-risk systems learn. The principle is that those investigating failures must be trusted by those who provide the evidence, and that principle does not depend on whether that failure occurred at 30,000 feet or at the bedside. Indeed, the more complex the system, the more important that independence becomes.
Modern healthcare, as I think we all know, is one of the most complex systems in society. When something goes wrong, the cause is rarely a single individual’s mistake; it is usually a combination of pressures, incentives, processes, communication failures and organisational decisions. That is precisely why HSSIB exists. Its purpose is not to determine who should be blamed, but to understand why the system allowed harm to occur. That distinction is fundamental.
My hon. Friend is making a comprehensive speech and getting to the nub of all the relevant points. He talks about the system failing; to me, that is the absolute nub. The CQC is absolutely part of the system and of the establishment. If anyone is put off from making a complaint to the CQC when they think the CQC may be to blame, how on earth can the functions currently exercised by HSSIB continue in any effective way?
My hon. Friend makes several key points, and he is absolutely right: what problem are the Government trying to solve here? If we believe in independence, believe in an investigatory body and believe it is working well-and it demonstrably is working well-why on earth would we change it? That goes to a further point: these clauses not only potentially provide for a transfer of HSSIB into CQC but add risk and failure in that procedure. My hon. Friend asks how we can be confident that the system is going to work if a patient or a clinician does not want to put their head above the parapet because they are frightened that there will be regulatory consequence. That is a fundamental problem with the Government’s proposal. As I have said several times in this speech, we have not had the answer to that and no answer seems to be forthcoming. I may touch on that in a bit more detail in a moment. My right hon. Friend the Member for Godalming and Ash was clear on this topic when he gave evidence to the Committee: “My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.” -- [ Official Report, Health Public Bill Committee, 16 June 2026; c. 29, Q52.] That is the problem that HSSIB was created to address and why I struggle with the Government’s argument. If the problem is that the NHS does not learn lessons effectively, the answer should be to strengthen the organisation designed specifically to help it to...
I am particularly keen to speak on clauses 59 to 63, because HSSIB was a key part of the Health and Care Act 2022, which I took through as a Minister. At that time, I was grateful for not only the fearless and tough questioning from the now Minister, who was on the Opposition Benches, but for her support. She said: “HSSIB is a really important new body” -- [ Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564.] She also said that it is a “new and important body, which we are all desperate to ensure works well.” -- [ Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 566.] It is fair to say that it does work well, as my hon. Friend the Member for Farnham and Bordon set out clearly in his detailed remarks. The thread running through his remarks, which is particularly important in this context, was trust. People who have had something go wrong and have reported a problem need to trust that it will be looked at independently and dispassionately. I fear that what is proposed here results from a deeply misguided decision, which has at the heart of its logic a fundamental flaw. As the hon. Member for North Shropshire set out, the decision fails to recognise that HSSIB’s role is fundamentally different from the role of CQC. It is an independent investigator; it is not a regulator or an enforcer, yet that somehow seems to be conflated in what the Government are trying to do here. They have simply failed to make a logical case for...
My right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.
My hon. Friend the shadow Minister is right to highlight, for want of a better way of putting it, the cumulative challenges that will potentially be piled on the CQC, on top of the pre-existing challenges with how that organisation is functioning. I read with great care the Adjournment debate that took place last night in the Chamber, which has been referred to by a number of hon. Members, in the name of my hon. Friend the Member for Harwich and North Essex, and I pay tribute to him for his work in this space. I worked closely with him in the context of the passage of the Health and Care Act 2022, and I know that the issue of patient safety is fundamental to what he seeks to improve and achieve in this House. I agree with him: I fear the Dash review simply fails to make the case for those changes. Also, as hon. Members have set out, it sadly appears to contain a number of errors and assumptions that are inaccurate, which I will turn to in a moment. The fundamental challenge is to establish a way for people to feel confident and trusting in challenging a culture of denial and blame. We have seen this most recently in the context of maternity failings and scandals. The need for that safe space, and for an organisation able to challenge the institutions, is very clear, and I fear that this change actually weakens the ability to do that. Dr Dash’s review, I fear, fails to fully recognise just how important the safe space concept is-not just in how it is drafted and framed...
On pages 8 and 9 of the Dash review, Dr Dash talks about this. She states: “Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.” She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.
I do think that the scope of the review, who determined the six organisations and how that was looked at is important, and I am sure that the Minister will be able to clarify that when she makes her concluding remarks. However, there are a couple of other issues that concern me in terms of some of what was in the review, which seems to be the basis on which this is being done. Finding 6 suggests that HSSIB has expanded its “scope of work beyond the original remit.” It goes on to say: “HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.” I have to say, as the Minister who took the Health and Care Act 2022 through, that is simply not the case. That Act does not limit HSSIB investigations to individual incidents. If I recall correctly, in some of the debates on the HSSIB clauses in the Bill, we alluded as a Committee to the need for it to be able to look beyond individual incidents and try to draw out common themes. What has been said simply does not accord with my recollection of the purposes of the legislation. Again, my hon. Friend the Member for Farnham and Bordon highlighted this. Recommendation 3 states: “Most investigations into safety incidents should continue to be managed within provider organisations”. That is the real challenge here. HSSIB’s independence is what allows it to range...
I wonder whether the right hon. Gentleman has had the experience that I have had as a constituency MP of very senior clinicians who work in the NHS attending my surgery and explaining that if they have raised concerns within their organisation, they have been encouraged either to leave or to retire. They feel frightened to raise concerns about safety that they have experienced in carrying out their duties, so it is really important that this safe space exists. Does he agree with that?
The hon. Lady makes her point extremely clearly, and I do agree with exactly the point she makes, because in any organisation it is a big step for an individual employed by or working in the organisation to make a complaint about their organisation or to whistleblow on something that has gone on or that they feel has not been got right. Key to getting people to do that is that they feel safe and empowered to do it in the public interest, and that is exactly what is at the heart of the air accidents investigation branch and the rail accident investigation branch model, so that the information is brought forward and learnings can be driven by it to improve safety for everyone. As the hon. Member for Bury St Edmunds and Stowmarket said, that safety is patient safety and that has to remain the golden thread that runs through everything we are debating. Whatever difference of perspective we have on this set of clauses, that must remain at the heart of what we are looking for.
I will just make two further comments. First, in terms of cost, I recognise that the Under-Secretary of State for Health and Social Care set out that this is not about cost last night in the Adjournment debate. At £6.3 million per year, I have to say that that is a tiny amount in the context of overall NHS spending. It is a large amount of money, but it is a tiny amount in the context of the NHS budget. That is money that does an incredibly good job for a relatively small budget as organisations in the NHS space go. I challenge anyone to come up with another organisation within the health and social care space with a budget of £6 million or so that does as much good and has the potential to do as much good when it comes to improving patient safety.
If the argument for this is not about money-if it is about simplifying a complex landscape and having fewer recommendations so that they are implemented-it is, again, the answer to a question that has not been asked. Clause 59 does not do that; it simply shifts HSSIB from A to B. In doing so, it does not save money. It will not necessarily reduce recommendations, of which HSSIB contributes only a small number anyway. What it will do is have a huge cost in terms of public trust and the ability of the organisation to get that open disclosure to be able to drive patient safety.
I gently say to the Minister that I hope that she will take away the strength of the feeling of members of the Committee. I hope that she will reconsider whether this move should be scrapped and whether we should be making these changes. When we should be strengthening measures to protect and enhance patient safety, I rather fear that the clause will do the opposite and risk weakening the provisions that are currently in place.
I know that the Minister is a diligent and thoughtful Minister who knows her brief very well, so I hope that she will reflect on the points made in Committee and reconsider the clauses.
It is a pleasure to serve under your chairmanship, Sir Roger. The issues relating to clause 59, principally the abolition of HSSIB, have been well articulated, not least by my colleagues on this side. I wish to add some of my own views too. The debate has been framed as a transfer of the functions of HSSIB to the CQC, and indeed that is the title of the clause. The Minister has certainly articulated her arguments in that way. Effectively, it is the abolition of HSSIB. In fact, clause 59(1) plainly says: “The Health Services Safety Investigations Body is abolished.” Its functions may be transferred, but that is quite a significant change, and I do not want that to be lost within the context of this debate. At the heart of it is this idea around investigatory and regulatory functions. While the argument remains technical-and it is of course easier for the Government and indeed Dr Dash to make the arguments to abolish HSSIB in the abstract-when we talk about the real-life implications and how real people react to different circumstances, it is plainly very significant and negative. That is particularly true when it comes to investigating where things went wrong and when the system is at least in question and could be at fault. When there are things that need airing that people are afraid to air, confidence in the new framework is essential. Regardless of the systems, processes or protocols that the Government may wish to put in place to ensure that the safe space concept...
As I said throughout my speech, I am against this proposal whatever the nature of the CQC. However, does it strike my hon. Friend, as it strikes me, that the problems of moving the functions of HSSIB into the CQC are compounded given that the CQC, as he alluded to, is not functioning well and does not have the confidence of patients and clinicians?
My hon. Friend leads me to a point I was going to make later, but I will make it now. He is absolutely right: the CQC has not had a lot of good press and does not instil a high degree of confidence in professionals and the public. That is a very real issue. The Minister and, I think, Dr Dash have said that the transfer of powers from HSSIB to the CQC will not happen until it is in a better place, and that is all very well, but these changes are intended to last for a long time-indefinitely, presumably. To merely wait until an organisation is in a better place to transfer those powers, and to expect that organisation to remain in a better place in perpetuity, is wishful thinking. The CQC has had leadership issues. We all hope and I am sure that the leadership will be in a better place in the near future, but if an organisation can be in such a bad place because of a failure of leadership, those circumstances can return in the future. Of course, it might be leadership failings within the regulator that HSSIB is asked to investigate. Again, if its functions are delivered by a regulatory organisation with leadership failings, there will be no confidence whatever that a truly independent and meaningful investigation can take place. Let us not forget that the public are somewhat jaded by investigations, inquiries and reports-justifiably so. They clearly have a valuable function, but their function is far more valuable if there is confidence in them. If a powerful organisation such...
My hon. Friend is rightly highlighting the importance of independence, and trust in the independence, of the organisations investigating failures and making recommendations. Does he agree that that is only half of it? Those organisations are not at fault when recommendations are not implemented, so the other half of this is that the NHS and the system need to act on those recommendations when they are made.
It is, of course. I have been focusing on public perception, and my right hon. Friend is absolutely correct that that is only one part of it-an important part of it. Probably, the most important part is what actually happens, and that requires the NHS to learn and improve, which is very unlikely to be improved by this proposal.
My hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or-
The Chair
Order.
The Chair adjourned the Committee without Question put (Standing Order No. 88).
Adjourned till this day at Two o’clock.