Health Bill (Third sitting)
House of Commons · Public Bill Committees · 18 Jun 2026 · 152 speeches · Official Report
The Committee consisted of the following Members:
Chairs: Sir Roger Gale, Dr Rupa Huq, Emma Lewell, † Sir Jeremy Wright
† Argar, Edward (Melton and Syston) (Con)
† Brackenridge, Sureena (Wolverhampton North East) (Lab)
† Chambers, Dr Danny (Winchester) (LD)
† Daby, Janet (Lewisham East) (Lab)
† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)
Irons, Natasha (Croydon East) (Lab)
† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)
† Joseph, Sojan (Ashford) (Lab)
† Kyrke-Smith, Laura (Aylesbury) (Lab)
† Morgan, Helen (North Shropshire) (LD)
† Prinsley, Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
† Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Thursday 18 June 2026
[Sir Jeremy Wright in the Chair ]
Health Bill
The Chair
Before we begin, I remind all Members to switch their electronic devices to silent, please. I am sorry to tell you that tea and coffee are not allowed; you are limited to water. As you are able to see, I am content if Members wish to remove their jackets, so please do so if it makes you more comfortable. Before we go any further, I believe that the Government Whip intends to move an amendment to the programme order agreed on Tuesday. Ordered , That the Order of the Committee of Tuesday 16 June be varied, in paragraph 1(b), by leaving out “and 2.00 pm”.- (Emma Foody.)
The Chair
We will now move to line-by-line consideration of the Bill. The selection list for today’s sitting is available in the room and on the parliamentary website. It shows how the clauses, schedules and selected amendments have been grouped together for debate. A Member who has put their name to the lead amendment in a group will be called to speak first. Other Members will then be free to indicate, by bobbing, that they wish to speak in the debate. Please do that on each occasion on which you wish to speak during proceedings. At the end of a debate on a group of amendments and new clauses, I shall call the Member who moved the lead amendment or new clause again. Before they sit down, they will need to indicate whether they wish to withdraw the amendment or the new clause, or to seek a decision. If any Member wishes to press any other amendment-including grouped new clauses-in a group to a vote, that is at the Chair’s discretion. My fellow Chairs and I shall use our discretion to decide whether to allow a separate stand part debate on individual clauses following the debates on relevant amendments. I hope that that explanation is helpful and that no Chair needs to give it again during the course of proceedings. Clause 1 Abolition of NHS England Question proposed, That the clause stand part of the Bill.
The Chair
With this it will be convenient to consider clauses 2 and 3 stand part.
Clause 1 formally abolishes NHS England as a statutory body, which is one of the key aims of the Bill. The current structure, with its two centres, has led to layers of unnecessary bureaucracy, duplication and unclear lines of accountability, and has come with significant cost, with the centre growing significantly in size since 2013. Through the Bill, we are simplifying the organisational landscape of the NHS and removing unnecessary complexity and overlapping roles among NHS England and the Department of Health and Social Care. The reform will enable leaders and staff to focus on delivering care, rather than on navigating bureaucratic hurdles. Importantly, it will also restore Ministers’ central role in national oversight and setting strategy, which the public rightly expect as part of a democratic system. The creation of an arm’s length body of this size was a mistake, and we seek to rectify it. Clause 2 is integral to the orderly abolition of NHS England. It empowers the Secretary of State to establish transfer schemes, which will provide a structured and transparent means of moving property, rights and liabilities from NHS England to the Department of Health and Social Care, the integrated care boards and other relevant bodies. This robust legal mechanism is required to ensure a responsible transfer of NHS England’s assets and staff. It ensures that all necessary legal powers and permissions for the transfer are in place, preventing uncertainty or loose ends for staff,...
It is a pleasure to serve under your chairmanship, Sir Jeremy. First, I declare a number of interests. I am a consultant paediatrician working in the NHS, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health. Like the Minister for Secondary Care, I got into politics after working in the health service. I am sure she agrees that what you see when working in the health service stays with you when working in the House, and that it benefits the House to have people who have done all different jobs working here. The NHS constitution says that health services should “improve, prevent, diagnose and treat both physical and mental health problems with equal regard”, yet in my work as a doctor-and I worked across several hospitals during my training-the gap between the vision of what should be delivered and the reality of what is being delivered has become apparent to me. The answer frequently given seems to be top-down reorganisation. As I will talk about in a minute, such top-down reorganisation has been done so many times but does not seem necessarily to have delivered in practice what it promised. Indeed, to an extent, we seem to be changing things from how they were to how they are to how they were, backwards and forwards. This Government have decided, in pursuit of better outcomes and cost savings, once again to reorganise the health service, and they seek to do so with this Bill and particularly clause 1. Clause 1...
In 2004, we had the first wave of foundation trusts, which were granted substantial independence over how to meet their obligations. A key feature of a foundation trust was that their communities would theoretically be able to vote in elections for governors, in order to ensure accountability. Although those changes were introduced by a Labour Government, the logic behind them was the same as that of the preceding centre-right Government-freeing more of the health service from state control. There were reasons why it was freed from state control, and we have gone back and forth again.
Despite the outcomes that these reforms brought, there was a recognition that the system was not working, and in 2007 the Department of Health published its “Next Stage Review”. It said-this is under a Labour Government-that
“high quality care cannot be mandated from the centre”
and recognised the importance of choice. Although health spending as a percentage of GDP grew from 4.9% in 2000 to 7.5% in 2010, health outcomes and patient safety still left much to be desired.
That brings us to the creation of NHS England. At this point, the Government were very keen on “agentification”. Politicians thought that separating steering from rowing would unlock new efficiencies, and that that could be achieved by creating quasi-autonomous bodies insulated from day-to-day politics. I note that when the coalition Government took office in 2010, they inherited 130 new quangos.
The 2010 White Paper “Liberating the NHS” set out the following objectives: eliminating red tape; freeing staff from top-down control; devolving responsibility; expanding choice, and strengthening the patient voice. If those objectives sound familiar, it is because they are the same objectives being pursued by the Government today, even while they are doing, in some respects, the opposite.
We must recognise that the reforms that created NHS England, which was originally called the NHS Commissioning Board, were part of a move under successive Governments towards more operational autonomy, and in 2012 the Government legislated to take operational autonomy to its logical conclusion. Ministers would set objectives and the NHS Commissioning Board would oversee delivery. The board would support new GP-led commissioning groups, which were intended to replace strategic health authorities and primary care trusts. The creation of health and wellbeing boards would bring together commissioners, local representatives, and representatives from the new Local Healthwatch, to work together to improve local wellbeing. I should note that Healthwatch is addressed later in the Bill, because it is being abolished, too.
The Government’s own impact assessment for the Bill acknowledges that NHS England
“was originally created as an arm’s length body to give the NHS greater freedom, increase transparency and reduce political micromanagement.”
It was created before I became an MP, but I recognise that the shift brought substantial challenges, as had been the case with every previous reorganisation. Reorganisation is not all about the structure, but there are pros and cons to each type of structure; we move from one to the other as we try to move away from the cons of one to the pros of another, and finally we reverse again.
When Governments try to cut bureaucracy, they often create new types of bureaucracy in the process. Greater autonomy for the health service necessitated more structures and more staff. In 2022, the Government-including my right hon. Friend the Member for Melton and Syston-addressed some of the challenges with new legislation that placed greater emphasis on collaboration rather than competition, by replacing clinical commissioning groups with new integrated care systems. Those systems would comprise integrated care boards responsible for the commissioning of services for populations, and integrated care partnerships, which would bring together integrated care boards and local authorities to develop a care strategy and consider the wider determinants of health. The Secretary of State had the power to direct NHS England beyond the objectives in its annual mandate, and the power to intervene in the reconfiguration of local services. Several organisations, such as NHS Improvement, NHSX and Health Education England, were folded into NHS England or retired. That is the system that we have today.
The 2022 reforms were cautious. The Government reshaped systems and the Secretary of State was better empowered, but the reforms represented an evolution rather than a revolution. The Minister for Secondary Care previously said:
“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money” -[ Official Report , 22 September 2020; Vol. 680, c. 809.]
I do not always agree with the Minister, but she was absolutely right in that instance. As I have demonstrated, we have seen years of change, back and forth, and an evolution of structures that has not necessarily delivered what it said it would. In fact, it can deliver delay. We will no doubt talk later about where Health Education England functions in NHSE will go, but we know that the workforce plan is a key part of that work.
The workforce plan was promised for Christmas last year-for December. It was then promised for spring this year. We know from the weather today that we are now in summer and it still has not arrived. There is therefore an extent to which this reorganisation could be delaying rather than speeding up the improvements that the Government want to make.
I remind hon. Members of what the previous Health Secretary, the right hon. Member for Ilford North (Wes Streeting) said:
“Just imagine if all the time, effort and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients-clearly, the NHS would not be in the mess it finds itself in today.” -[ Official Report , 12 September 2024; Vol. 753, c. 984.]
Shortly after this Government took office, it seemed that Ministers had listened and decided that they did not want a top-down reorganisation, and it was not on the cards. The Minister for Secondary Care said:
“We are not going to look at changing structures. We want to work with the system that we have inherited.” -[ Official Report, 3 September 2024; Vol. 753, c. 24WH.]
The then Health Secretary also said that
“we will not repeat the mistakes of top-down reorganisation. With the architecture of the system, we will take an approach of evolution rather than counter-revolution.” -[ Official Report , 12 September 2024; Vol. 753, c. 994.]
The Government have not been clear about why they changed their mind. One of the Ministers suggested the other day that it was because they found different things when they came into office. In fact, the Government commissioned an independent investigation into the health service. When I say “independent”, we should note that the author of that investigation was a former Labour Minister. Lord Darzi’s final report said:
“While a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable, there is more work to be done to clarify roles and accountabilities, ensure the right balance of management resources in different parts of the structure, and strengthen key processes such as capital approvals.”
He warned:
“Constant reorganisations are costly and distracting. They stop the NHS structures from focusing on their primary responsibility to raise the quality and efficiency of care in providers.”
Ministers have chosen to ignore that warning, as though it were never made. When the Minister responds, can she explain what caused the Government to change their mind about reorganising the health service? They had access to the civil service before coming into Government, they said they had a plan, and they had Lord Darzi’s report, which did not favour reorganisation, so what made them want to reorganise the whole system?
This is an interesting point, and it is always helpful to have one’s comments put back to one. I am happy to come back to this again. I ask my question again: do the Opposition oppose the abolition of NHS England? I do not think the Opposition oppose the abolition; they think it is the right thing to do. I appreciate that that was confirmed on Second Reading. As I have said before, the previous Government had the opportunity to do this in 2022 and chose not to. The fact that it has not been opposed suggests that it is the right thing to do. As for what we found on coming into Government, we thought that delivering on our manifesto through the existing powers, flow of funds and priorities would be possible. We were clear that we did not seek this as an initial outcome, but having got into that position, we immediately found, even while developing the 10-year plan and bringing together one team, that it was not possible. I am afraid that the line through which ministerial intentions could be delivered was convoluted, and obstructed by various measures throughout the system. That independence-
The Chair
Order. I am sorry to interrupt-
Sorry, I know that was not an intervention.
The Chair
Yes, that was the point I was about to make. I know the Minister is trying to help and answer the point that was raised. As she knows, she has another opportunity to speak at the end of the debate. If she wants to briefly summarise the point now and then come back to it in more detail, she is more than welcome.
I am happy to come back to it.
The Chair
Very well. I call Caroline Johnson.
Thank you, Sir Jeremy. I will be grateful if the Minister clarifies at the end, because she seems to be suggesting that Lord Darzi’s report was wrong in some way. He was assessing the NHS at the same time that she was, with the experience of having been a Minister, and made the counter-suggestion. It is not just about what one does; it is about how one goes about it. As we heard on Tuesday, there is in general a plan of what is going to happen, but so many decisions have not been made yet in relation to this. In particular, one of the witnesses from the union talked about how unsettling that was for staff and how difficult it is for staff to be asked to go from the current location to a destination unknown. It is very difficult to make transformation in a direction when it is not clear where one wants to be. In March 2025, the Government announced that NHSE would be abolished. The largest healthcare union described the handling of the announcement as “shambolic”, coming only days after the announcement of a 50% cut to staffing levels at the centre. In the days and months since, Ministers have provided only some clarity about what they are trying to achieve. According to the Government, the restructure will cut red tape, save money, devolve power and improve accountability, all with a view to improving patient outcomes. Those are not new objectives; they are the same objectives that underpinned the creation of NHS England. How is it that the same objectives require...
Yesterday, the Health Service Journal reported the Minister saying that it is “important” that the new Department of Health and Social Care is established by 1 April next year, but experts such as Ian Dodge, who is NHS England and NHS Improvement’s longest-serving executive board director, have said that it could take at least until April 2028. Last year, Ministers set out to reduce the headcount at the Department and NHS England by 50% by March 2028. I am yet to be presented with convincing evidence that the Government did not pick that number out of thin air. Twelve months after the announcement of the abolition of NHS England, Ministers have achieved a mere 2.6% reduction in the number of staff working there.
As things stand, the Government are not on track to deliver savings from headcount reductions, even ignoring the cost of redundancies. When previous Governments have tried to streamline arms of the state by axing hundreds of staff, they have often had to pay later down the line to regain the same expertise. Can the Minister reassure the Committee that that will not happen with the abolition of NHS England?
That brings me to the fiscal case for abolition. In November, the Government announced that abolishing NHS England and restructuring ICBs would save £1 billion per year. Moving from two sets of comms, IT and human resources could of course reduce costs. They will no longer need data-sharing agreements, or have the Department phone up NHS England every time it requires information to answer parliamentary questions. That is good, not just because it may mean I get some answers to my parliamentary questions, but because there will be less duplication, which I welcome.
However, how can we be certain that fewer staff and less bureaucracy will save £1 billion a year? How can we be sure that those savings will be realised in the face of the substantial costs that come with reorganisation? The Department’s permanent secretary wrote to the Public Accounts Committee that
“the estimated overall cost of redundancy exits across DHSC, NHSE, ICBs and Commissioning Support Units (CSUs) is estimated at approximately £1bn to £1.3bn”.
So, all things being equal, it will take some time just to break even. We know that cost savings-if they do exist-from top-down reorganisation take years to materialise and are often eclipsed by the financial toll of transition.
The cost is not all measured in finance; disruption carries a significant opportunity cost. I recently tabled a written question to ask the Minister about the disruption to new services resulting from the abolition of NHS England, and she responded by saying that it is not causing any disruption, but I am not sure that that is 100% accurate in the light of the evidence we heard on Tuesday. We heard that the abolition of NHS England is putting the delivery of projects at risk because experienced staff are leaving, and we know from the National Audit Office that restructuring NHS England is affecting the new hospital programme. In its January 2026 report, the National Audit Office wrote that
“the plans to dissolve NHSE have resulted in some disruption to the programme.”
It also wrote:
“DHSC has rated the risk of vacancies leading to delays as red, and capabilities affected included digital, legal, commercial, project delivery and technical knowledge. These capability gaps could slow delivery, cause over-reliance on the PDP and delay later waves, which include the larger schemes. DHSC recognises that this is a significant risk to the programme”.
During the evidence session on Tuesday, several other witnesses said that they were aware of disruption. Jeanette Dickson of the Academy of Medical Royal Colleges- I again declare my interest as a member of the Royal College of Paediatrics and Child Health-said that the abolition of NHS England is “increasing the time” that things take to move. Sarah Woolnough of the King’s Fund said that her think-tank was aware of multiple teams “in limbo”. Maria Higson said that abolishing NHS England has been “a large distraction” among the staff trying to deliver the Government’s three shifts in the 10-year plan. Members may know that Managers in Partnership-the union that the Minister and another member of the Committee declared interests in-conducted a survey in May 2026; 92% of respondents said that the changes resulting from the abolition of NHS England had had a negative impact on their work, and 46% said they had considered leaving as a result.
On the most basic level, this is a question of resource allocation. Let us consider other delayed projects that NHS England has been involved in. Ministers pledged in this House that 24/7 mechanical thrombectomy services would be rolled out universally by April 2026. That is a very important service for people who have major strokes, and it makes a huge difference to their outcomes. As of April 2026, seven of the 24 stroke centres were not providing those services. Can the Minister confirm whether disruption from the abolition of NHS England and other restructuring was in part to blame?
Ministers pledged that they would deliver universal fracture liaison services by 2030, yet, again, the Government are not on track. Could the Minister confirm whether the disruption from the abolition of NHS England is in part to blame for the failure to be on track with that manifesto commitment? The cancer plan also faced extensive delays.
The workforce plan, as I said earlier, faced extensive delays, and we are still waiting for it. I understand, from a response to a parliamentary question, that it is now due “imminently”. I am not quite sure what “imminently” means, but it is obviously quicker than “soon”. If the Minister could enlighten the House on when she expects it to be published, that would be really helpful. We also still await a brain injury action plan and several modern service frameworks that were promised for the spring but have not yet materialised as we go into the summer.
I tabled a question on 18 May asking whether the Government expect NHS England’s review of the preference-informed allocation method to be completed by the time NHS England is abolished. I am sure you will be aware, Sir Jeremy, that that is the allocation method by which resident doctors in their foundation year are allocated a post. That is not meritocratic, and it is being reviewed. My question on whether it will be done by the time the NHS England team performing it is abolished has not been answered, so I presume the answer is, “We don’t know.” Every minute that staff spend worrying about their jobs, or frantically applying for others, is a minute fewer spent on delivering for patients.
Dr Hugh Alderwick of the Health Foundation has said that
“history tells us that rejigging NHS organisations is hugely distracting and rarely delivers the benefits politicians expect.”
Thea Stein of the Nuffield Trust said:
“Previous reorganisations of the NHS have often delivered a lot of disruption for uncertain benefits.”
Similarly, Sarah Woolnough of the King’s Fund said that
“history shows that reorganisations on their own do not automatically improve care for patients.”
Is it the Minister’s position that these health policy experts are misguided? Why is it that everyone outside Government thinks that the way this is being done may not deliver the benefits the public are being promised? I hope the Minister can answer that when she responds, because this is not just about the principle of the abolition of NHS England; it is about how it is done. That principle is in clause 1, and there may be benefits to that abolition, but the way it is being done-falling into clauses 2 and 3-is still uncertain, with so many decisions still not made.
Sir Jeremy, you will be aware of the by-election that is occurring today. We know that, in the past, at least one of those candidates has made comments about NHS restructuring, suggesting that they are not terribly keen-indeed, comments such as:
“Cuts and reorganisation are a toxic mix.” -[ Official Report , 12 December 2012; Vol. 555, c. 328.]
But the Government are doing cuts and reorganisation, so is it a toxic mix? If we have a change of Prime Minister, will this Bill proceed or not?
I remind Members of what Lord Darzi wrote in his independent investigation:
“Constant reorganisations are costly and distracting. They stop the NHS structures from focusing on their primary responsibility to raise the quality and efficiency of care in providers.”
When the independent investigation was published, the Government did not dispute his assertion that reorganisation is disruptive. Can the Minister confirm whether the Government planned to abolish NHS England before the outcome of Lord Darzi’s investigation, or whether they made the decision afterwards?
When abolishing something, or giving instructions to the civil service to abolish it, it is worth thinking, “What do we want to do instead? What is going to be the replacement?” We heard from my right hon. Friend the Member for Melton and Syston about how, with his Bill back in 2022, he changed the way that ICBs were structured. There was a vision then. There was a clear, coherent path for how that was going to occur. With this Bill, there has been a decision to abolish NHS England and to take political control. There may be good reasons for that, but all the detail-the “how”, what happens to this or that function, where it goes, who will transfer it, when it will be transferred and what is happening to stuff-just does not seem to be there.
There are hidden costs, too. The impact assessment mentions the transition costs of external consultancy, executive recruitment and actuarial advice-those can be quite expensive. What does the Minister expect those costs to be for the abolition of NHS England?
In December, my hon. Friend the Member for Huntingdon (Ben Obese-Jecty) tabled a question about the projected cost of abolishing NHS England, including consultancy fees and administration and restructuring costs. In her response, the Minister stated:
“The Government is committed to ensuring that Parliament and the public are appropriately informed of exit costs, as well as material consultancy, administration, and restructuring costs. Information will be published at the appropriate time”.
Given that the Committee is considering legislation that will abolish NHS England, I would contend that now is the “appropriate time”. I tabled a question asking the Minister whether her Department has used management consultants for the purpose of abolishing NHS England and, if so, what the cost has been to the taxpayer, but I have not received an answer.
There is another aspect that has not received much scrutiny. The abolition of NHS England will centralise power in the hands of the Secretary of State, once again politicising resource allocation. Private NHS contractors have been operating in a depoliticised commissioning environment, but they now face operating in a politicised one, potentially with less stability. Further clauses in the Bill relate to that, but I will not go into them now.
Private firms with NHS contracts are now aware that this legislation makes it possible for the Secretary of State to force commissioning bodies to cancel contracts or even elbow them out in an ideological push. That political uncertainty may command a risk premium, which would mean more expensive contracts and additional pressure on the public purse. The hidden danger of the Bill is that it creates new costs elsewhere in the system that may be less noticeable and more difficult to control.
One of the Bill’s aims is to improve accountability, which I support. If arm’s length bodies are in control of things for which Ministers are normally responsible, there is a democratic deficit. When hospitals were closed or services reconfigured against the express wish of communities, Ministers would say that it was out of their control. The architects of the 2012 reform did not intend for that to happen, but it did. That is not what the public expect from their elected representatives. For all the theoretical benefits of placing responsibility with arm’s length bodies, Ministers are paid to do a job, not to outsource it.
In my personal view, that is the Government’s strongest case for abolishing NHS England. The re-establishment of democratic accountability requires legislation that allows Ministers to take control, but there is a difference between taking control of some things and taking control of everything. If the Bill is not amended, the Secretary of State will assume powers of direction greater than those of NHS England. As the former Health Secretary, my right hon. Friend the Member for Godalming and Ash, said on Tuesday, abolishing NHS England only makes sense if the intention is not to increase control and impose more targets. I will save my remarks on that matter for more relevant clauses.
Clause 2 facilitates the movement of property rights and liabilities from NHS England to the Secretary of State and public bodies. I recognise that transfer schemes are necessary to reorganise parts of the state, but in this instance the scale of the transfer is extraordinary-and the extraordinary necessitates additional scrutiny. It has often been said that NHS England is the world’s largest quango. It is responsible for more than £4 in every £10 of public funds given to arm’s length bodies; it holds billions of pounds in assets and liabilities.
Clause 2 permits the transfer to a defined list of entities such as integrated care boards and trusts, but also the transfer to “any other public body”-it is a very broad clause. If the Government have identified seven types of entities that may receive parts of NHS England, as outlined in paragraphs 2(1)(a) to (g), why is there a need to include “any other public body”? This is further evidence that Ministers want Parliament to rubber-stamp the disassembly of an organisation worth £180 billion without a plan in hand.
Clause 2 contains no requirement for the Government to report to this House on the transfers that have been made. We know that the Government have been rummaging around for loose change, so there is a real risk that NHS England’s resources are transferred to places that may be flattering to the balance sheet but not necessarily in the best interests of the health service. Will the Minister commit to providing full transparency about what happens to the property, rights and liabilities of NHS England?
The clause also enables the Secretary of State to transfer employment contracts from NHS England to other entities. We must not forget the shambolic way in which the Government have gone about abolishing NHS England so far. The Institute for Government called it “chaotic and incoherent”. Staff have gone-not many; 2.6% -and those who are left fear they may be next.
In Tuesday’s sitting, the Minister said that she accepted much of the criticism about how it would have been better to do things more quickly, but that is not where we are. Can she confirm how many employment contracts will require changes because of this reorganisation? What protections apply to staff whose employment contracts have moved between public entities? Can she give an assurance that no NHS England staff member transferred to a public entity will be employed on less favourable terms or a less favourable salary for doing the job that they were doing before?
Clause 3 provides the Treasury with new powers to make regulations that adjust tax rules for transfers under clause 2. These provisions are clearly necessary. Without clause 3, the abolition of NHS England, and the transfer of its assets, could produce new tax burdens. In their memorandum to the Delegated Powers and Regulatory Reform Committee, the Government state that the clause is necessary because the tax implications that could arise “cannot be fully anticipated”, and that there is a precedent in section 107 of the Health and Social Care Act 2022. As with clause 2, I do not take issue in principle with clause 3, but I do not want to see the disassembly of NHS England take place until Ministers have produced a plan showing how they will get from A to B, as well as what B looks like.
The politicisation of the health service is part of the larger risk of putting control back into the Secretary of State’s hands. There are debates on various health topics in this House, celebrity campaigns on others, newspaper and media campaigns on further topics, and then there are other conditions without those celebrity or media campaigns. How will the Minister ensure that the principle of the NHS-that it is based on clinical need, not on the ability to pay, shout the loudest or have the best celebrity campaign-is maintained, and that people can be confident in Ministers choosing on the basis only of clinical need and patient need?
The question for the Committee is not only whether the Government should abolish NHS England, but whether they should abolish it without a plan or detailed costs, on the naive assumption that this reorganisation will be different from the many reorganisations that have gone before. That is why we have tabled an amendment to put the brakes on until the Secretary of State publishes an operating model document and a workforce transition plan. We will get to those later in our discussions.
It is sensible for the Government to seek to make the health service more efficient, but history shows us that reorganisation in itself is no silver bullet, and, if done badly, could make things worse. The health service has gone through many organisational transformations, but the costs of care and the challenges of providing it have only grown with time. They are destined to grow even further as our population ages and life expectancy increases. That is why we need to ensure that this reorganisation is done well.
I thank the Minister for Secondary Care. Her colleague, the former Health Secretary, the right hon. Member for Ilford North, has cut and run, but she has committed to seeing this legislation through. I know that it is important to her personally. I respect that and look forward to her response.
We all know how important our NHS is to the people we represent. I know how frustrated patients and staff have become after years of rising waiting lists, cancelled appointments and growing bureaucracy. Since coming into office, this Labour Government have already started to turn things around by delivering more than 3 million extra appointments ahead of schedule, cutting waiting lists and agreeing a new GP contract that begins the work of restoring the family doctor. However, the challenge remains enormous. We inherited an NHS facing the worst crisis in its history, and public finances under severe pressure. That means that every pound must work as hard as possible for patients. That is why I welcome the decision to abolish NHS England and bring its functions back into the Department of Health and Social Care. The complex structure created by the 2012 reorganisation has left us with duplication, inefficiency and too many layers of management, separating decision makers from the frontline. Far too many NHS leaders and clinicians tell us that they spend their time filling in reports and navigating bureaucracy, when they should be focused on delivering care. We owe it to taxpayers and patients to change that. These reforms are not about criticism of the dedicated public servants working in NHS England; they are about creating a simpler, more accountable system that supports staff rather than holding them back. By reducing duplication and cutting unnecessary bureaucracy, we can...
The Liberal Democrats broadly support the abolition of NHS England. As constituency MPs and users of the NHS, we see a huge amount of duplication and unnecessary bureaucracy as our local health organisations try to navigate the processes of securing capital investment, for example. Reducing duplication between the Department and NHS England is clearly welcome if done well, but we have concerns about the way in which that is being undertaken. We think that this centralising process, under which the Secretary of State takes on more powers, risks political capture. That may not seem like a huge risk considering who the current Secretary of State and shadow Secretary of State are, but given the febrile political atmosphere that we are working in, it seems a poor time to give a Secretary of State sweeping operational powers over the detailed functioning of the NHS, with few checks and balances. I will speak about the most concerning elements and make the argument in greater detail when we debate cause 11. As the hon. Member for Sleaford and North Hykeham said, the former Health Secretary, the right hon. Member for Ilford North, said that top-down reorganisation of the NHS was the last thing he wanted to do, and yet that is where we find ourselves today. It feels as if the plan has been pulled together very quickly, and that it has been complex to turn into a piece of workable legislation. It has taken a long time even for the Treasury to agree on the funding of the redundancy...
It is a pleasure to see you in the Chair, Sir Jeremy. One of the most powerful things we can do as Members of this place is bring our constituents’ stories here so that they can form part of our discussions. That is what I will do as we discuss the future of NHS England. I openly admit that I have never knocked on a door and found that someone’s burning question was about the abolition of NHS England. I have never had that particular discussion, but I do have regular discussions about the NHS. We know how important it is to people. They value the greatest gift that the Labour party has ever given the United Kingdom. As we have those discussions, one thing that comes up time and again is that people will always want more; they will always want better healthcare, and they should be able to expect it. Across my constituency, the biggest health need is access to primary care. Two towns each make up one third of my constituency, so a third of my constituents live in Burntwood, 4 miles up the road from Lichfield- I believe my constituency is misnamed, but that is a matter for the boundary commissioner, not for me. When I talk to people about healthcare and access to primary care in Burntwood, one thing comes up time and again: the new health centre for Burntwood that was promised but never delivered. That centre was promised in 2009 when the old one was demolished, but its funding was cut in 2011 following the change of Government, and we are still waiting. A modular building had...
As we look at this process, all I can see is that what we have does not work. A couple of years ago, the doctors’ surgery in the modular building was told that it would have to close because some computer system at NHS England said that the contract could not be extended until the replacement building-at that point promised by the end of last year-was built. It just could not happen: “Nope, sorry; it’s going to have to close.” We ended up with a bizarre situation where a surgery closed, and 5,000 patients in a town of 30,000 people- a significant proportion-were distributed to the other surgeries in the area. That created such disruption that another surgery had to rent the same space back from the ICB in order to deliver the same care. All that legality, inefficiency and uncertainty was caused because a computer system at NHS England said, “No.”
If I aim to bring my constituents’ voices to this place, I absolutely want to say that what we have does not work. It has failed the people of Burntwood for well over a decade. Anyone in that area needs to be able to contact an elected official and bring them that story, because the arm’s length body has not delivered. Political oversight of this is important because, like with all Members, my constituents expect that when they come to me with an issue-“Why is this doctors’ surgery still not built, Dave?”-I can give them a better answer than, “Oh, NHS England says that we can’t extend that, and the planning system is too complex and it’s very difficult to isolate.” They want me to be able to write to a Minister, raise it in the House and use the levers that we have as Members of Parliament to place that on the record, and for that to deliver real change.
Removing NHS England-this super-quango that has sat in the middle between Ministers and delivery-will improve that democratic accountability, and the democratic process of us being able to voice our constituents’ concerns to the decision makers who we elect to run the NHS. I absolutely, wholeheartedly support being able to do that without having that quango in the way and making that difficult.
To go back to my original point, I have never knocked on a door and been asked to abolish NHS England, but I have regularly knocked on the doors of people who want to see improvements in the NHS. Removing this quango-this quasi-block in the middle, where nobody quite understands where the line lies and there is all this duplication between DHSC and NHS England-can only be a good thing for me being able to give my constituents the answers that they want and deserve. I place on record my support for the abolition of NHS England and the process that the Bill lays out, because it allows us to get on with that and not have a protracted reorganisation. Going back and trying to unpick every single line of this piece of legislation and say, “This can’t go to the Secretary of State; it’s going to have to be delineated in this way or that way,” just extends that reorganisation.
My constituents are eager for change. They want their doctors’ surgery. Thousands of my other constituents do not want to be in a situation where they are failed. We should all support being able to abolish NHS England in the way that we are, which allows it to happen as quickly as possible. I place my support for these clauses on record.
I approach this with a sense of déjà vu-standing in a Committee Room in the Palace to debate a Health Bill opposite the Minister for Secondary Care, the only difference being that our sides and places have swapped over in the interim. It is a pleasure to be on this Committee opposite the now Minister. I will focus my remarks largely on clause 1. My hon. Friend the Member for Sleaford and North Hykeham raised a number of questions about clauses 2 and 3 and their breadth, but I consider them to be necessary and consequential on clause 1, so I will focus on the points made in that clause, which sits behind them. One thing I want to address is the Minister’s question about why, in the Health and Care Act 2022, the Conservatives did not abolish NHS England. I have to say that arguments were made on both the pros and the cons, but the simplest answer is the context of that legislation. At the time, we were just emerging from a pandemic, and I wanted that legislation to retain a clear focus on my vision for the NHS: a linking of ICBs at the local level with the upper-tier local authorities, so that we could deliver social care through a permissive model, rather than a prescriptive one, allowing that local co-operation. I was also conscious that, emerging from the pandemic, there was only so much that the system could realistically bear while it was still grappling with its immediate aftermath, hence the approach we took. In reality, it cannot be disputed that, inevitably, this is a...
I too think the hon. Member for Lichfield gave an excellent speech on the need for clarity, but there is another factor to consider. Not only is NHS England being abolished, and ICBs are having their budgets halved, but in Hampshire and other areas we also have local government reorganisation. We are going from having district councils and county councils to unitary authorities, and a mayor will be coming in next year. This is another level of reorganisation in the delivery of healthcare and social care, so there is a huge amount of change. However, there seems to be no clarity, at any level, on how this will affect services on the ground, because there are so many moving parts coming in at once.
The hon. Gentleman makes his point very clearly and he is absolutely right. Not only is there a lack of clarity in the legislation and in the plans for how the NHS will look, but, as was alluded to during evidence, the missing bit from the Bill, which is highly relevant, is social care. It will be deeply concerning if, when the implications of local government reorganisation emerge from the Ministry of Housing, Communities and Local Government in a few weeks’ time, the two are not properly meshed together, because we will risk, yet again, a widening disconnect between the two vital parts of our health and social care system, both of which have to work well in tandem for the whole system to function. The hon. Gentleman makes a pertinent point. He also highlights ICB budgets. I suspect hon. and right hon. Members around the country are already seeing the genuine impact of those changes to the budgets, which are actually pulling through into the frontline services that our constituents receive. I know that the Minister cares deeply about our health and social care services, and has a wealth of experience from in this place and outside it. Given the comments from our witnesses and the impact assessment, which has page after page listing the risks associated with this approach, I ask her how she will mitigate that loss of focus and that distraction, which is an inevitable human reaction when there is uncertainty. When she comes forward with the plan to merge NHS England into the...
It is a pleasure to serve on the Committee with you in the Chair, Sir Jeremy. I echo and endorse all the comments made by the shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham, who was comprehensive in setting out our position. I therefore speak from a broad consensus surrounding the Committee that the final days of NHS England as a body are here, and so be it, because there are advantages to be gained from its abolition. The Minister set out some of the leading reasons why she and the Government are abolishing NHS England. She referred to the growing bureaucracy, the unnecessary complexity, and the overlap of roles and responsibilities between the organisation and DHSC. She also spoke about being able to better focus on delivering care rather than navigating bureaucratic hurdles.
I plainly agree with those laudable aims and I am sure that, without NHS England, there will be opportunities to achieve all of those things in the future. However, they are not inevitable; it is not inevitable that three, five or 10 years down the line we will not be back in a situation of bureaucracy and complexity, with the doubling up of roles and a focus on trying to navigate procedures rather than delivering care. NHS England was never intended to do those things. From the outset, the Lansley reforms intended to achieve some positives, and some were delivered. It is because of contact with reality and the development of time that bureaucracy in NHS England has grown to a size it was never meant to be.
My namesake the hon. Member for Lichfield made some persuasive arguments about democratic accountability, from the Minister straight through to the operation and delivery of services without the bureaucracy of NHS England. I do not seek to disagree with his comments about where we go from here, but NHS England has not removed the fundamental ministerial and governmental accountability for the way we deliver health and social care in this country. I suspect there is not a Health Minister, a Secretary of State or indeed a Prime Minister who has not felt the direct responsibility of trying to deliver better health and social care. Sweeping away a bureaucratic institution does not necessarily change that fundamental.
In terms of accountability, the intention behind setting up NHS England was to try and take the politics out of delivering health and out of operational decision making. The concern is that the reverse will happen if we get rid of it; we may layer in extra politics around it. At the end of the day, the responsibility falls on us to ensure that, whatever our different opinions-it is entirely legitimate, right and necessary that we have different opinions- it is done for the right aims and objectives.
In another speech, made by another politician in another way and in another place, cutting bureaucracy might also be described as cutting costs. Where the money saved from cutting that bureaucracy management is spent and directed is fundamental. My right hon. Friend the Member for Melton and Syston set out that there seems to be a lack of detail about where the savings will be and where the money will go. I accept that the Minister cannot set out great reams of detail in her speech now, but if she can point us towards something on that issue, it will give us more confidence about where the money savings will be felt and redirected.
I will give a couple of anecdotal examples. Bureaucracy and waste were unfortunately in the system long before NHS England came about, and they are worse in some parts of the NHS than others. General practitioners and GP practices are not part of the formal structure of the NHS, but deliver healthcare free at the point of use under contractual arrangements with the NHS. They represent some of the most efficient parts of the system because they cannot run the deficit that the NHS itself does. Even so, reports suggest that NHS England has spent over £17 million over three years encouraging GPs to consider other electronic record systems, even though they are fully digitised, and resulting in only five GP practices taking on a new system. That sort of mad decision making is not going to disappear just because NHS England disappears.
In my own NHS trust-the hon. Member for Winchester referred to Hampshire and Isle of Wight-there appear to be 800 jobs under threat, yet I have seen correspondence in which an existing provider of electronic records offers what appears to be a £1.2 million saving by rolling out the record system they already use to other services under an existing contract, and the offer has not been taken up. I do not seek to substitute the management decision making with my own and I am not in a position to make the ultimate call on that, but the fact that that offer has not even been responded to for months-possibly years-points to endless missed opportunities to save money and be more efficient. That is not going to change with the abolition of NHS England.
While I welcome the aims and what the Minister has said, I caution against excessive optimism in this place that simply doing away with NHS England will naturally give rise to savings and reduce doubling up of jobs and slightly unfathomable decision making. I will also take this opportunity to say that some of the institutions and frameworks that will continue, such as ICBs, are being subjected to cuts while being asked to take on more responsibility. I do not agree with some of those responsibilities being shifted, such as merging Healthwatch and the patient voice, but that will come up later in the debate on this Bill, so I will not say more on it at this time.
My hon. Friend talked about how the ICBs have merged. There are lots of different types of reorganisation going on at once: the abolition of NHS England, the changes to local authorities, the introduction of mayors in some areas, and the changes and cuts to ICBs. What effect is that having in his part of the country?
The shadow Minister points to a much wider issue entirely relevant to the Government’s plans here: the more reorganisation we do, the more we shrink the bandwidth to deal with smaller and more operational problems because so much of the resource has been pulled in. In my area, although it is probably true everywhere, reorganisation of Department or Government responsibilities causes endless frustration that while Governments and politicians-I take some responsibility for my own side’s actions at times in the past in very limited ways-talk about reorganisation when so much can be done on what might be termed low-hanging fruit. I worry that the Government are missing out on opportunities here to make a much more meaningful difference day to day and much more quickly than this huge reorganisation will achieve. Everything is about priorities. Plainly, no Government can do everything they want to do all at one time. It slightly surprises me that reorganisation of the NHS and doing away with NHS England has become such a major priority, considering it did not feature in the Labour party manifesto just two years ago. I do not seek to put words in the Minister’s mouth, but the gist of her evidence to this Committee was that within eight months of this Labour Government coming into power, they realised that NHS England had to go. Eight months is eight months, but it seems a short timeframe in which to decide to do away with a fundamental way that health is organised and delivered in...
Adjourned till Tuesday 23 June at twenty-five minutes past Nine o’clock.
Written evidence reported to the House
HB42 Heidi
HB43 Huntington’s Disease Association
HB44 Chris Byrne MBA
HB45 Don Beckett, Director, Healthwatch Worcestershire
HB46 Healthwatch North East & North Cumbria (joint submission)
HB47 Care and Support Alliance
HB48 Health Foundation
HB49 British Medical Association (BMA)
HB50 Richmond Group of Charities
HB51 Young Lives vs Cancer
HB52 Radiotherapy UK
HB53 Faculty of Public Health
HB54 Dr H J Gallagher, medical and dental governor
HB55 Royal College of Pathologists
HB56 Dr Ata-Amonoo MD MSc MBA (International Economics/Risk)
HB57 LifeArc
HB58 Public Health Medicine Committee (PHMC)
HB59 Simon Adams, Chair of Healthwatch Worcestershire
HB60 SpaMedica Ltd