Health Bill (Fourth sitting)
House of Commons · Public Bill Committees · 23 Jun 2026 · 119 speeches · Official Report
The Committee consisted of the following Members:
Chairs: Sir Roger Gale, Dr Rupa Huq, Emma Lewell, † Sir Jeremy Wright
† Argar, Edward (Melton and Syston) (Con)
† Brackenridge, Sureena (Wolverhampton North East) (Lab)
† Chambers, Dr Danny (Winchester) (LD)
Daby, Janet (Lewisham East) (Lab)
† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)
† Irons, Natasha (Croydon East) (Lab)
† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)
† Joseph, Sojan (Ashford) (Lab)
† Kyrke-Smith, Laura (Aylesbury) (Lab)
† Morgan, Helen (North Shropshire) (LD)
† Prinsley, Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
† Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
† Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Tuesday 23 June 2026
(Morning)
[Sir Jeremy Wright in the Chair ]
Health Bill
Clause 1
Abolition of NHS England
Question (18 June) again proposed, That the clause stand part of the Bill.
The Chair
I remind the Committee that with this we are considering clauses 2 and 3 stand part.
Casting my mind back to before the weekend, we had a wide-ranging debate on clauses 1 to 3 but, I think, substantial agreement about the central proposition to abolish NHS England. I pay tribute to my hon. Friend the Member for Lichfield, who succinctly put his finger on the key issue: it is fundamentally right that people and their elected representatives should be able to hold Ministers to account for the performance of the health service. It is also right that Ministers should have the tools to make the changes that are needed. The abolition is a necessary result of restoring that principle. The debate raised a number of questions, a substantial number of which we will address during the course of the Committee as we reach the relevant clauses. However, I will pick up a couple now. I reassure the right hon. Member for Melton and Syston that the Government do take the impact of this process on staff seriously. We will treat people with the care, respect and fairness that they are owed through this process, now and in the months ahead. I am also committed to consulting recognised trade unions and I have a joint partnership forum to support ongoing engagement. More broadly, we recognise that change of this type is never easy, but we will need to go through the process quickly, which means, of necessity, proceeding in parallel with the legislation on the detailed internal design work for the new Department. That is in the interests of staff, patients and the public. The hon....
This brings back memories of being in probably this same Committee Room a few years ago. I made this point during the previous sitting, but is the Minister able to commit that before the Bill leaves the Commons, a full and detailed statistical breakdown of the costs and benefits will be published, given their absence from the impact assessment?
I can tell the right hon. Member that we expect that NHS England coming into the Department will deliver up to about £1 billion in annual savings by the end of the Parliament, driven primarily by reductions in headcount, calculated using the average staff costs-about £77,000 per staff member in the Department and £94,000 per staff member in NHS England-including all pension and employer costs, which I think should help contribute to those numbers. As I think he knows, we will publish all accounts in the usual way. I commend the three clauses to the Committee. Question put and agreed to . Clause 1 accordingly ordered to stand part of the Bill . Clauses 2 and 3 ordered to stand part of the Bill . Clause 4 Reducing inequalities
I beg to move amendment 13, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert- “1C Health improvement and health inequalities duty (1) In exercising any functions relating to the health service, Secretary of State must have regard to the need to- (a) improve the health of persons in England, (b) reduce inequalities between the people of England with respect to their ability to access health services, and (c) reduce inequalities between the people of England with respect to the outcomes achieved for them by the provision of health services. (2) Health inequalities ‘between the people of England’ means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England. (3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants. (4) Under subsection (3) ‘general health determinants’ are- (a) standards of housing, transport services or public safety; (b) environmental factors, including air quality and access to green space and bodies of water; (c) employment prospects, earning capacity, and any other matters that affect economic security; (d) access to public services; (e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health; (f) any other matters that are determinants...
The Chair
With this it will be convenient to discuss the following: Amendment 29, in clause 4, page 3, line 22, leave out lines 22 to 29 and insert- “1C Health improvement and health inequalities duty (1) When considering whether or how to exercise any functions, the Secretary of State must have regard to the need to- (a) improve the health of persons in England, (b) reduce health inequalities between persons in England, and (c) reduce inequalities between persons in England with respect to their ability to access health services and to the outcomes achieved for them by the provision of health services. (2) Health inequalities ‘between persons’ living in England means health inequalities between persons, or persons of different descriptions, living in, or in different parts of England. (3) ‘Health inequalities’ means inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants. (4) ‘General health determinants’ are- (a) standards of housing, transport services or public safety, (b) environmental factors, including air quality and access to green space and bodies of water, (c) employment prospects, earning capacity and any other matters that affect levels of prosperity, (d) the degree of ease or difficulty with which persons have access to public services, (e) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle,...
I apologise for being a little delayed, Sir Jeremy. I am moving the amendment on behalf of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). It would place a clear duty on the Secretary of State to have regard to health improvement and health inequalities when exercising functions. Between 2011 and 2021, the UK was one of only five high-income countries where healthy life expectancy fell. Over the same decade, we faced a cost of living crisis, the covid-19 pandemic and economic decline across the post-industrial regions. We cannot shy away from the fact that ill health is rising. Economic inactivity due to sickness is at its highest level since 2012, and we witness a widening disparity in health outcomes. People living in the most deprived areas of the UK, on average, live just 52 years of healthy life. There is now a 16-year gap in life expectancy between the richest and poorest parts of the UK. Even within individual constituencies, the life expectancy gap can be as wide as seven years between local postcodes. The purpose of the amendment is to ensure that decisions taken at the highest level of the health system consistently reflect the reality that health outcomes differ sharply depending on where someone lives, the conditions that they live in and their opportunities to achieve good health. The amendment would require the Secretary of State to have regard to the need to improve the health of persons in England. The intention is that this duty would...
It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on. On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later. I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning. If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health...
I will finish by talking about the use of data. Clearly, there are different uses of data when assessing where there are gaps-in this case, gaps or issues around health inequalities. Different Governments can and do use different data, and they reassess and re-evaluate the sort of data that they want to rely on; this Government will, and do, use slightly different data from the previous Government, but I want to raise the issue of different Departments in the same Government using different data.
My detailed knowledge of the way in which data is used within the Department of Health is probably too scant for me to say anything particularly meaningful in the context of this debate, but I will use an example that again relates to my local area and to health inequalities: MHCLG’s use of data to assess local government funding to deliver adult social care and children’s services. Both pockets of money clearly relate to health inequalities and their removal. Amendment 30 tries to tackle that by placing a duty on the Secretary of State to
“have regard to the need to involve all departments”,
But even then, within one Department, MHCLG, different data is used to assess the connectivity and remoteness, of, for example, the Isle of Wight when funding the Isle of Wight council and the way it delivers adult social care and children’s services. I have yet to find a logical explanation why the remoteness of the island on which I live, the challenges of which are known in terms of cost, remoteness, crossing water and recruiting people to work in schools, hospitals, care homes and so on, should be dealt with differently when dealing with children’s services or adult social care.
Using one dataset to decide funding from one pot of money, and another for another pot of money seems quite arbitrary-or at least not joined up. If that happens within one Department, there is greater scope for it happening across different Departments-indeed, it is certain that it will. By my reading, that is what amendment 30 is designed to address. Whether this is the right place for that, and whether it will actually achieve anything, I am not sure, but it is certainly a debate that needs to be had. It may well be that here is better than anywhere else in terms of including it somewhere in law.
It is a pleasure to speak to clause 4 and this group of amendments. Health inequalities are commonly defined as the systemic differences in health status and distribution of health resources between different population groups. There are limits to how far the state can equalise health in a free society, but I am sure all Members would agree that the service should not preside over differences in access to health resources. Unequal access runs contrary to the vision of the NHS as a comprehensive service, available to all and based on clinical need, not ability to pay. Those principles are violated when people without fixed addresses struggle to access general practice, or patients in rural areas, such as my constituency, miss out on treatments-for example, specialist cancer treatments-that are available in more urban areas. The Health and Social Care Act 2012 inserted section 1C in the National Health Service Act 2006, placing a duty on the Secretary of State to consider the need to reduce inequalities in the benefits that people obtain from the health service. As the explanatory notes to the 2012 Act made clear, the intention of that was to “include consideration of the need to reduce inequalities in access...and the outcomes”. Clause 4 of this Bill takes that which was understood and makes it more explicit. The Minister will be pleased to hear that I support updating that duty-she is smiling. The word “benefits” in the original section is a nebulous and subjective term. The...
My hon. Friend hits the nail on the head. Although all these amendments come from a very good place, they are so obvious that they should already be happening, and are too obvious to be enshrined in some overriding duty in a Bill.
I agree. The amendments include, in many cases, a statement of what someone’s job is. Does the Member who tabled them think that the Secretary of State is not doing his job and therefore needs to be told what his job is? That could create a whole load of bureaucracy detracting from the actual job in hand. Amendment 34 concerns transport access. I understand that that is a problem for many people in rural areas, such as my constituency. They often have a harder time, as the distance they need to travel is longer and public transport services are infrequent. Healthwatch, which will be cancelled by this Bill if the Government get their way, has heard from patients who struggle to book transport online, and whose transport turned up several hours early or was cancelled with little or notice at all. Those problems are well documented. I visited Lincoln county hospital, which has a unit for renal dialysis, where I heard that although transport is provided for individuals having dialysis, which is good, it often does not turn up when it should or does not pick people up at the time that it is supposed to. More concerning is the fact that if they need a transplant and transplant assessments, most have to go to Leicester to have that done, which is several hours’ drive from some parts of Lincolnshire. Most disturbingly, I heard concerns that some people would choose not to go through the transplant programme, and a factor in that decision would be the ability to get to the transplant...
It is an honour to serve under your chairship, Sir Jeremy. The hon. Member for Isle of Wight East highlighted extremely well the difficulties of accessing hospital services on an island, but it can be a problem anywhere, including in rural constituencies. Winchester is about 60% rural. Since I was elected, an issue that I have had a great deal of correspondence about-even protests and petitions-has been the cancellation by Hampshire county council of bus services, particularly from rural villages such as Colden Common. People need buses for a variety of reasons-obviously to get to work and school-but the No. 1 issue concerning people is that of mainly elderly people using the bus to access hospital and GP services. They are really worried. It is causing a huge amount of stress that they will not be able to access hospital and GP services and not be able to remain living independently in the village that they have lived in for years. One of the new hospitals in Hampshire is due to be built in south Basingstoke. Extraordinarily, the consultation on the location of the new hospital did not include consultation with the South Central ambulance service. When moving an A&E department and maternity service to another location, it seems blindingly obvious that the ambulance service should be heavily involved in deciding where a new hospital may be located, given that it is primarily responsible for ensuring that people can get there in a timely manner. Although there is obviously a...
On amendment 13, the shadow Minister asked why my hon. Friend the Member for Stoke-on-Trent South felt the need to table amendment 13. One can only assume it is because health inequalities have continued to widen for far too long. In a 20 or 30-minute drive across my Wolverhampton North East constituency, life expectancy drops by seven years. I accept that tackling health inequalities is not just about health; it is about a wider web of societal issues, including educational, employment and housing inequalities. That very long list is beyond the responsibility of the Secretary of State for Health and Social Care. Amendment 13 will put the tackling of preventable ill health and health inequalities at the centre of national decision making by ensuring that the Secretary of State must consider not just NHS treatment but wider social and economic factors. Will the Minister assure the Committee that future Secretaries of State will not overlook the wider social and economic factors that drive ill health and unequal life expectancy, and that there will be a responsibility to work across Departments to tackle that wider and growing inequality?
I am grateful to all hon. Members who tabled amendments in this group, some of which have not been spoken to. I will address the central points that Members have rightly highlighted. I am grateful to the Chair and members of the Health and Social Care Committee for their report and recommendations for the Bill. Before I turn to the detail of the amendments, I will set out what clause 4 does. As my hon. Friend the Member for Wolverhampton North East highlighted, the wider determinants of health inequalities are important. On the point that the hon. Member for Isle of Wight East made about the Labour party, they absolutely run through our DNA. Clause 4 restates and reaffirms our commitment to tackling health inequalities. It reformulates section 1C of the National Health Service Act 2006, aligning it with the duty imposed on NHS England by section 13G of that Act. It makes plain the need to achieve greater equality between the benefits that people receive and the provision of health services-for their ability to access those services and for the outcomes achieved. Importantly, “outcomes” includes the safety and effectiveness of health services and the quality of the experience undergone by patients. The clause will ensure that the Secretary of State must have regard to reducing inequalities in respect of all those benefits. The wording of the revised duty more directly encapsulates the benefits that must be taken into consideration and obtained from the health service to...
Before the general election, I was the Liberal Democrat housing spokesperson, and one thing that came up regularly was how important housing is, and not just for obvious physical conditions-mouldy houses can cause breathing issues. Temporary accommodation is devastating for the long-term health outcomes of the people who are placed in it. Does the Minister agree that working with MHCLG to improve housing-particularly social housing-is critical to achieving the Government’s objective?
The hon. Lady pre-empts my next comments. I absolutely agree with her, and so do the Government. That is why we are improving living conditions through the new decent homes standards, which set standards across all rented sectors. Awaab’s law requires social landlords to act promptly to fix housing hazards. Since coming into government, we have launched the warm homes plan, the Keep Britain Working review and the homelessness strategy. In April, we published a renewed women’s health strategy, marking a decisive shift to ensure that women and girls receive the care, respect and outcomes that they deserve. Last November, we published England’s first ever men’s health strategy, to improve the health and wellbeing of all men and boys. Within the Department, we are reviewing the Carr-Hill formula and the Advisory Committee on Resource Allocation to ensure the funding matches need. However, there is much more to do. The Minister for Public Health and Prevention, my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), will continue to engage with key stakeholders, including representatives of Health Equals. I have a meeting with representatives of that body this week. I sympathise entirely with the motivation underpinning amendment 13, which was moved by my hon. Friend the Member for Bury St Edmunds and Stowmarket, and I commend hon. Members for working on this important agenda, but I am not convinced that the amendment is necessary. I note that it draws on the...
I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Clause 4 ordered to stand part of the Bill . Clause 5 Patient involvement and choice
I beg to move amendment 59, in clause 5, page 4, leave out lines 2 to 4 and insert- “(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services. (2) For the purposes of subsection (1), the Secretary of State must ensure that patients who are referred for a service to be provided outside a hospital setting (‘out-of-hospital services’) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B. (3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must- (a) offer the patient a meaningful choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board; (b) provide the patient with information to support an informed choice, including for each available provider- (i) indicative waiting times; (ii) the location at which the service would be provided; (iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available; and (iv)...
The Chair
With this it will be convenient to discuss clause stand part.
This group is about how patients can exercise choice. When the national health service was founded in 1948, patients could select their own GP, but it was difficult to change things and exercise choice elsewhere in the system. The health service has come a long way since then. Successive Governments believed that they could make state institutions more responsive by treating the public, to some extent, like customers. Today, patients can choose their GP, hospital, consultant and different types of end-of-life care and mental health service, but choice is about more than just selecting among providers.
Every medical practitioner knows that choice is important for care, because patients need to choose which type of care that they receive. When patients receive elective care-planned procedures and treatments that are not emergencies-there is often more than one option, and different options carry different trade-offs. Those might be surgical options or radiation therapy for people with a basal cell carcinoma, for example-they may decide to have it removed or to have radiotherapy. They can make different types of choices, and the right one depends on the patient, their condition and their individual preferences. Clinicians can or should provide information so that the patient can make a fully informed choice, but the patient knows their preferences.
That is why choice and patient involvement is so important. It was first enshrined in the NHS constitution published in 2009, which set out that patients have a right to make choices about their care and the right to the information necessary to support those choices. The successor Government amended the National Health Service Act 2006 so that the Commissioning Board-now NHS England, which the Committee has agreed to abolish-had a patient choice duty.
Clause 5 will impose an equivalent patient choice duty on the Secretary of State. As I mentioned, NHS England is being abolished, so the clause is a necessary continuity measure. In addition, it will not be possible for the Health Secretary to improve the health service unless he focuses on patient choice. Choice can reduce bottlenecks, and people may pick providers for which demand is weaker so that they can be seen more quickly, relieving pressure on the more stretched hospitals. When people can choose based on rankings, waiting times, reputation and so on, providers have an additional incentive to improve quality. Money follows the patient, and no signal is greater than individuals voting with their feet. Choice can reduce geographical disparities in access. It allows patients to leapfrog underperforming local providers and access the same standard of care available to those in other areas.
As in many other policy areas, when Government give people the freedom to choose, we tend to end up with better outcomes across the board. Notwithstanding those points, I am concerned that the clause is not sufficiently robust, because, when put under the microscope, it has a weak legal threshold. It requires the Secretary of State to promote the involvement of patients and to act with a view to enabling patients to make choices, but what does that look like in practice? If a patient-or a set of patients represented by a charity-identifies that choice is not being offered in one particular area, what is their legal recourse? A view refers to a person’s thoughts, not to a specific obligation. If we are to legislate, the measure needs to have teeth, or it is just a statement of someone’s job, as we said earlier. Unless there are breakthroughs in mind-reading technology, how would we prove that the Secretary of State did not think about patient choice while closing a hospital, downgrading the NHS app or squeezing out a specific type of provider?
Members cannot legislate just for today’s Government; they legislate for future Governments who may interpret legal duties in different ways. The amendment, therefore, would strengthen the patient choice duty in the clause from a general aspiration into a specific and enforceable right to choose between providers for out-of-hospital services. Integrated care boards would have a legal duty to offer patients a meaningful choice of at least two providers from their area and, where relevant, in neighbouring areas. The latter part is important for those located in rural areas and for those with uncommon conditions.
My amendment would prohibit ICBs from limiting patient choice of provider based on commercial interest or organisational type. That would safeguard against ideologically motivated directions, which can undermine patient choice. The Minister is a sensible person, but some of her detractors, and future Ministers, may not be. They may view choice and private sector provision as part of a grand conspiracy. We cannot provide them with the tools to undermine many years of progress. For that reason, I hope that Members will support the amendment. I look forward to hearing the Minister’s choice.
I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59. The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending-that is a good thing. Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.
Does the hon. Member recognise that there are circumstances in which independent provision within a district has the effect of disabling the NHS service? A pertinent example is the ophthalmology world. Services have become difficult to deliver in NHS hospitals because large numbers of NHS staff have chosen to work in the independent sector. That makes the comprehensive provision of a service in an eye department difficult, as the staff are all off operating on cataracts.
I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.
When I met surgeons, they said that one reason they like working in elective independent sector hospitals is that they can do more operations on a given day. The shadow Secretary of State visited a provider of cataract treatment yesterday. It is able to perform more treatments on a given day, partly for organisational reasons. The NHS, which is quite frustrating for surgeons, could learn from that. Does my hon. Friend agree?
My hon. Friend is absolutely correct. I do not want to go down the cataracts route, but she and the hon. Member for Bury St Edmunds and Stowmarket have both mentioned them. Clearly, cataracts are a relatively low-complexity, high-volume type of operation. My hon. Friend is absolutely right to say that some providers can do five or six operations per list, while other places are doing two or three. That is often about the private sector being able to move more quickly, which is obviously better for patients, as well as for clinicians, who want to do the surgery that they have trained for. Unlike the hon. Member for Bury St Edmunds and Stowmarket, I think that competition can play an important role in driving improvement. When providers must attract and retain patients, they have a stronger incentive to deliver timely, high-quality services, and to innovate in how they provide care. In that sense, competition is not an end in itself but a means of improving outcomes and responsiveness for patients. If both sides of the Committee support clause 5, because we are interested in choice and competition, amendment 59 is the logical extension of that. The amendment is also clear about where the new obligation choices would apply. It covers a range of out-of-hospital services, including diagnostics, audiology, hearing-aid care, dietetics, physiotherapy, ambulatory cardiac monitoring and so on. By clearly defining the services in scope, it provides a realistic and workable road map for...
I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee. We almost went down a cataract rabbit hole, but I think the points were well made. I will outline the Government’s general approach to choice and then move on to the amendment. I recognise that hon. Members from both sides of the Committee are committed to protecting and upholding patient choice in our system, as are the Government. That is why clause 5 introduces new duties that require the Secretary of State to promote “the involvement of patients, and their carers and representatives” in decisions relating to the prevention or diagnosis of their illness, and their care or treatment. That applies when the Secretary of State is exercising health functions. The clause also requires the Secretary of State to “act with a view to enabling patients to make choices” about the health services provided to them. The Government are committed to involving patients and carers in decisions about their care. We know that supports a better experience of care and, in many cases, better outcomes. Furthermore, if they want to be, patients should be active participants in decisions about their own care, rather than passive recipients of services. I appreciate the sentiment of the amendment in the name of the hon. Member for Sleaford and North Hykeham, but I do not think it is necessary. It turns a general duty into one with more prescriptive detail, which risks adding complexity....
Clause 5 ordered to stand part of the Bill.
Clause 6
Promoting innovation
I beg to move amendment 58, clause 6, page 4, line 10, leave out from “promote” to end of line 11 and insert- “(a) innovation in the provision of health services and in the arrangements made for their provision; (b) take steps to ensure the timely adoption and spread of clinically effective innovations across the health service in England; (c) identify and seek to remove barriers to the uptake of innovation by NHS bodies, including procurement barriers, regulatory barriers and cultural barriers to change; (d) promote access to innovation so that patients in all parts of England, and patients from all socioeconomic backgrounds, have equivalent access to effective new technologies, medicines and care models; and (e) have regard to the economic and industrial benefits to the United Kingdom of developing and deploying healthcare innovation in the NHS.” This amendment would further define the meaning of promoting innovation in health services in England.
The Chair
With this it will be convenient to discuss clause stand part.
In healthcare, as in many parts of life, innovation is the way in which new ideas, products and services are developed to solve problems and improve patient outcomes. Here, the entire country has a record to be proud of that goes back a long time. Dr John Preece, a GP and research fellow at the University of Exeter, was the first general practitioner to use a computer in a patient consultation. He co-designed a model with IBM in 1969, and his work led to the creation of the electronic patient record, the forerunner of the electronic patient record that we will discuss later. Innovators working with NHS England have also been seeking to reduce single-use plastic in gastrointestinal procedures, improving outcomes for haemodialysis patients, as well as improving the environment.
In February, the shadow Secretary of State, my right hon. Friend the Member for Daventry (Stuart Andrew), and I met the scientist Professor Hanna and his team at Imperial College. It was a fascinating visit; Professor Hanna is looking at a breath test for pancreatic cancer. Outcomes for pancreatic cancer and other cancers of the upper GI tract are very poor, but he discovered that, before the cancer is detectable in any other form, volatile organic compounds are present in the breath. He has developed a machine that an individual can breathe into that will detect those compounds in order to detect the cancer early and potentially treat it. It is estimated that that will improve the pancreatic cancer survival rate threefold, although from a low base, from 7% to 21%. That will make a huge difference.
It is exciting how widespread that could become. If people travel to the continent, in particular to France, they have to carry a breathalyser, which costs just a few pounds, in their car. Professor Hanna is talking about how his technology, once it has been proven, could be developed on that scale so if someone was concerned about their symptoms, they could go to their GP or pharmacy and procure a breathalyser test to reassure themselves or to acquire a referral.
Innovation has the potential to save lives, which is very impressive. In a technological form, many people, including me, wear watches that tell them what their heart rate is and that monitor their exercise. There is so much available now that was not before, so we need to encourage innovation because it will improve our healthcare and survival rates.
Members will have seen many reports about the productivity challenges facing the NHS. In sectors like manufacturing and software, new technologies allow organisations to significantly increase their output per worker, but that is difficult in healthcare: nurses can make use of new equipment and better techniques, but taking care of a human will always remain labour-intensive. Breakthroughs like robotic assisted surgery are impressive, but not necessarily frequent. The NHS has to offer increasing salaries to attract workers from other sectors, even if productivity is growing more slowly than in other parts of the economy. That is why innovation is so important: it is one of the ways that the health service can improve outcomes and productivity at the same time.
Currently, NHS England has a legal duty to promote innovation. That is set out in section 13K of the NHS Act 2006, which was it was inserted by the Health and Social Care Act 2012. As the Government are abolishing NHS England, that duty will disappear. The Government have chosen for clause 6 of the new legislation to place the duty on the Secretary of State instead. If innovation is encouraged and supported across the health service, it can unlock better outcomes and higher productivity, which is good for the Government, taxpayers and patients.
Does the shadow Minister accept that, in order to encourage innovation within the health service, we need to do whatever we can to support clinical academics? It is within the academic departments of universities, where people are working in hospitals and teaching in medical schools, that we see the most fruitful innovations.
The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those. We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.
One of the challenges of recruiting staff in Shropshire relates to exactly that point: some areas of the health service are perhaps less exciting to work in than others. Ensuring that innovation is driven across every NHS site and every region will help us understand the recruitment and retention problems that have plagued some of the country’s more rural areas.
The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress-in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation. I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that-not because they are not taking higher rates of tax, but because they are squeezing the economy. There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is...
What my hon. Friend describes is the real nub of the Bill. If we are to abolish NHS England and move most of its functions to the ICB level or to the Department of Health under a Secretary of State, it would be utter madness for us to, at best, move one set of bureaucrats from NHS England to the Department of Health and therefore gain no extra efficiency, or at worst, as seems to be the case in this clause, not only transfer the NHS England bureaucrats, but create a whole new set of bureaucrats and committees to continue the functions already performed under NHS England. We need to understand whether the Bill is really about making our NHS more efficient by removing levels of bureaucracy, as was the stated intent of the Minister and the previous Secretary of State, or whether it is simply a political power grab where we keep all the bureaucrats and the inefficiency of the current system.
My hon. Friend, as ever, puts things very succinctly. Much of what is said about the Bill is different from what it seems to mean in practice. We have heard the Government talk about the decentralisation of power so decisions are made locally, but in the oral evidence session, even the union rep said that the Bill is more of a centralisation of power. I agree that creating new bureaucracy to replace old bureaucracy-particularly if that involves redundancies-does not help to save money or to make the system more efficient. I tabled amendment 58 to make the duty on innovation more robust. It would make clause 6 specifically require the Secretary of State to promote innovation in the provision of services, ensure that innovations are spread and adopted across the NHS, tackle barriers to innovation and consider the wider economic benefits of innovation. That is important, because when we talk to people in the life sciences industry, they tell us that one of the biggest challenges is the roll-out of innovation. They can develop innovations in the UK, but it can take a long time to get them on to the shop floor, which is a disincentive to innovating in the United Kingdom. That process needs to move more quickly. As currently drafted, the clause does not make it clear what innovation is for or whom it is meant to benefit. Amendment 58 would make it clear that innovation should be to benefit patients, no matter their location or socioeconomic status. I welcome the principle of...
The Chair
I gently suggest to all Committee members that it would help me tremendously if they could stand at the beginning of the debate on a group if they wish to be called.
I will speak in support of clause 6 and against amendment 58. I work with a great many rare disease groups as part of my work as a Member of Parliament. Those people have specific health needs, and innovation is key to developing ways of dealing with their needs and to making their lives better, so innovation is at the heart of what we do. We have many great institutions. In my region of the north-east, I will mention Newcastle University, which is doing a huge amount of research into a range of rare diseases and is working collaboratively with other institutions, particularly in partnership, to address those health needs. The clause allows the Secretary of State the breadth to encourage that innovation and to help to make it into a viable spin-off. We too often lose the benefits of the innovation that we create, and it is adopted in other countries. Amendment 58 would put this important clause in danger of being too prescriptive, and sometimes, if we prescribe particular things, we lose the ability to do other things. I support the clause, and I do not support amendment 58.
The clause, and amendment 58, deal with innovation. Although the NHS is responsible for some great healthcare innovations, not only in this country but around the world, unfortunately, it is often an example of a complete failure to innovate, or even to use fairly basic technology that has been around for a long time-I am thinking of using computers for patient records, as paper records have lasted for far too long. Promoting innovation is clearly a good thing-it is essential-so I support the amendment. I will speak about the details in a moment.
I want first to refer to a rather puzzling provision in clause 6:
“The Secretary of State may make payments as prizes to promote innovation in the provision of health services in England.”
An explanation of what is meant by “prizes” might assist not only the Committee but the public more widely. It is a rather odd word and does not sit hugely comfortably with the serious issue of promoting innovation in the NHS and healthcare in this country. It rather more conjures up the idea of a lottery or a game show. Are these payments to be unlimited? What are they for? Where is the pot of money? We know something of the way in which the Secretary of State may make those payments, because the clause sets out that they may “establish a committee” to give advice about dishing out prizes and that they may pay money to those people who sit on the committee to help the Secretary of State decide who deserves a prize and who does not.
At a time when the Government and the Minister talk about efficiencies and saving money and when excellent organisations such as Healthwatch, which delivers its work for a surprisingly limited amount of money, are to disappear, it is rather remarkable to see these provisions without greater context, although I do wonder what context would suggest that a prize is a useful way of promoting innovation. Are there to be any restrictions in the way the prize money is spent? Are there any categories in which a person or organisation falls within the potential pool of prize winners and any categories where they do not? For example, could a prize winner be an individual? Does the Minister envisage money being paid to individuals? Perhaps more likely, could a non-NHS organisation, like a GP practice-notwithstanding the fact that they are very important for delivering NHS services-win a prize? If a GP practice were to benefit from prize money, if indeed they could, would there be any restriction on how that money is spent? Might there be a giving of prize money with one hand and the taking of money with another, which would make the prize simply a cut in some sort of other payment and nothing more than a gimmick? If not-if prize money is to be genuinely additional money-is that actually the best way of distributing money? When an organisation-take again the example of a GP practice, or set of practices, or primary care network-demonstrates innovation, that innovation may have led to...
Of course, innovation, and the environment that leads to innovation, does tend to thrive in a competitive environment, but I have some concerns without further context about whether incentivising competition through prize money is the way to go. Certainly, if we asked the great British public the straightforward question, “What is the best way to achieve greater innovation in healthcare?”, it would take them a long time to say, “Set up a committee and pay those committee members to advise the Secretary of State on dishing out prizes to those who show innovation.” I suspect we would have to go a long way to find a member of the public who came up with that idea, and it would probably take just as long to find someone to back the idea without further explanation, but perhaps we will get some clarity when the Minister speaks.
Turning to amendment 58, there is consensus that innovation is a good thing and that the Department and the Secretary of State should promote it. The advantage of the amendment is that it provides more detail on what innovation means and how it should be targeted, promoted and delivered.
For example, the amendment would require that the Secretary of State must
“take steps to ensure the timely adoption and spread of clinically effective innovations”.
The NHS can be excellent at innovating, but the adoption and take-up of those innovations across the health service can be frustratingly slow. Indeed, there are numerous examples where it does not happen at all. Expressly referencing the taking of steps to ensure the spread and adoption of effective innovations is a strong, meaningful and necessary amendment.
The amendment would also require that the Secretary of State must
“identify and seek to remove barriers to the uptake of innovation”.
Sometimes, the reason why innovation does not spread is not lethargy, apathy or neglect, but because there are various structures within the NHS and procurement and regulatory barriers that, although not set up or designed to restrict innovation, nevertheless have a tendency to do that. The focus of the amendment is on identifying and seeking to remove such barriers to allow that uptake of innovation.
I note that the amendment mentions “cultural barriers to change”. In my previous career working for a national health charity, part of my role was to roll out specialist nursing services, working in partnership with NHS organisations and others operating in the health and social care space. We embedded new practices that might be described as innovation. In fact, a lot of it was not overly innovative in thought or practice, but it was innovative for certain corners of the country where those practices were not happening.
For example, on the adoption of electronic record-keeping systems, certain trusts used a number of them that did not speak to each other. There was a cultural barrier-if by culture, we mean work culture-in that some NHS trusts were very good at embedding and adopting an electronic patient record system that was uniform across the trust, or, where more than one system was operating, the systems were interoperable and spoke to each other. In other NHS trusts, there was a cultural issue of wanting to leave teams alone and not disrupt their working practices, even if the imposition of a new system would have delivered efficiency and better patient outcomes.
I think this is the first time we have had a Robertson on Robertson intervention. It is a pleasure to break that duck. The hon. Gentleman is making a powerful point about the need to change culture to embed innovation across the NHS. There is an example that we always come back to: fax machines. Fax machines were used in the NHS for far too long. It was mandated in 2018 that the use of all fax machines had to be stopped by the end of March 2020, yet in 2023, the NHS still owned 600. That mandation came up against a cultural barrier and it did not work, because 600 of them survived for three years after that. In amendment 58, I see more mandation and nothing on culture. The problem with the amendment is that, by trying to mandate innovation too closely, we would miss the cultural point. We could undermine the Secretary of State’s power to say that all parts of the system are fair game for them. Would the hon. Gentleman like to respond to that point?
I thank my namesake for his intervention. I do not completely understand what he says, because the amendment refers to cultural barriers. He is absolutely right that we have to be careful when we mandate things, but the strength of the amendment is that it has a broad application and does not seek to mandate specific detail. I accept that it has more detail than the Bill, but its strength is that it gives some direction without being overly detailed. I again draw his attention to the fact that it asks the Secretary of State and the Department to identify and remove cultural barriers.
I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham. We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector-I know that Labour Members have antibodies against the private sector-or to university research functions? It is very unclear who the prizes will go to. Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to “work done at any time (including work before the commencement of this section).” So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to. Then the clause says that the Secretary of...
My hon. Friend is describing something a little like “Dragons’ Den”, which is a very good TV programme-perhaps it will be televised or livestreamed. How will the Government ensure that there is no conflict of interest?
My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out-I will not say what that makes me. What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham- I hope I am not misrepresenting her-is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of “timely adoption and spread of clinically effective innovations”. Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system. By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for...
I am grateful to hon. Members for bringing this discussion to the Committee. We heard about the excitement in our constituencies around innovation-my hon. Friend the Member for Blaydon and Consett mentioned Newcastle University at the start and the hon. Member for Sleaford and North Hykeham mentioned her visit to Imperial College. Those visits are inspiring. Other universities and centres of excellence are available, but they made the case for why this is so important to the Government’s approach to innovation. I will talk about that and then turn to the amendment. The Government are fully committed to innovation. It is absolutely central to our ambitious priorities to digitise health and care, support prevention and early diagnosis, and enable a shift to neighbourhood care, to growth in our economy, and to regaining our place in the world as a centre for innovation, which was lost under the Conservatives over those 14 years. That is why clause 6 places a clear duty on the Secretary of State to promote innovation in the provision of health services, including in how services are arranged and delivered. The clause also incorporates the Secretary of State’s existing power to incentivise innovation and research through the payment of prizes, as we have discussed. That is a flexible tool that will allow him to stimulate breakthrough ideas and reward innovation across the life cycle, including an early-stage report. On some issues that have been raised, the Conservative party...
The Minister talked about the flexibility of the committee, and my hon. Friend the Member for Farnham and Bordon explained why it is helpful to have some direction. Could the Minister explain why there is no stipulation for the chief medical officer or the chief scientific officer to be part of the committee?
I am happy to come back to the hon. Lady if I am not correct in this, or if there is another reason, but in the existing duty and under NHS England, the committee’s membership needs to reflect the matter in the question. If there is anything to add to that, I will certainly come back to her. We are also committed to spending more on innovation, raising the NICE threshold to ensure that patients have access to more innovative medicines on the NHS. That is action, not just words. The Government commend the intent behind the amendment tabled by the hon. Lady, and she spoke well about that. As a clinician, I recognise her support for innovation, but we recognise that barriers remain to the systematic spread of innovation. That is a long-term problem that existed under previous Governments as well, and we seek to rectify it. The ministerial foreword to the “Life Science Sector Plan” published last year says: “We are clear-eyed about the challenges. For too long, the journey from discovery to delivery has been too slow, too fragmented, and too often held back by outdated systems.” That is why we need to remove barriers at every stage of the journey; however, the amendment is the wrong way to do that. The experience of supporting innovation in the NHS suggests that we need flexibility in our approach to tackle emerging barriers as they arise. Specifying several areas of focus in the Bill would limit that flexibility; those are better set out in published strategies and guidance,...
Clause 6 ordered to stand part of the Bill.
Clause 7
Education and training
I beg to move amendment 33, in clause 7, page 4, line 31, at end insert- “(2) Training under subsection (1)(a) includes training in general health determinants as defined by section 107ZB of the Local Democracy, Economic Development and Construction Act 2009.” This amendment would place a duty on the Secretary of State to ensure that the health and care workforce is adequately trained in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.
The Chair
With this it will be convenient to discuss the following: Amendment 50, in clause 7, page 4, line 32, at end insert- “(4) After subsection (2) insert- ‘(2A) The Secretary of State must publish independently audited forecasts of the NHS’s workforce needs every five years.’” This amendment would require the Secretary of State to publish independently audited forecasts of the NHS’s staffing needs every five years. Amendment 54, in clause 7, page 4, line 32, at end insert- “(4) The Secretary of State must exercise functions under this section with a view to ensuring that managers in the NHS, who have appropriate clinical training, must also undertake clinical care. (5) The Secretary of State must record the proportion of direct clinical care provided by those with professional qualifications both in terms of the proportion of their areas and full time equivalent by pay grade, and the Secretary of State must increase the proportion.” This amendment would require the Secretary of State to ensure that NHS managers who are clinically trained must continue to undertake clinical care. Clause stand part. New clause 44- Medical training places - “The Secretary of State must double the number of medical school training places to 15,000 by 2031-32.” This new clause would put a duty on the Secretary of State to double the number of medical school training places. New clause 45- Data collection: clinically trained staff - “(1) The Secretary of State must collect and publish data on the...
As the Committee knows, my hon. Friend the Member for Worthing West (Dr Cooper) is one of the five medical doctors in the parliamentary Labour party. It is a great pleasure to move the amendment, which she tabled. The amendment is about education and training. My hon. Friend would like us to consider whether there should be an additional subsection after proposed new subsection (1)(a), which is about ensuring that “there are sufficient people with appropriate education and training to meet the workforce needs of the health service”. My hon. Friend would like to include within that specific training about wider health determinants, which, as we discussed earlier this morning, consist of things like housing, air quality, occupation, and substance abuse-tobacco, alcohol and so on. Her opinion is that that needs to be specifically incorporated into the legislation.
I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised. I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill-as I have said, however, I think that otherwise the training element is pretty good. Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency. Amendment 50 would also increase transparency and trust. One of the key things that we will...
I rise to support clause 7 and amendment 33, tabled by my hon. Friend the Member for Worthing West. Having worked in the NHS for many years, I have seen that education and training, especially mandatory training, is absolutely necessary. Some may argue that health staff have too much training, particularly mandatory training, but this amendment specifically concerns training “in the wider determinants of health such as housing standards, exposure to air pollution, occupational risk, and use of harmful substances like tobacco.” We may have staff, especially those working in mental health, who have training in some of those areas, but staff in A&E, where patients first present, may not have that training, and may be missing that curiosity. We have heard many incidents involving families living in mouldy houses or people exposed to air pollution. It is important that staff have the curiosity to consider where a patient has come from when they turn up at A&E, or, when planning a discharge, where they are being discharged to. In the last few years, we have seen many internationally trained healthcare workers join our health sector who may not be familiar with the social and housing situation in this country. Whether this is to be a part of their initial training as nurses or doctors, or through mandatory training at work, the amendment is important because it could help to prevent illnesses and identify them earlier through professional curiosity. I support amendment 33.
I declare an interest as a member of the NHS workforce and an NHS consultant paediatrician. In England, around one in every 17 working people is employed by the national health service. That is quite a shocking statistic. It is the largest employer in the country and, indeed, in Europe. It has grown significantly over time, in part because the needs of the population have changed. Life expectancy is longer, which is something to be cherished-that is a good thing-but it brings challenges to the health service, as people are more likely to be living with multiple chronic conditions rather than easily treatable ailments. They require more tests, medicines and clinical care. Demographic change requires a larger NHS workforce, particularly in secondary care. The previous Conservative Government not only recognised the scale of that challenge but took swift action to increase staffing levels across the board, adding more than 42,000 doctors and 55,000 nurses, health visitors and midwives. Conservative Ministers also supported the pipeline responsible for producing the next generation of medical practitioners. They funded 1,500 additional medical school places and opened five new medical schools, including in Sunderland, Lancashire, Chelmsford and Canterbury, and one just outside my constituency in Lincoln. Emergency care became the fastest-growing specialty, with the number of emergency care doctors doubling. That is what support for the NHS workforce looks like. Conservative...
The Chair adjourned the Committee without Question put (Standing Order No. 88).
Adjourned till this day at Two o’clock.