Caroline Johnson MP: speeches

Speeches

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q My second question is for Professor Croisdale-Appleby. The CQC has been reported to be in a relatively difficult place, facing challenges at the moment. It is being asked to take on event healthcare supervision and roll the HSSIB within it. Is that asking too much? Professor Croisdale-Appleby: Obviously, I am not here to speak on behalf of the CQC, although I am a non-executive director of the CQC. You are quite right that it has been in a challenging position, from which it is taking very substantial steps to recover, principally in changing back to a system of having chief inspectors who are very knowledgeable about their particular area of expertise that they can apply. The Department has asked the CQC to take on additional responsibilities in its regulatory capability and, to some degree, in an inspectorate capability. I cannot really agree that it is too much for the CQC to take on, but a substantial amount of work is certainly being added to the CQC.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q I should say that I also work as an NHS consultant paediatrician. The single patient record offers a great opportunity for doctors, clinicians and patients to all be much more joined up, but I have a quote from the Secretary of State on Second Reading: “rather than data being transferred from where it exists at the moment to a new system, it will remain where it is—in GP surgeries, hospitals and so on—but it will be linked up so that one person, including the patient, can see all that data”. —[ Official Report , 1 June 2026; Vol. 786, c. 890.] How easily will that work in practice? In the trust that I work in, we have different systems for blood results, results, tracking patient appointments, maternity and A&E. Is it realistic to expect someone to be able to log on from one part of the country and to understand all the different systems in all the other parts of the country, or do you think that it needs to work in a different way? Dr Imam: About a month ago, we published some NHS England guidance on best practice for frailty. Included in that are examples of shared care records, where people who are living with frailty who have been assessed by health services can actually view one record. The way those work is to take information from multiple different records and place it into one shared care record, in order for clinicians from various different backgrounds and multidisciplinary teams to work together.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q What effect is that having on managers and their ability to do the day job and deliver care? Presumably, a lot of time, effort and energy, and perhaps a lot of worry, are going into the process of reorganisation. What effect does that have on the delivery of services and the development of new ones? Jon Restell: This, for us, is the crux of what is going on. The Bill is the Bill, but there is a finite management resource in the health service. I think that, internationally, it is considered to be quite low. Certainly, Lord Darzi, the Institute for Government and Institute for Fiscal Studies have all pointed to a shortage of management being one of the potential weaknesses of the NHS, so what is going on right now is knocking another big hole in an already limited resource of managers in the health service. That has the potential to create very large workloads for people in the new system, such that, inevitably, certain things will not get done or will not get done well enough. It certainly feels like we have gone into an environment where we are cutting a management cost without thinking about the management capability the health service needs to innovate, deliver reform, and do basic safety and resource management.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  No, I mean the system as a whole. My right hon. Friend the Member for Melton and Syston spoke earlier about how ICBs were designed to link in with upper-tier local authorities, and he gave a reason why. Under these reforms, Lincolnshire ICB, which was part of a mayoral authority, will now link in with Derbyshire and with Nottinghamshire, which are part of another mayoral authority but not a complete mayoral authority. You have things jumbled up. I wonder whether that is because, rather than having a vision, you have started to unpick somebody else’s work because you did not like it. Likewise, with the single patient record, we have heard that lots of necessary decisions were not made before the Bill was introduced, so people are being asked to deliver things that have not been properly considered. Is that fair? Karin Smyth: I think they are two separate things. On the provision made in the Bill, abolishing NHS England brings with it a lot of technical detail to ensure that the legal responsibilities and duties are placed, rightly, on the Secretary of State and into ICBs. It clarifies the landscape on very technical matters such as licences and foundation trusts, and there is a large chunk of detail on the consequences of abolishing NHS England. Alongside that, there is a move to give ICBs a larger footprint, in parallel with the Government’s agenda on devolution. I accept that that is a lot of change in all our constituencies and for all our areas. We are making sure that we make the most of mayoral authorities to allow mayors to be on ICBs, as they are largely determiners of a lot of economic development, transport and indeed the wider determinants of health. We are still going through some of that change; you will recently have been written to for your views on it as local Members of Parliament, along with local government. We need to make sure that that is embedded as quickly as possible so that we can stabilise that side of the system. On the single patient record, the Bill will provide enabling powers to bring it forward in regulations. There will be further detailed consultation both with clinicians and with patients and the public, as we have heard, because building trust is critical. That will come next, which is usual in parliamentary terms: as legislators we understand that primary legislation makes provision and secondary legislation sets out regulation. I thought Dr Byrne was very helpful earlier on the point about bringing public trust with us and explaining the two stages of bringing this forward.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Of course, it would need to be viewable across the whole country for people who travel around. What about the security of this data? Lots of people have expressed concerns about the security of the data, both from people who are a bit nosey and who want to have a look, and from people who would wish to do the country harm, hacking large volumes of data. How do we keep it safe? Dr Cocker: That is a pertinent question. I know that that has been the focus of a lot of concern since the Bill was publicised. I believe that the structure of the SPR would be recognised as a critical national infrastructure-type of project, so it would have access to more resource to protect it. But there will always be inherent risk, when you have something centralised, that it is a single target rather than multiple targets that could be attacked—for example, in a cyber-attack. Role-based access would be important—for example, having an understanding that the information should be accessed only for the provision of clinical care. How it would be delivered on a technical level would have to be finalised; that was not the type of the prototyping work we did, because it was more about a proof of concept than those more minute technical challenges. Dr Byrne: I am glad that Dr Cocker took that question first, because he has given you a helpful technical answer. As National Data Guardian, my mission and concern is primarily around public and professional trust. Trust in whether this system can be relied on in terms of people’s confidentiality is something that concerns me very much, as well as people’s trust and confidence in secondary purposes, how the system will be used and what the safeguards around it will be. I would be happy to answer from that perspective when it comes to people’s confidence. I think you have heard a lot about the potential benefits of this system, but it is important to bear in mind that if people do not trust it, the programme will fail, however great the potential benefits are. As a clinician, I would share the excitement, and I am very supportive of the ambition, but people will not trust it if they perceive the risks to the security of their data and confidentiality to be too great. With that in mind, I want to draw attention to two things that concern trust. I want to emphasise that trust is not simply important—I know that the word “trust” has come up repeatedly today—but absolutely foundational to the success of this. The question about how demonstrably trustworthy the system is should be the primary foundational question; all other questions, including the technical ones, flow from that one question. On the confidentiality aspect, I think there is a provision under clause 47 that potentially has very significant unintended consequences. I understand that that is not the intention of the drafting, but I have concerns about it and I have a potential solution to suggest. In clause 47, proposed new section 250E(3) creates the power for the Secretary of State to remove the duty of confidentiality for any processing in the SPR in line with regulations. I need to register my concern about that wholesale lifting of the duty of confidentiality from the entire system. At a system level, there are two risks. One is to patient and professional confidence in the confidentiality of the data once it is accessed or in a system. Confidentiality is absolutely the cornerstone of all clinician-patient relationships. It means that people are comfortable to share the most sensitive information about themselves and often loved ones—it is not just information about ourselves on our records; it is often also information about our loved ones. If people do not trust that that confidentiality is a constant ethical constraint for anyone accessing the record further on, they may be less able to share information about themselves or their loved ones. Clinicians may also be less likely to document that information if they have ethical concerns about who may access it further on if it is particularly sensitive. That will negatively impact on care and the quality of data for any secondary purposes in future. The second point I will make about that confidentiality provision is that I understand that the drafting intent is to remove any ambiguity in terms of people’s concerns about duty of confidence when allowing access to their data at an organisational level. However, as currently drafted, the provision could be interpreted to remove the duty of confidentiality for not just direct care but secondary purposes. Secondary purposes in future could be dealt with by regulations. That lack of clarity poses a risk. The solution I suggest is to redraft that provision, drawing on the precedent already set in the Health and Social Care Act 2012. Section 259 prevents disclosure of data from an organisation from being a breach, so people could allow access at an organisational level with confidence. You have removed that ambiguity, but it does not remove wholesale that duty of confidence—that ethical safeguard for the data in the system itself. I think that that is important for people’s own direct care, and, as I said, it is particularly important if there are any questions around secondary uses in future. Dr Imam: That was a comprehensive answer; I have nothing to add.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Minister, you have 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.] In response to a written question this week, though, which asked what assessment you have made of the disruption of development of new services caused by the abolition of NHS England, you said: “The abolition of NHS England is causing no disruption to the development of new services.” I wonder which of those statements you agree with the most and whether you want to change your mind in the light of any of the evidence you have heard today. Karin Smyth: I do not know exactly what year you are quoting from, but I am happy to take that full on. Of course, change, reorganisations and changes in legislation have consequences at different times depending on what they are. That will determine changes to some services at local level. I think that quote probably relates to the 2012 changes, which, as I have often said, brought me into Parliament. The entire infrastructure of the health service was destroyed and changed in order to bring forward that legislation. I can never find anybody—I think I have heard Lord Lansley say this—who thinks that was a good thing. I am very happy to say that part of the rationale was the fact that, despite lots of warnings about the damage to that infrastructure, that lesson was not learned. We will not go through the history of the passage of that Act. It even had to be paused mid-way through to enact other ways of making things work. I am sure that you will come back in your second question to decisions about some of the provisions in this Bill. It is true, and a matter of record, that as an incoming Government we did not intend to abolish NHS England as an organisation; in our determination to change the outcomes of the health service, that decision was made some eight months into our being in government. Today, we have not heard a single person suggest that that decision is wrong. Dr Johnson is from the Opposition. The Bill was not opposed in principle on Second Reading. There is overwhelming consensus on the major provision in the Bill—the abolition of NHS England—and on the single patient record. I am mindful, on a personal level, of the consequences for individual people’s jobs and of trying to get that right. I accept much of the criticism from Mr Restell about how it would be better to do it much more quickly, and about making sure that it is done in a different way, but the consequences of abolishing NHS England are some of the things that we are seeing.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q We have heard a lot today about things not being quite finalised yet; we are not quite sure where the destination is. Is it difficult for managers to be asked to transform from a current service to a new service if there is no well explained vision and understanding of what “new” looks like? Jon Restell: That is probably driving most of the anxiety and uncertainty that people are experiencing, and it is why, for some members, this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere, and what will potentially go to trusts from ICBs and from ICBs to regions. Despite all that uncertainty, people are being told to make decisions about voluntary redundancy and the future where they do not understand where that future potentially sits for them. That is undoubtedly driving a lot of people to feel psychologically unwell and distressed, and they are leaving. People are beginning to leave, because they need to protect themselves. There is another part to this. Obviously, that is a very personal issue for our members, but the other thing is that they are really worried about the service to the public, the safety of the changes and what will happen to various functions that they are responsible for, if teams get halved and responsibilities are taken to a higher level in that more centralised model. For example, we have a lot of members working in ICBs who have really hands-on roles in the care of individual children, particularly where providers fail. Those kinds of concern are not being properly addressed in terms of risk and continuity of service to those people. We are going to survey our members—we will share the results with the Committee—in the next week or so about what specifically is worrying them about the way that change is being managed. With due respect to the Minister, this was all announced without a plan, and we are now waiting for a plan to emerge, 18 months into the process.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Good afternoon. Social care is one area that is absent from this Bill. To what extent is it possible to make the health service more efficient without tackling problems in adult social care? Sir Andrew Dilnot: It is largely absent from the Bill—indeed, when I was asked to come and give evidence to this Committee, I was initially somewhat puzzled, since it is so largely absent. The question you ask is absolutely to the point: certainly, we can improve the efficiency of the NHS without doing anything about social care, but we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care. That is partly because not having a good social care system means that we are not achieving the levels of human flourishing that are the objective of the health service and the social care system. It is also the case that the social care system is now under such pressure that it is leading to direct challenges for the NHS. We hear a lot about delayed transfers of care, which are an important part of this, but it is not just those; it is people who end up needing healthcare because they have not had appropriate social care support. The short answer to your question is that we can make the NHS a bit more efficient without reforming the social care system; but until we address social care we have at least two hands, and probably one foot, tied behind our back. It seems pretty astonishing to me that we have a 10-year NHS plan but no real plan for social care.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q 60 Good afternoon, gentlemen. My first question is to the NHS Alliance. In a survey published last month, your organisation found that two thirds of trusts and integrated care board leaders are likely to need to cut or reduce patient services to meet their financial plans. Given the financial pressure that ICBs are clearly under, what do you make of their ability to become more strategic commissioners and to innovate? Sir Ciarán Devane: First of all, the ICBs have had their 50% cuts and they are in the middle of reorienting themselves and joining up, so there has been a degree of distraction. The second thing, though, is the idea that the ICBs should be strategic commissioners, working well to commission plans that genuinely reform services. I think we all support that, and the move to give them GP commissioning, pharmacy provision and so on. All of that is good. The challenge will be that the baseline for the current year is not necessarily the outturn of last year, because there were some one-off savings in that, so our members across the NHS are saying that this is the year when the trade-offs have to be made. Some of those trade-offs will be good, in the sense of we can reconfigure this service, move some services into the community and do some good things—I am sure we will hear about some of those—but some of them will require difficult decisions to do with whether we shut down the service in this hospital and double down on the one over there. Making those decisions will need political cover locally as well as nationally, so we are in a tricky place. What we are saying is that we all understand the state of the public finances and suchlike, but we need some capital to allow places to reconfigure and redesign their services, whether that is new IT, AI or diagnostic services. Those are the things that will allow the transformations to take place, which is where the productivity and the money will come from. What we and chief executives, finance directors and chairs across the NHS are saying is that there is only so much heavy lifting that asking people to run around the hamster wheel a bit quicker can do. We have to make some of those big decisions.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q That does not sound very good. The Government said that they were going to regulate NHS managers. What impact do you think that would have? Jon Restell: Our members have been on a bit of a journey on this one. I think that they would broadly support the regulatory proposals that the Government will bring forward after the consultation. I think the real impacts will be very limited, covering a relatively small number of people and being used in very exceptional circumstances, so I do not think that they will transform management culture and deal with the management capability issue we have. They are a very personal form of professional regulation that will have very limited impact.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q What are your thoughts on the abolition of Healthwatch? Does Healthwatch have teeth? Does it influence people? Is it influencing the decision makers? Could it be reformed or should it be abolished? Professor Croisdale-Appleby: It is quite interesting to think that we have had 52 years of independent organisations representing the patient voice, as well as that of the carer. I think everyone here will be aware of it, but there was a step change in impact after the Mid Staffs situation, when Healthwatch—both Healthwatch England and the 153 local healthwatch bodies—was set up. We have produced over 20,000 reports; if anyone is interested in accessing any of them, we can certainly provide access by the end of the week. Since I joined Healthwatch in 2023, in my view it has been very successful in reaching out to those communities often referred to as “difficult to reach”—diasporas and so on, where we all know the health inequalities are often the deepest. I think Healthwatch has been very successful in ensuring that we have not just listened to the easy-to-reach groups but deliberately sought information and views from those other parts of our society, which form an increasing part of it. The research being done with those communities has recognised that there is quite often an investment of some six months for one of our people go into a particular community—whether a cultural community or an ethnic community—and win the confidence of the people so that they actually talk to us about the problems. I have to ask how that depth and focus is to be replicated under the arrangements suggested in the Bill. That is my extended first point about Healthwatch. I think we have had a lot of impact, and I use the word “impact” as a researcher myself. Impact is measured by the change that you make. When we produce reports, whether national or local, we include recommendations. The important thing is that we always follow up on those recommendations and ask, “Are they being implemented? Are they being listened to?” Each year, we produce a report that says, “What change has occurred as a result of the recommendations that we make?” I think that is extremely valuable, because it is about independence and holding organisations to account. Clearly, those organisations report in line function to the Department of Health, NHSE or local authorities, but we are not only the ears of the patient and the carer; at times, we hold feet to the flames over whether something sensible is being done. We do not give up on this; we pursue it down the rabbit hole.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Does removing local authority representation from ICBs weaken the link with local elected representatives, or is it beneficial? Councillor Wright: I assume that was directed at me, as I am a representative in local government. We feel it is going to weaken it. Having someone on the ICB is useful to help shape health strategy and ensure that the wider determinants of health are taken into consideration when planning health. We would like to see some kind of structure where local authorities and other partners involved in determining health from a wider perspective have a voice within the NHS delivering health locally.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q May I press you on the answer to my first question before I move on to the next? In the light of what you have heard today, do you want to correct your statement this week, in response to a written question, that the abolition of NHS England is “causing no disruption”—yes or no? Karin Smyth: In terms of service delivery—I think the written question was about delivering services— I stand by that.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Does it surprise you that the Bill is being brought forward before it has been properly and completely designed? We have tabled some amendments to clause 47; I appreciate that you will not have had a chance to look at those yet, but we would be interested in your thoughts if you could provide them to the Committee afterwards. We keep hearing that it is difficult for people to have to repeat their story. I understand that stories can be traumatic and repeating them can be unpleasant, particularly if it must be done many times, but is there sometimes a clinical value in asking people to go through their story? If so, what is it? Dr Imam: My specialty is frailty, which is a medical condition characterised by a loss of independence. Although it is associated with ageing, it is not an inevitable part of ageing. The treatment that I deliver as a clinician is called a comprehensive geriatric assessment. It is evidence-based and we know that it improves patient outcomes and maintains independence. What it describes is a multidisciplinary team approach to a holistic assessment that focuses on what matters most to the patient. One of the issues that we have right now, however, is that the NHS does not consistently identify people who are living with frailty right across the system from community to hospital. If we are identifying people and diagnosing them with a condition, you would expect treatment options to be offered, yet we do not consistently do that across the country. That is essentially driving ineffective and inefficient care. Sometimes, therefore, when a crisis sets in—we have seen this in other reports around corridor care—that can ensue in older people living with frailty. In my day job, where I look after people in a busy A&E department, I see people who have may have had a fall or become confused, or where there has been a breakdown in their social situation. My practitioners and I are spending hours trying to piece together information from multiple different sources. Those could be paper-based, digital or telephone—we could be trying to phone people to get up-to-date information. As you can imagine, sometimes they do not pick up the phone, so we are sometimes working from incomplete information and things that are not up to date. Once we have done that, we try to create a care plan for a patient that allows them to be looked after in the community. However, that care plan may not follow the patient, because everyone uses different electronic patient record systems. Some important partners in that care, like social care or ambulance services, cannot actually see the care plan that I have developed for my patient. Unfortunately, if a patient with frailty then succumbs to a crisis of some kind, the default setting is, in many cases, to trigger an admission to hospital. If a patient does not need to be in a hospital environment and they are frail, they can end up becoming more frail and weak, and lose their independence. That means that they will need even more social care than would otherwise have been required. Where the solution comes in is that a nationally rolled-out single patient record system could fundamentally reshape this form of care, because we would be moving it from the fragmented, reactive model that I just described to one that is proactive, co-ordinated and truly centred around a patient. Another thing about frailty is that there are so many different people involved in that person’s care, so we need to try to restore the continuity of care for that type of patient, which has become eroded over time. The SPR addresses that with a single up-to-date view of a patient. It enables earlier risk identification, faster clinical decision making and that whole-system integrated response I have been describing, which is lacking at the moment. There is often duplication; one of the other issues is that assessing patients in this manner can take a long period of time—up to two and a half hours is often quoted by the British Geriatrics Society. You can imagine that if you had an electronic record that could be auto-populated or could rely on the most recent, up-to-date plan done by someone else, that would avoid reassessment as we would be working from contemporaneous information. Over time, you can see how, for frailty and many other conditions, that could lead to a more preventive approach that is more community based, that reduces the need for admissions, and that provides a better overall experience for staff and patients. Importantly, there needs to be a shift towards neighbourhood working on frailty, and this allows the multidisciplinary team to work towards one plan. You have also heard today about patient voice and carer voice, and this type of care plan also gives them the opportunity to become partners in looking after themselves. Dr Cocker: The brief answer to the original question would be that communicating and getting a history from a patient are the cornerstone of the patient-doctor relationship. I do not think that the SPR is ever intended to replace that. Where I see its value within maternity, although I am sure that this is the same across all specialties, is that it would form a reliable means of cross-referencing information and being able to get information that—as we have alluded to previously—is often held on many separate systems. As a clinician, you will often not have the ability or the credentials to access that. For example, in maternity care at my trust we use a certain piece of software. If you do not work in maternity, although you might be able to get generic access to it, you might not be able to navigate that system. The idea of the SPR is that it would pull out those key bits regarding current concerns about the pregnancy or what follow up has been arranged—all those kinds of things. That would not rely on the ability to use lots of different systems; instead, the information would be available. If there is information that requires cross-referencing or checking, it would also give you the ability to do that rather than replacing the process of taking a history and working out what is wrong with someone. Dr Byrne: It is a terrific question. Healthcare is a relationship; it is not simply a transaction of facts. At its best, it is a working relationship between a clinician and a patient, but that is also why it is so hard sometimes. Our stories are a combination of two things: the facts and the interpretation of those facts. We heard a moving example earlier of someone saying that they had had five miscarriages and those facts were then not known and how distressing it was that they were not. That is a good example of why getting the facts from conversation to conversation could be really helpful. Our life story changes over time, however, as does the interpretation that comes up in a conversation. As a doctor in the moment with a patient, I am sometimes as interested in what they are choosing not to tell me at a particular time as what they are choosing to tell me. For all of us, the story changes and is fluid. I think that is a potentially helpful distinction to make.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q We do not have a plan of where we are going, but you have been asked to go somewhere. Jon Restell: Obviously, we have the 10-year health plan, which most people broadly see as a good vision for the service, but there are too many key design questions around the new department, the role of the department’s regions, what ICBs will be doing and what trusts will take on as part of this reorganisation. Behind it, there is a lot of capacity and resource organisational memory being taken out of the system. We do not talk nearly enough about the work of the commissioning support units staff, who are providing internal consultancy and a huge range of business services to the health service, including overseeing child immunisation programmes in some cases. It is really unclear what the future of those functions is. We are taking out a lot of staff who have skills, expertise, organisational memory and commitment, but we do not quite know yet what the precise form of those organisations will be. It is a very difficult change to manage.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q As a Lincolnshire MP, I am delighted to know that that is operating, if not necessarily in my constituency, then certainly in the county. I have a question for Kath: how does the single patient record apply to maternity in terms of safeguarding and access to that sort of information? As an aside, this Bill allows the Secretary of State to set targets. How would you see that working in maternity care? Kath Abrahams: On digital exclusion, the same risks apply, although there is a different age demographic. If you have somebody who has a particular disability, has English as a second language, or has difficulty reading, we need to ensure that alongside the single patient record we are not excluding people without meaning to. Having said that, there are real opportunities to reduce inequities as a result of this change, such as by ensuring that everyone’s information is there, and that people do not have to retell their story if they find it difficult to speak to their clinician. What the single patient record will not do is solve all the problems found in the national maternity and neonatal investigation. An action plan will come out of that investigation, and it must be looked at really seriously. A single patient record does not replace compassionate care or somebody really being looked after well, but it can potentially provide a safer environment—I am very happy to go into detail on that. The national maternity ambitions have expired, but we are pushing very hard for them to be restated. There is potentially an opportunity to use the data at a broader level to measure progress. If it was possible to use the single patient record to understand how things were going towards improvement, that could be very helpful.

• 16 Jun 2026 · Health Bill (Second sitting) · Hansard source

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  Q Mr Blythe, what value does your council of governors add to your trust? James Blythe: Councils of governors across the NHS have added significant value since they were instituted and brought into foundation trusts. The foundation trust councils of governors play two roles. The first relates to the appointment and holding to account of the non-executive directors on the board. The second relates to securing public and patient involvement and voice in the organisation and the management of our services. Since councils of governors were instituted, we have developed increasingly sophisticated ways of getting public and patient voice into services. If you look at innovations such as maternity and neonatal voices partnerships, which really involve service users in how services are developed on the ground and are very close to the teams that are running them, that gives us different ways of involving patients and the public in services where possibly councils of governors have not been able to do in the past. Councils of governors have played a really important role in foundation trusts, but certainly in terms of that patient and public voice function, we have moved on as a system and developed more sophisticated ways of doing that.

• 15 Jun 2026 · NHS Dentistry · Hansard source

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  I congratulate the hon. Members for Yeovil (Adam Dance), Sunderland Central (Lewis Atkinson) and Waveney Valley (Adrian Ramsay), and my hon. Friend the Member for Farnham and Bordon (Gregory Stafford), on securing this important debate. Madam Deputy Speaker, I once read that nothing you wear is more important than your smile, because it is your smile, and the laughter that comes with it, that brings joy and happiness to the world. In that spirit, I start by acknowledging some progress that this Government have made. The previous Conservative Government began establishing dental schools in Norwich and Portsmouth, to bring the next generation of dentists, hygienists and dental therapists to local people. We started fixing the roots of dental education, and I am pleased that this Government have continued that, allocating 25 training places to each of those schools. That is of course good news. As the Minister will know, it has been a long-standing campaign of mine to get a dental school in Lincoln. Excellent progress has been made so far, with the hub-and-spoke model to help rural areas, as my hon. Friend the Member for Bridgwater (Sir Ashley Fox) described. The team at the University of Lincoln are just waiting for the final sign off from the General Dental Council and the Privy Council. I am hoping that there will soon be places for Lincolnshire in the plans for dental education. To help bolster NHS dentistry, in 2024 the Conservative Government consulted on proposals to require dental graduates to work in the NHS for three years after qualifying. This Government’s 10-year plan committed to that policy, but I think we are waiting for a consultation to set out the proposals in greater detail. Can the Minister tell us whether it is still the Government’s intention to introduce tie-ins to NHS dentistry for dental graduates and when the proposals will be in place? As the Liberal Democrat spokeswoman, the hon. Member for Epsom and Ewell (Helen Maguire), said, the previous Conservative Government committed to expanding dentistry training places by 40% over 15 years, and, despite population growth, there are still more dentists per 100,000 people than there were in 2009. This Government’s workforce plan should lay out how many dentists, hygienists and therapists we need to recruit, and how the Government are going to do it. Unfortunately, that workforce plan was due last year, before being delayed until spring ’26. It is now summer ’26. In response to a recent question, the Minister said that it was due imminently, which I am sure is quicker than “soon” and much quicker than “in due course”. If the Minister has time to define “imminently”, I would be most grateful. It is not all about numbers. As the Minister himself has said, the issue is not the number of dentists, but the paucity of dentists who are doing NHS work. There is a case for making the NHS more attractive to dentists in the first place, as we know that dentists are disincentivised from working in the NHS. The main problem with that, as many have identified, is the contract created under the previous Labour Government in 2006. This has been a problem for some time; when I moved to Lincolnshire in the early 2000s, I remember travelling back to Redcar to see my wonderful NHS dentist, Mr Dixon, until he retired. There are several issues with the units of dental activity model in the contract. First, the units fluctuate bizarrely between practices, creating inequities in payment. Secondly, the UDA does not really equate with the real-time cost of delivering complex care. Thirdly, the UDA does not always cover the costs of care, meaning that dentists may be asked to provide some NHS care at a loss. The Conservatives started to change those issues by raising the minimum UDA payment and giving care commissioners the tools they needed to address UDA rates locally to better support delivery of care for patients. The former Secretary of State said that he would sort it by meeting the BDA on day one, and I believe that he did in fact meet the BDA straightaway, but there seems to have been little progress since. In April, the Minister promised that a consultation on fundamental contract reform would launch before the summer, but we are now in June—can the Minister say when that will be ready? Does he expect to reform the dental contract in this Parliament, as he promised? The Government are focusing a lot of resources on abolishing NHS England and have cut ICB budgets by 50%. Are they so focused on restructuring that promises to patients are not getting delivered? Speaking of delivery, the Government promised 700,000 urgent dental appointments and commissioned 1 million. In March, however, they admitted that just 100,000 additional urgent appointments had been taken up. I am aware of some dentists who are staffing appointments on call, on an in-case basis, so how many unattended appointments did the Government pay for? The Minister has now broadened his definition of urgent, but is he confident that we will have the urgent need met, and that it will not be crowded out by his broader definition? We have heard much about children’s teeth. In 2015, 42,209 children were admitted to hospital to have dental extractions due to decayed teeth; by 2024, that had fallen to 30,567—a drop, but still far too many. In 2025, however, that number rose to nearly 34,000. The previous Government introduced a Big Brush Club in south-west England, and I note that was the only region to have a reduced number of admissions in the year 2024-25 for decay extraction. What has the Minister made of that programme? How does the Government’s programme differ from the Big Brush programme? Children need their teeth brushing during the holidays, at weekends and in the evenings—how is the Minister working on ensuring that parents deliver on their responsibilities then? It is indeed their responsibility to ensure that their children brush their teeth twice a day. The Government’s 10-year plan rightly focuses on prevention, and one important preventive measure is the fluoridation of the water supply. The Government’s “Water fluoridation: health monitoring” report in 2026 found that children living in areas with a fluoridation scheme had a 20% lower incidence of tooth extractions. Will the Minister say what he is doing to explore expanding water fluoridation to help eliminate tooth decay? Dentistry is important, because good oral health is not just about our teeth, mouth and gums. Research published in The Lancet reports a growing body of evidence suggesting that oral health is closely associated with conditions such as cardiovascular disease, diabetes and Alzheimer’s. One’s dentist may also identify symptoms of Peutz-Jeghers syndrome, Sjögren’s syndrome, nutritional deficits, Crohn’s disease and oral cancers. Delivering on NHS dentistry is important for our wider health too, but so far it feels as though the Government have been all smiles but little action when it comes to making NHS dentistry work for everyone. I hope that the Minister and his new Secretary of State will not seek to blame others, but instead recognise that they now have the levers in their hands—indeed, they have had them in their hands for nearly two years now—and use them to address these concerns, and quickly.

• 11 Jun 2026 · Secondary Breast Cancer · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate the hon. Members for Wokingham (Clive Jones) and for City of Durham (Mary Kelly Foy) on securing this debate, which I know is extremely personal to both of them. I also congratulate the hon. Member for West Lancashire (Ashley Dalton) on her speech. It is quite common in this place for people to say that an hon. Lady or hon. Gentleman has given an extremely powerful speech, but that was an extremely powerful speech. I was moved by it, and I am in great admiration of her courage and the frankness with which she speaks in this House about her illness. I was fortunate enough to be at a roundtable earlier in the week with the New Statesman about the cancer plan, with the hon. Member for Wokingham and others. I found it very insightful and thought-provoking, like the contributions we have heard in the Chamber today. As has been said, for many people, primary breast cancer never comes back after treatment, and treatment for primary breast cancer has significantly improved. But sometimes the cancer cells spread to other parts of the body—commonly the bones, lungs, liver, brain or skin—which is called secondary or metastatic breast cancer. As we have heard, the best estimate we have is that there are around 61,000 people living with secondary breast cancer in the United Kingdom, but that statistic is uncertain and the data is unclear. One point in the cancer plan was that the Government would collect the data on secondary breast cancer from 2026. We are almost halfway through 2026, so I would be grateful if the Minister could provide an update on how that is going and when we will see that data. Also, how frequently does she expect it to be published—will it be published monthly, quarterly, every half year or every year? What are her plans for that? There needs to be definition in order to do that, so I wonder if she has settled on that too. Another point in the cancer plan is the desire to improve screening. Again, I commend the hon. Member for West Lancashire on her work on the cancer plan, but there are women in Lincolnshire waiting five weeks and more for referral to their appointment when they discover a breast lump, and we know that the longer it takes for diagnosis, the more likely metastasis is to occur. Could the Minister give more detail on the promise to expand screening? What does it look like? What workforce will be necessary and when will that be in place? What mammography machines or ultrasound machines might be needed? Are they to be bought and installed, and how quickly does she expect that to happen? For those who need genetic testing, what plans does she have to expand the availability of genetic testing, and what will the timescale be? The cancer plan, which I am glad is very ambitious—it should be—will work only if it is delivered. It was published just over four months ago, but it is not clear what progress is being made or that the work is continuing at the necessary pace to deliver the ambitions we all want to see achieved. One thing slowing progress is the reorganisation of integrated care boards in response to the cutting of their budgets by 50%, and the Health Bill’s abolition of NHS England. The people who would be organising and planning are organising and planning something else. Some of them are leaving, so we are losing expertise, while others are being made redundant—or leaving before they are made redundant. That is disrupting the planning of our health services. Will the Minister comment on that? As has been said, there has not been the same progress for treatment of lobular breast cancer as for other forms of breast cancer. The previous Conservative Government committed £20 million to the Moon Shot project, to research ways of advancing treatment of that particular form of cancer, which needs more attention than it has had of late. Will the Minister tell us whether this Government are committed to providing that money for that research? Hospices provide amazing services for people towards the end of their lives, but, as we have heard in other debates in this Chamber, they are struggling. They have a lot of staff because theirs is a very person-delivered service, and they accrue extra national insurance costs from employing all those members of staff. I appreciate that the Government have put a lot of money into hospices, but that is capital money to enable them to redecorate, build extra bits, provide extra equipment. That is lovely, but it does not help if there are no staff to run the service and provide the care that the patients so desperately need. What discussions has the Minister had about the effects of national insurance contributions on hospices? Has she considered an exemption? What are her plans to help to support the hospice movement? The hon. Member for West Lancashire referred to what happens when a patient has run out of options. As a doctor, I am always told that a doctor never runs out of treatments. Palliative treatment is treatment, so even when they run out of treatments, they are still providing a treatment. However, what happens when we run out of treatment that is active or likely to be successful in prolonging life or curing disease? It is important that research is supported and able to continue. I look forward to the Minister’s words on what the Government are doing to support research so that new drugs can come online. During the pandemic, we saw how quickly vaccines were brought through the pathway. What is gumming things up now? How do we speed it up so that people can get the necessary drugs more quickly? What happens in the grey zone, when a drug is going into trial and is sort of but not quite available yet? We have compassionate use schemes, about which I asked an urgent question in the main Chamber this morning. Such schemes are used when individuals have reached the end of the treatment options and perhaps do not qualify for any of the trials that are currently available—in paediatrics, that could mean that they are a few days out of the age bracket—or perhaps the trials are full. Those schemes are also used when a patient received the drug in a trial, but the trial is finished and negotiations about the drug are ongoing. In some cases, the drug companies will provide those drugs to patients for free to help them. Unfortunately, towards the end of last year, the Government decided to charge VAT on the deemed value of such drugs. That means the companies have to pay sometimes quite significant charges to give those drugs to patients. One large pharmaceutical company has pulled out of the compassionate use scheme, which means that its drugs are not available for the people who need them—that issue was raised by my hon. Friend Member for Hornchurch and Upminster (Julia Lopez). The enforcement of that tax by His Majesty’s Revenue and Customs has been paused for review, but the liabilities remain. We therefore have a situation in which some drug companies are pulling out and others are considering their position. People with secondary breast cancer, and those with other cancers and serious illnesses, cannot wait for the autumn Budget. They need the Government to make a decision to sort this problem out now. Only last month, the Government decided that they would take VAT off rides at Alton Towers. That is great, but if they can do that, they can sort this issue out as well, and they need to get on with it. Will the Minister raise the matter with her colleagues in the Department of Health and Social Care and in the Treasury to see what she can do to help people who have no option other than these new and special drugs to keep their hope alive? In summary, the cancer plan is ambitious, which is great—it has some great targets that I hope can be achieved—but we need to see delivery. I am looking to the Minister for the detail on how the plan will be delivered.

• 11 Jun 2026 · Compassionate Use Medicine Schemes: VAT · Hansard source

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  I declare an interest as a consultant paediatrician. One of the worst moments as a paediatrician is when all treatments have failed and there is no suitable clinical trial. At that point, in those dark moments, compassionate use schemes can be a glimmer of hope, and new unlicensed medicines with clinical potential have been provided free to the patient, and free to the NHS. Last year, however, the Government started charging VAT on the deemed value of those drugs, meaning that companies had to pay tax to give the drugs away. When hearing that “every meeting” with Labour MPs was about “who can we tax in order to pay benefits to others?” few would have imagined that that would include potentially lifesaving, charitably given drugs for sick adults and dying children. Following lobbying by my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez), the Government have paused enforcement while they review the situation, but they have said that liabilities remain, and they are taking too long. Bayer has now withdrawn from the scheme, and others could follow. Patients are at risk. Does the Minister recognise that that makes trials in the UK less attractive, and that HMRC’s pause is not enough? How much money do the Government expect to raise with this VAT? How did the Government find time to reduce VAT on fairground rides at Alton Towers, but not to sort out this problem? How many patients have missed out so far? Does the Minister recognise that this delay could cost lives, and who was the Minister who signed this off? Was it the Health Secretary when he was a Minister in the Treasury? I understand that the Government say this situation is not new, and that it may apply to a law dating back over 30 years. I gently point out, however, that the application is new, and that the levers to change it—and change it quickly—lie in this Government’s hands. Patients need them to act swiftly.

• 11 Jun 2026 · Compassionate Use Medicine Schemes: VAT · Hansard source

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  (Urgent Question ): To ask the Secretary of State for Health and Social Care if he will make a statement on the effect of VAT on the availability of medicines through compassionate use schemes.

• 10 Jun 2026 · Draft Food Supplements Purity Criteria (Magnesium L-threonate monohydrate) (England) Regulations 2026 · Hansard source

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  I just have a couple of questions. I have read about magnesium L-threonate: it is supposed to promote relaxation, unlock true cognitive potential, improve sleep, mood and overall wellbeing, and enhance mental clarity, memory and focus, so I was thinking I might get some of that. However, if I were to recommend it as a supplement, there are a couple of things I would need to know. What would the dosing be? Can the Minister confirm whether the plan is to set the dosing of magnesium in line with other types of magnesium supplements and in line with the EU, or has that not been decided? Will that be decided on a different day? My other question is how, when we look at supplements, we can be sure they contain what it says on the tin. The Food Standards Agency regulates that, but how many reports has it had of concerns about the content of supplements, and how many products does it test? I looked at its retail survey for 2025, which found that 83% of caffeine supplements failed because they had the wrong amount of caffeine, there were allergens not described on the labels, or they contained substances that should not have been there. How often should we expect the supplements to be tested? What sort of programmes are in place to ensure that the huge variety of supplements that people can choose from in shops these days are safe and that they contain what they say they do? Other than that, I am happy with the regulations.

• 9 Jun 2026 · Health Inequalities · Hansard source

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  I thank the Secretary of State for his answer. Does he therefore share my concern at reports that some children are being turned away from state-funded healthcare because they are not attending a state school? Will he look into those reports and ensure that he makes provision for children who are not attending state schools to receive the healthcare they need?

• 9 Jun 2026 · Health Inequalities · Hansard source

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  Does the Secretary of State agree that state-funded healthcare should be provided to all children based on clinical need, not economic or educational status?

• 1 Jun 2026 · Health Bill · Hansard source

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  Before I start, I must declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health, as well as someone who has been moved to the back of a waiting list, after asking for a consultant review for the third time, and finding that I still do need it but it will have to wait a bit longer. Churchill once said: “Healthy citizens are the greatest asset any country can have”. Good health is perhaps the most important asset that any individual can have, and I am sure that across the House, we all want the very best healthcare and the most efficient NHS for our constituents. As such, I am confident that this Bill has been brought before the House with the very best of intentions, but does it achieve its goals? In general, organisational restructure involves some sort of assessment of where we are now, followed by a vision of what the future should look like, and then a focus on how to get smoothly from A to B. The Government started with a review of the current system. They called it the “Independent investigation of the NHS in England”, although the House should note that it was independently conducted by a former Labour Minister. In his report, Lord Darzi said that “a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”. The then Secretary of State, the right hon. Member for Ilford North (Wes Streeting), seemed to agree. In September 2024, he was reported as saying that a top-down reorganisation was the “last thing” he wanted to do. Within six months, he seemingly changed his mind, which he is allowed to do, but it is regrettable that, having begun the last thing he wanted to do, such little progress has been made on his promised first acts, such as the roll-out of fracture liaison services. So many other promises are delayed, undelivered or, in the case of the promise to double the number of medical school places, somewhat bizarrely denied. Another of the Government’s stated objectives is improving the patient experience. At the moment, we have Healthwatch—an independent organisation that listens to patients and provides feedback. More than 300,000 people a year share their experiences with their local Healthwatch to improve services, and that feedback has led to positive change. The Government cited Healthwatch data in their King’s Speech publication. Against the backdrop of rising clinical negligence claims, concerns about maternity care and even reports of abuse in hospitals, it is clear that more must be done to listen to patients and address the problems, but this Bill abolishes Healthwatch England and effectively ends local Healthwatch organisations. The Government plan to replace it with a patient experience directorate within the Department of Health and Social Care. As Councillor Dr Wendy Taylor of the Local Government Association has warned that this “risks organisations being seen to mark their own homework.” There is another concern. Facts are stubborn, but statistics can be pliable. How can the public ensure that they are getting reality and not spin from the Government? Ministers keep celebrating falling waiting lists, when in fact patients are being removed from the list without treatment because their appointments have been cancelled, because they missed an appointment they were not told about, because they have not filled in a form, or because they were called several times asking if they still needed an elective operation and agreed to see a consultant to check. My hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) made a passionate speech about the importance of HSSIB. This Bill seeks to abolish the Health Services Safety Investigations Body. It provides a safe space, modelled on air accident investigations. Through the avoidance of blame and liability, it can get to the truth and prevent future tragedies. The Bill abolishes HSSIB apparently to simplify the patient safety landscape and reduce the number of organisations. In response to criticism, the Government have attempted to provide reassurance by saying that HSSIB will retain autonomy within the CQC, but the Government cannot have it both ways. Is HSSIB being abolished, or is it being hidden within the CQC? Either way, the new unit within the CQC will face a number of challenges, such as the undermining of confidence in safe spaces, because it will be within a regulatory body. Its independence will be undermined, because Ministers have now signalled their intent to direct the vast majority of investigations and because the national quality board will prioritise any recommendations that they make. We will also have a CQC board without full oversight of what it is accountable for and, somewhat bizarrely, a risk that if the regulatory part of the CQC wants information from the safe space, and the other part of the CQC does not want to publish it, we could see the CQC suing itself. We have all this upheaval to have one less—or at least the illusion of one less—organisation. How on earth does that improve patient safety? As many have said, including my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer) and for South Northamptonshire (Sarah Bool), the single patient record is a good idea in principle. Patient information is currently fragmented across different parts of the healthcare system, and bringing it together could save lives, save time and improve prevention. However, the introduction of such a system must be well executed. First, there are practicality concerns. Do patients want their full medical records, including sensitive conditions and perhaps including sexual health records, visible to every health professional? The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talked about the difference between a single patient record that is all of the same type and one that is part of a federated platform. The Secretary of State talked about linking up people’s ability to see the current system, but there is huge variety in systems. Even within one hospital, there might be a different system for maternity, A&E, blood results, historical notes and current clinic appointments. Will NHS staff be required to learn all those systems for all over the country, or will data be transferred to a new system? Either move has its downsides, but I am not clear which the Government intend to do. Secondly, there are security concerns. As has been said, the NHS has the most valuable health dataset in the world. The Government must provide clarity in relation to who controls the data, who is responsible for maintaining its accuracy, and how it will be kept securely. Hackers are already trying to gain access to it, knowing that even if it is encrypted, quantum computing will be able to unpick encryption in the years to come. The Government must ensure that they are quantum-ready. What role is the National Cyber Security Centre playing in this regard? Life, in all things, is a balance. If arm’s length bodies are in control of things for which Ministers are nominally responsible, we have a democratic deficit, and it is understandable that the Government want to recoup that, but, as we heard from my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti), the powers in the Bill for them to take control of everything risk the creation of a politicised service in which those who shout the loudest get preferential treatment. Those with very rare conditions such as corticobasal degeneration, Wiskott-Aldrich syndrome, Lafora body disease, Friedrich’s ataxia and many more such conditions may not have as well-funded or celebrity lobby groups acting on their behalf as those with other conditions. How will the Secretary of State ensure that clinical need drives the provision of services, rather than the resources of lobby groups or access to Ministers or, indeed, the Secretary of State? As the NHS is undergoing a massive reorganisation, I am mindful of what the Minister once said: “The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”. —[ Official Report , 22 September 2022; Vol. 680, c. 809.] It also stalls progress and takes a lot of staff time, which may be why we have a 10-year health plan that took a year to write, why the workforce plan has still not been produced, why the so-called “rapid” national maternity investigation has not been completed, why waiting lists are up for patients referred for admission in several specialities, why we have a glacially slow roll-out of fracture liaison services, why the mechanical thrombectomy service promised for stroke victims by April is not available, why there is no response to the Hughes report, why there is a denial of the promise of an increase in the number of medical school places, and why doctors have announced their 16th strike, costing millions of pounds in appointments. The Government promised results, but all they have delivered is disruption, delay and disappointment. I feel for the current Health Secretary. His predecessor was more focused on unseating the Prime Minister, and he is left to pick up the pieces. However, despite our political differences, I do have hope. Previously, he insisted that trans women were women, but I understand that he has now changed his mind. He has listened, and he has accepted that biological women are distinct and require single-sex spaces, in line with the law, biology, and common sense. I am therefore hopeful that the new Health Secretary will also listen to concerns about the Bill, and that we can work together in Committee to improve it. As I said at the beginning, we all want the best possible health service for our constituents.