Caroline Johnson MP: speeches 2026

Speeches

• 30 Jun 2026 · Health Bill (Ninth sitting) · Hansard source

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  Clause 40 prepares for the preparation of the annual accounts of NHS trusts and integrated care boards. Existing legislation in section 65Z4 of the NHS Act 2006, “Consolidated accounts for NHS trusts and NHS foundation trusts”, requires NHS England to prepare a set of accounts every financial year and consolidate the accounts of all the trusts and NHS foundation trusts. The Secretary of State can give directions about the content for methods and principles, and the accounts must be accompanied by reports or other information as directed by the Secretary of State. A copy may be sent by NHS England to the Secretary of State and the Comptroller and Auditor General. The latter must then examine and certify those accounts before sending a copy to the Secretary of State and NHS England, and NHS England must then lay a copy of the consolidated accounts and the Comptroller and Auditor General’s report before Parliament. That is how it works at the moment. Clause 40 rewrites section 65Z4 and the duty to prepare the consolidated accounts every financial year moves to the Secretary of State, and the list of what gets consolidated now includes the ICB accounts. The power to give directions to NHS England about accounts is removed, which is fair enough because there would be no need for it, as the Secretary of State is now preparing them and NHS England will cease to exist. The requirement for the accounts to be accompanied by such reports or other information as the Secretary of State may direct has been removed. The accounts go straight to the Comptroller and Auditor General, who reports back only to the Secretary of State. At the end, the Secretary of State lays the accounts before Parliament. The changes are necessary owing to the abolition of NHS England. I want to ask about the consolidation, including the ICB accounts, which was not there before, and what impact that will have. Will the accounts be sufficiently detailed so that it is possible to disaggregate that information if people are interested in doing so? Clause 41 changes which NHS companies can be covered by the scheme that meets certain losses, legal claims and liabilities. Currently, section 71, “Schemes for meeting losses and liabilities etc of certain health service bodies”, of the NHS Act 2006 enables the Secretary of State to establish schemes to meet the losses of NHS England, ICBs, trusts, the National Institute for Health and Care Excellence, the CQC and several other bodies. The list of bodies includes “(ha) a company formed under section 223 and wholly or partly owned by the Secretary of State or NHS England”. In the new legislation, clause 41 rewrites paragraph (ha) so that it is “a company formed under section 223 other than by an integrated care board by virtue of section 223A”. That narrows the scope of the liability scheme by preventing ICB-created companies from automatically gaining protection, presumably to encourage ICBs to manage risk responsibly.

• 30 Jun 2026 · Health Bill (Ninth sitting) · Hansard source

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  I do not think the Bill is very clear on that. It says that the Secretary of State “may by order impose limits on the expenditure that may be incurred by an NHS foundation trust in respect of a single financial year.” However, it does not say whether that is an overall limit, whether it is for capital or revenue or whether it is a limit on a specific item, so the degree to which the Secretary of State has control is not clear. I presume it is an overall limit and that it is for dealing with budgets, but perhaps the Minister can provide some clarity for my hon. Friend. Clause 34 requires foundation trusts that have been newly authorised, or that have recently acquired another trust or another foundation trust, to prepare the final accounts for their predecessor trust or foundation trust. It does that by modifying section 36 of the NHS Act 2006 to add new provisions that require foundation trusts to prepare accounts for the final period for which they were an NHS trust, establish that part of schedule 7 and part of the Local Audit and Accountability Act 2014 apply in relation to those accounts, and define the final accounting period. It does the same for section 56AA of the 2006 Act.

• 30 Jun 2026 · Health Bill (Ninth sitting) · Hansard source

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  Clause 31 introduces schedule 4, which essentially makes series of amendments to other Acts. It amends the Public Finance and Accountability (Scotland) Act 2000 to remove a cross-reference to other categories, and it amends the Audit and Accountability (Northern Ireland) Order 2003 and the Public Audit (Wales) Act 2004 for similar purposes. It also amends the National Health Service Act 2006 by deleting section 62 and schedule 10, relating to the audit of accounts of NHS foundation trusts, to end the old audit scheme. Schedule 4 amends section 3 of the Local Audit and Accountability Act 2014 so that foundation trusts are now included in the list of bodies that must keep accounts in the standard way, it amends section 4 to specify which documents count as accounts of foundation trusts for the purpose of auditing, and it amends sections 8 and 10 so that the auditor appointment procedure and the auditor panel’s role now cover foundation trusts. In addition, schedule 4 rewrites section 13 of the 2014 Act so that if a trust fails to appoint a local auditor, it is the Secretary of State’s job to step in. Previously, that was NHS England’s job; clearly, that needs to change, because NHS England is being abolished. The schedule also amends section 21 so that the auditors’ general duties now apply to foundation trusts too, and it amends section 30, relating to unlawful expenditure and activity, and section 32B, relating to the independence requirement, to remove a now-redundant item from the list. Schedule 4 also amends schedule 2 to the 2014 Act to formally add foundation trusts to the official list of audited bodies; schedule 5 so that the rules on who can be a local auditor now cover foundation trusts too; schedule 6 to remove an outdated segment from the audit practice code rules; schedule 7 to tidy the reporting rules and extend them to foundation trusts; schedule 9 to realign data matching rules that apply to foundation trusts in the new system; and schedule 11, relating to the disclosure of information, to remove a reference to NHS England, which is no longer necessary because NHS England is being abolished. In general, clause 31 aligns the audit process for accounts of foundation trusts with those of standard trusts and integrated care boards. Clause 32 removes the need for NHS England to maintain a register of foundation trusts and the fees associated with maintaining it. Section 39 of the NHS Act 2006 requires NHS England to maintain a current register of NHS foundation trusts and specifies what must be in that register. Section 50 states that an NHS foundation trust must pay NHS England a fee that NHS England may determine in respect of exercising its functions under section 39, which relates to keeping the register, and section 39A, relating to a panel for advising governors. Clause 32 deletes sections 39 and 50. The explanatory notes say that the requirement to maintain a register does not need to be transferred to the Secretary of State when NHS England is abolished because, the Government argue, the information will already be available centrally, and there is no need for a fee to keep that in place. That seems sensible to me. Clause 33 enables the Secretary of State to impose limits on a foundation trust’s annual capital or revenue expenditure. Section 42B of the 2006 Act allows NHS England to make an order imposing a limit on the capital expenditure of a foundation trust in a single year. Section 42C sets out that NHS England must publish guidance about the exercise of its power under section 42B, including about the circumstances in which it is likely to make an order and the method it will use to determine the capital expenditure limit. Clause 33 entirely replaces sections 42B and 42C with rewritten sections, with some notable changes. The wording is changed from “capital expenditure” to “expenditure”. The power is therefore widened from capital expenditure limits to limits on any expenditure—capital and revenue. The Secretary of State replaces NHS England as the entity with the power to impose limits, which makes sense, and the subsection requiring an order to specify the trust, the financial year and so on has been removed in full. The change gives the Government financial control to stop overspending by NHS foundation trusts. I note that in financial year 2023-24, NHS trusts overspent by £1.2 billion, so presumably this is the Secretary of State getting a tighter grip on spending. In some respects that is sensible, but overspending is often due to staffing costs and day-to-day pressures, not capital expenditure, so there is an argument that the capital limits themselves are not sufficient to deal with the problem. Under the new governance model, the Secretary of State has oversight and responsibility for the health service, and financial control aligns with those changes. The new power could prevent one organisation’s failures from undermining the health service’s wider financial position or impacting other providers. However, the purpose of foundation trusts is supposed to be that they have greater independence over spending, and the Government have stated that their aim is to create a more devolved and autonomous health system. How does broadening the Secretary of State’s ability to interfere in expenditure devolve power or make foundation trusts more independent? Imposing expenditure limits may control overspending on paper, but it does not address the reasons why it is happening, so limits could lead to a deterioration in the health services delivered by some trusts. What plans does the Minister have to deal with that? Because the power moves from an arm’s length body to the Secretary of State, interventions could be politically motivated, rather than in the best interests of the NHS. How does the Minister consider that that will be managed? The power for the Secretary of State to impose expenditure limits at any time during or before the financial year could create uncertainty among trust leadership and undermine long-term planning. If a trust is given a budget for the year, it knows what it has to work with, but if somebody says halfway through the year, “Actually, you are going to have to work with less money than that,” it is very difficult for the board to plan its expenditure, because it is always looking the other way. Why does the Secretary of State need that power? Can the Minister clarify that, if there is a change in the expenditure limit during the year, it will always be revised upwards, and never downwards?

• 30 Jun 2026 · Health Bill (Ninth sitting) · Hansard source

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  Clause 35 essentially establishes the right of the Secretary of State to convert a foundation trust into an NHS trust in certain circumstances. Currently, section 25 of the NHS Act 2006 establishes trusts and introduces schedule 4 of the same Act, which makes provision about NHS trusts. Section 56AA sets out how additional requirements concerning acquisitions of a trust or foundation trust are to work. Clause 35 deletes section 25(2), which specifies that an order in this context is referred to as “an NHS trust order”, and amends subsection (3), so that no order under section 25—previously no “NHS trust order”—can be made until any consultation that has been prescribed is complete. Clause 35 introduces proposed new section 57B into the 2006 Act, “Conversion of failing NHS foundation trust into NHS trust”, which provides the Secretary of State with the power to convert if the foundation trust breaches its licence or other legal duties. The trigger is broad and includes non-compliance with any statutory requirement. The proposed new section requires an order to specify when it takes effect and also requires the Secretary of State, when deciding to issue an order, to consider among other things “the seriousness of the failure…the health and safety of patients…the quality of the provision by the trust of goods and services…the financial position of the trust, and…the way that the trust is being run.” Before making an order, the Secretary of State will be required to consult the trust, any ICB where the trust has facilities and “any other person to whom the trust provides goods or services…whom the Secretary of State considers it appropriate to consult.” The proposed new section also provides the Secretary of State with the power, when the conversion order is made, to “terminate the appointment of the chair or any executive or non-executive director”, and to “appoint a person to be the chair or an executive or non-executive director”. It also time-limits the powers to intervene with management to one year after the order is made. Clause 35 also introduces proposed new section 57C into the 2006 Act, “Guidance about conversion”, which requires the Secretary of State to publish guidance about matters to be considered when deciding to make an order and requires them to consult persons considered appropriate before publishing or revising guidance. The clause removes “NHS trust order” from section 276 of the 2006 Act, “Index of defined expressions”, and updates schedule 4, so that an NHS trust may be established by an ordinary order under section 25 or a conversion order under proposed new section 57B. Schedule 5 to the Bill inserts proposed new schedule 9A to the 2006 Act, “Conversion of failing NHS foundation trusts”, which provides that, on conversion, the foundation trust’s chair and directors become the initial chair and directors of the new NHS trust, unless they are removed by the Secretary of State under the procedures we have just talked about. The proposed new schedule initially keeps the board the same size, until new arrangements are made. It provides that the foundation trust’s public dividend capital carries over to the NHS trust and that the conversion does not affect continuity of the body —it will remain the same organisation, just with NHS trust status. The proposed new schedule provides that the trust’s property and liabilities, including criminal liabilities, continue unaffected. It also provides that existing contracts continue and that the trust remains party to them. It clarifies that those contracts do not automatically become NHS contracts under section 9(1) of the 2006 Act, provides that the trust keeps any corporate memberships that it held before the conversion, and clarifies that the continuity provisions do not affect the Secretary of State’s wider powers to make directions. The Secretary of State will have a direct power to act where the foundation trust has failed—for instance, where there have been patient safety lapses—and there are clear benefits to that. There are also transparency requirements built in: the Secretary of State must publish guidance and consult before issuing guidance or undertaking conversion, and the power to change the management is limited to a year. However, the last Labour Government said that independence was central to the success of foundation trusts. In 2005, the then Secretary of State, Patricia Hewitt, said: “We know that independence from central Government control and greater freedoms are giving NHS foundation trusts the opportunity to innovate new approaches to healthcare and healthcare services, for the benefit of NHS patients.” —[ Official Report , 7 November 2005; Vol. 439, c. 5WS.] The challenge with innovations is that, even with the very best intentions and the very best advice, some will work and some will not. If any failure at all is a reason for trusts to be taken over, will that cause them to be shy about innovating, for fear of their independence being undermined as a result? There is a balance to strike, so I wonder whether the Minister will comment on that. The change also makes it easy for the Secretary of State to convert a foundation trust for political reasons—for instance, because of pressure from local Members of Parliament. That is a positive in some ways and a negative in others. Again, it could have a chilling effect on the very autonomy and innovation that Ministers want to see, so the question is how they think they will balance that.

• 30 Jun 2026 · Prisoner Releases in Error · Hansard source

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  I understand that the total is 441, which over a two-year period is the worst on record and means that, in less than 24 months, Labour has released more prisoners in error than were released in the previous six years combined. That is a disgrace. How many of those released in error early were convicted of rape?

• 30 Jun 2026 · Prisoner Releases in Error · Hansard source

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  5. What estimate he has made of the number of prisoners released in error since July 2024.

• 29 Jun 2026 · NHS Breast Screening · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate Gemma Reeves on bringing forward the petition and the hon. Member for North Ayrshire and Arran (Irene Campbell) on introducing this important debate. It has been very moving to hear so many stories from hon. Members on both sides of the House reminding us of the human cost of this disease. Breast cancer is very common, as other Members have said, affecting one in seven women during their lifetime. The Minister and I have had a number of debates in this Chamber about various diseases and forms of cancer. One of the core principles we often discuss is that early diagnosis saves lives. Cancer Research UK says that 85% of women who live more than 10 years after a diagnosis of breast cancer were diagnosed at stage 1 or 2 —the earlier stages to be diagnosed at. It was for that reason, and on that principle, that the UK introduced the world’s first national screening programme for breast cancer in 1988. Since then, much has changed. In particular, survival rates have improved dramatically. Now, 76.6% live more than 10 years; the figure was very much lower in the 1980s. There are still some issues with screening, however, as hon. Members have said. One is that women with denser breasts find it more difficult to locate lumps, and when doing mammograms, it can be more difficult to locate cancerous tumours. Will the Minister update the House on what work has been done on using ultrasounds and MRIs to identify tumours in women with denser breasts? I understand that the National Screening Council is looking at this subject in detail. When is it due to report its findings to the Minister, and when does she intends to bring them to the House? The effectiveness of treatment has improved, but the risk of overtreatment is higher in younger women. The incidence of the disease is increasing in younger and older women: the Cancer Research UK website says that the rate has increased by 12% in women aged between 25 and 49, and by 72% in women aged between 65 and 69. Should younger women therefore now receive screening, and should older women receive more frequent screening? The cancer plan, which the Government published earlier this year, said that they will engage with manufacturers to look at mammograms that are more accessible to those with a physical disability, who at the moment struggle to receive their screening. Will the Minister update the House on the engagement she has had with manufacturers and on the progress that has been made? The age trial in Oxford is looking at women aged between 47 and 49, and between 71 and 73—the ages just outside the current range of screening. I understand that early results are due in December 2026. Has the Minister had any indication of the results yet, and is she preparing for any results that come forward? Has she engaged with the people running that important trial? Community diagnostic centres, which were initiated by the previous Government and rolled out across the country, provide screening close to people’s homes, which makes it much easier for them to attend. Will the Minister update us on how she is improving the number of CDCs available across the country? The Government have talked about the shifts that they want to produce in healthcare, one of which is about prevention. According to the Cancer Research UK website, 23% of breast cancer cases are preventable. Will the Minister update us on what she is doing to reduce the number of preventable cases of breast cancer? Many hon. Members have talked about attendance at screening tests. The hon. Member for Epsom and Ewell (Helen Maguire) spoke about some of the reasons why women do not attend screening. It is important that we understand why about a third of women do not attend. It is only by understanding what puts women off and makes them not attend that we can improve the services so that more women do attend. It was sobering to hear how many lives could be saved if more women attended screening. How are we making screening more accessible for women? Are we ensuring that women know that it is happening and that they need it? Do they understand the benefits of it? I would be interested to hear the Minister’s thoughts. Another shift relates to the digital NHS. AI provides us with a number of ways to improve breast cancer screening and treatment. It could help us to understand who should be invited to screening and how often, and it can help when looking at mammogram scans. A few years ago, the Health and Social Care Committee visited Stanford in California and looked at the AI there. We saw a study comparing two radiology consultants looking at a scan, two AI computers using two different programmes, and a person and an AI computer. It discovered that the person and the AI computer were the most accurate. That can help to reduce the number of people we need in the workforce and, importantly, can improve the accuracy of screening results. That brings me on to the workforce. We know that the Government have a workforce plan, although its publication has been much delayed. We have been told repeatedly over the past few weeks that it has moved to “imminent” status—imminent being quicker than soon—but we do not know when imminent is. Does that mean it will be published before the summer, or do we need to wait for the new Prime Minister to make a decision? It would be helpful to know that from the Minister. As we heard about radiology and radiotherapy, the workforce is incredibly important. We need a thorough plan, otherwise we will have recommendations from the NSC for screening and no people to provide that care. I also wanted to raise with the Minister the Lobular Moon Shot Project. We have discussed before the importance of research into lobular breast cancer, which is more difficult to diagnose and treat. The last time we spoke about this, the Minister was looking at research projects that the Government could fund to identify new treatments and ways of screening for this disease, hopefully saving lives. Will she update us on how she is getting along with that? Much of my time at the moment is spent with another Health Minister—the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth)—in Committee Room 9, debating the Health Bill. That is where I will be tomorrow. The Bill relates to one of the important organisational factors in screening. At the moment, screening programmes are generally organised by NHS England, which is being abolished. NHS England and the Department of Health and Social Care wrote a letter in March saying that commissioning responsibility will be directly delegated to ICBs, in the same way that they are currently delegated to NHSE, by the Secretary of State. Does the Minister expect that to cause any disruption to the breast screening programme? Integrated care boards have had their budgets cut by 50% just as they are asked to take on this work. We know that they are merging and reorganising in cells. The Government’s plans are that they should follow the mayoral authority boundaries, but the mergers that have taken place so far do not follow those boundaries. There is therefore a risk that we will need reorganisation all over again. Does the Minister think that that will have an effect on the screening programme? If so, what is she doing to mitigate that effect to ensure that as many people as possible get the very best screening and we can reduce the number of people suffering from the disease? The screening programme offers a real opportunity to diagnose, treat early and save lives, but it needs to be delivered well. We need to ensure that the right people get the right type of screening at the right age, and at the right frequency. I will be interested to hear the Minister’s response.

• 29 Jun 2026 · Prisoner Early Release · Hansard source

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  During the passage of the Sentencing Act, we were told that the perpetrators of the “most serious, heinous crimes” would not be included in these measures, so can the Minister explain why the Government do not think that the rape of children is one of the most serious and heinous crimes, and how many individuals who committed it will be coming out early?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  Does my hon. Friend agree that when somebody—particularly a vulnerable person—receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill—a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  Will the Minister give way?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times. Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was “no formal national policy supporting minimum waits”, local areas may “choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”. I do not understand why we would want to make people wait longer than necessary. The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is “counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.” Age UK deemed it a “rationing approach” that is “potentially harmful to the health and wellbeing of older people.” NHS England has made it clear that ICBs cannot introduce minimum waits of more than 18 weeks—that is longer than the target, so that makes sense—but waits between 12 and 18 weeks are permissible. Will the Minister explain why that is a good idea? Amendment 51 seeks to ban ICBs from introducing any operational policies requiring patients to wait a minimum number of weeks before they may access treatment. There are safety risks involved in introducing minimum waiting times. They distort clinical priorities and may make patients wait in unnecessary pain and anxiety. Treatment should be delivered when possible, based on clinical needs. If a patient has a high level of clinical need, they might need to be treated earlier than the minimum waiting time because of the suffering they are experiencing. Minimum waits are not only detrimental to patient experience by forcing people to live in greater pain and discomfort; in some cases, the delay may make the patient’s condition worse, and the treatment they need may be more extensive and even more expensive. Their condition may even become life-limiting or life-threatening as a result of the delay. The introduction of arbitrary minimum waiting times that do not have any relevance to patient clinical need raises worrying issues, clinically, professionally and ethically. Minimum waits will also hinder the NHS’ ability to cut waiting lists and get waits to within 18 weeks. Some providers will have a list of people who can be available at short notice for a procedure, who they can call on if there is a cancellation on the day. If that person has not waited the minimum, that may be left as a gap, and that operation or appointment may not happen. That is wasted NHS resource. Each month that goes by, many people are added to the waiting list, and some are removed from it. We are aware that there seem to be a lot of unexplained removals from the waiting list, and that has spiked recently. Among the people treated by NHS providers in April, around 600,000 were treated within eight weeks of referral, versus 74,000 who were treated between 14 and 18 weeks. The introduction of a minimum waiting time will therefore push back many people’s treatment by as much as 10 weeks. Minimum waits also worsen and entrench postcode lotteries, because patients who have differential waits, based on whether their ICB has decided to implement minimum waiting times, may experience differential levels of care because of where they live. They are also another way of undermining patient choice, because patients may want to be treated in one area or one hospital because of the waiting time. If they all have different minimum waiting times, that distorts patients’ ability to choose. Minimum waits are also completely contrary to the 10-year plan for health, in which choice and productivity were considered central features, along with the Government’s wider commitment to keep people healthy. I hope the Minister will agree with amendment 51, which would ensure that minimum waiting times cannot be instituted. Amendment 52 also concerns waiting times. You will no doubt have seen, Dr Huq, the many newspapers articles about the Government fiddling the figures on waiting times, and there has been a spike in removals from waiting lists. People have found themselves removed from lists or going back on lists, or have suddenly found out that their waiting time started more recently than they thought. Amendment 52 would require the Secretary of State to publish the number of patients who are taken off treatment waiting lists each month and why they were removed. It is important that we are able to explain to our constituents why the Government have decided to remove them.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities. Because of the order in which the Government have done this—removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation—we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size. There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs working in relation to mayoral authority areas. Yesterday, the Minister for Care suggested at his appearance before the Health and Social Care Committee that the ICBs should be aligned with strategic authorities, but the only way in which that can happen once the Government have decided where the strategic authorities will be is if things are changed once again. That brings ongoing costs—financial costs, opportunity cost for service development, and cost to the people delivering these services. The people working hard to try to deliver the Government’s plan find themselves and their jobs threatened and chopped and changed all the time. We heard evidence that the concentration on reorganisation rather than service delivery, provision and development is causing distress to those people. We also heard about the effect on social care, which, certainly in Lincolnshire and in other places, is delivered by the upper-tier local authority, but not all mayors have any responsibility for health—our mayor does not. We will therefore have someone who is not responsible for health on the ICB while someone responsible for delivering social care will have their seat on the ICB removed. I am afraid that I simply do not understand that. I watched through several times the Minister for Care’s Select Committee appearance, and I still do not understand the rationale. I will be grateful if the Minister for Secondary Care could explain that.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  I beg to move amendment 51, in clause 16, page 12, line 10, at end insert— “(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.” This amendment would prevent minimum waiting times for NHS treatment.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert— “(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include— (a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A); (b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A); (c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and (d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any). (2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations. (3) The constitution must set out the process for making nominations under sub-paragraph (2). (4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of State as to the selection of candidates.” This amendment modifies Clause 21 so that, rather than replacing the existing mandatory membership requirements in Schedule 1B to the National Health Service Act 2006 with a requirement for mayoral representation alone, the new sub-paragraph (2) reinstates and consolidates the full range of required ordinary members.

• 25 Jun 2026 · Health Bill (Seventh sitting) · Hansard source

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  As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed. I accept what the Minister says—she wants those criteria to be set out more flexibly than can be done in primary legislation—but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them? Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?

• 25 Jun 2026 · Health Bill (Sixth sitting) · Hansard source

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  Unfortunately, the Minister’s reassurances have not convinced me. In relation to change, “significant” means various things to different people. As for “proportionate”, what is “proportionate” to one person is not necessarily “proportionate” to another. Amendment 57 makes reasonable provision for a situation in which there is a change from national to local commissioning, or from local to—mostly, it is from national to local commissioning. Therefore, I would like to push it to a vote. Question put, That the amendment be made.

• 25 Jun 2026 · Health Bill (Sixth sitting) · Hansard source

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  But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition—the largest that has ever happened in this country. Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.