Gregory Stafford MP: speeches

Speeches

• 25 Jun 2026 · Civil Service Pension Scheme · Hansard source

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  As the Minister will know, behind every statistic and delayed case is a pensioner who is not receiving their pension after years of public service. I have constituents whose cases have been outstanding for months, including one from Farnham whose case took nine months to resolve. The end-of-June deadline is now effectively upon us. Does the Minister genuinely believe that Capita will make that deadline? If not, what sanctions or remedial action will she pursue to resolve the issue?

• 25 Jun 2026 · Civil Service Pension Scheme · Hansard source

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  1. What recent discussions he has had with Capita on the performance of civil service pension scheme administration.

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

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  Thank you, Ms Lewell. You have certainly saved me from myself, if not anybody else. I think I have belaboured the point; I will leave it there. I sympathise with and indeed support the ambition of new clause 2, but I have a real problem with the lack of detail on how it would be achieved. I turn quickly to clause 14. As my hon. Friend the Member for Sleaford and North Hykeham said, it has bits that we welcome, but there are some concerns about how the ICB structures fit over the local government structures, and cutting ICB administrative budgets by 50%, while asking them to take on more power and responsibility for commissioning services and many other things, is a real problem. Likewise, we have welcomed, and I think both sides of the Committee agree, having neighbourhood health—however we want to describe it—and care closer to home, and having commissioning closer to home. It is therefore strange that my best performing ICB, Frimley ICB, has been abolished or merged with a number of other ICBs that have been performing far less well. If the Government want to have the principle of place-based, locally responsive commissioning, they have to have a real focus on, actually look at, what fits with the current structures and to ensure that those ICBs that are performing best are encouraged and kept and that those that are not are dealt with. I have real concerns about, for example, the superstructure of the new Surrey and Sussex ICB. It is huge and, essentially, entirely antithetical to what the Government were trying to achieve by making stuff local—closer to home.

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

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  I wanted to ask a different question, but okay.

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

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  Does my hon. Friend agree that this Bill would have been the perfect time to align health commissioning services with local government structures and that the fact that these structures are being created totally without the new local government structures is not just an oversight, but a potential problem with the whole Bill? Does she also agree—I think that she was outlining this already, but I want to ensure that the Minister is clear on it—that the Government still have a chance to amend the Bill to ensure that the commissioning structures and commissioning areas outlined in the Bill neatly map out to the new local government areas? In relation to, for example, the current Hampshire and Isle of Wight ICB, Hampshire is potentially being split up into a number of local government areas. I am against the way it is being split up, but if the Government are pressing ahead with it, this would have been the perfect opportunity to align commissioning with those areas. The problem is that we will now have a situation in which they do not match up, and the problems that my hon. Friend has outlined in her speech thus far will come to the fore.

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

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  That is a helpful clarification, but it raises a number of other questions. I entirely agree with the hon. Lady that named GPs are most appropriate; all the clinical evidence suggests that even for people with non-complex needs, having a named GP whom they can see regularly improves patient outcomes. I therefore support her on that, but does she believe that we currently have sufficient GPs for that to go ahead? Even the six-month lag in her new clause would not be enough time to recruit thousands more GPs. If she does not believe that there are enough GPs at the moment, when does she envisage that they would be in post? How much would that cost? Where would she get the money to fund those extra GPs? Rather than just expressing what I would call “motherhood and apple pie” statements about things that we all want, we in this House have a duty to be honest with our constituents about how we would achieve them—and, if we have to achieve them within six months, what funding and impetus will have to be put in place.

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

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  I think that clarifies that there is no real concrete plan for how to fund this new clause. I do not mean in any way to demean what the hon. Lady is trying to achieve, because she is trying to achieve something important, and which we all want, but we have to be honest with our constituents about how we can do that, and some ethereal money to come through some ethereal plan at some point in the future—

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

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  I will start where the Liberal Democrat spokesman, left off, with new clause 52 on dental provision. I have a lot of sympathy for what she is trying to achieve with the new clause. In my own constituency, as far as I can tell, looking earlier today, not a single dental practice is taking new NHS patients for dentistry, whether that be children or adults, and that is extraordinarily concerning. Even more concerning—this somewhat relates to the changes that the Government are making in the clause through bringing the commissioning of dental services to ICBs—I have a fully equipped and fully functional dental surgery in Haslemere hospital in my constituency, but it has remained entirely unused for a number of years, because it sits within the hospital, which is run by the Royal Surrey NHS trust, but is commissioned by the ICB. That seems like an utter waste of resources. That is something that could be clarified through new clause 52 and, I hope, through the clauses tabled by the Government. On new clause 2, about GP practices, I am disappointed that the hon. Member for North Shropshire did not want to take my intervention because she will not be able to answer my questions, unless she intervenes on me now, which I hope she will. Again, I sympathise entirely with what she is trying to achieve. We want to ensure that people have timely access to their GPs. I am sure that, like me, she has constituents who cannot get a GP appointment in any reasonable time. They can wait numerous weeks, upwards of five or six weeks, for something that they should be seen about. A lot of questions are unanswered by new clause 2, however. I will not repeat the questions asked by my right hon. Friend the Member for Melton and Syston and by my hon. Friend the Member for Sleaford and North Hykeham, but I have some others. For example, the new clause states that the Government must “establish a scheme to provide every patient with the right to a GP appointment”. Although the hon. Lady clarified that that could be a telephone consultation, what is not clear is whether that is an appointment at the named GP practice at which the patient is registered, or is just with any GP, through something such as the NHS 111 service.

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

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  Will the hon. Lady give way?

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

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  It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed. I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.

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

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  Let me finish this point. I am not in the mind of the current Prime Minister, and I am certainly not in the mind of the potential next Prime Minister, but even if the hon. Lady is right my understanding is that he—either is probably a he—is unlikely to have changed our relationship with Europe within six months.

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

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  It is a pleasure to serve under your chairmanship this morning, Ms Lewell. It is right that Ministers are ultimately responsible to the House for the performance of the health service and subjected to the scrutiny of Parliament for its execution, but there is an important distinction between accountability and operational control, which I fear the clause risks eroding in some cases. The national health service has over many years developed a structure that seeks to balance political accountability with operational independence, and that balance exists for a reason. Decisions on what services are commissioned, where they are delivered and how resources are allocated are not purely political judgments; they are complex, technical decisions that ought to be guided—primarily, in my view—by clinical evidence, patient need and professional expertise. Transferring commissioning functions directly to the Secretary of State, as the clause will do, risks drawing those operational decisions more directly into the political sphere, even if that would not happen in every case. The more that Ministers are involved in determining which services are commissioned nationally and which are not, the greater the risk that over time those decisions will be influenced by short-term considerations and short-term pressures rather than long-term patient outcomes. Even when no such influence is intended, the perception that that could occur will be damaging. As I said in discussions on previous clauses, the NHS depends heavily on public trust, and that trust rests in part on the belief that decisions are being made in the best interests of patients and on the basis of evidence, rather than political expediency. We should therefore be cautious about any measure that threatens to blur that line. Despite the Minister saying that the stated intent in the Bill is to decrease centralisation, the clause appears to move some parts of the system closer towards centralisation, rather than maintain that balance. I do not believe that the Committee should take that step without careful consideration of the potential consequences. There is also a practical dimension to this issue. Under the clause, the Secretary of State potentially assumes direct responsibility for any and all decisions currently exercised at arm’s length. That raises legitimate questions about capacity and focus. As I said previously, the health service, as we all know, is vast, complex and complicated, and decisions, especially about specialised commissions, are technical and require detailed expertise and understanding. What is not immediately clear from the clause is that such decisions are best taken by the Secretary of State rather than by bodies with dedicated expertise and a degree of operational independence. Both my hon. Friend the Member for Sleaford and North Hykeham and the Liberal Democrat spokesman, the hon. Member for North Shropshire, spoke about highly specialised services, where essentially there is a capacity issue and a need to be able to look at the demand as a whole. They both raised the danger that, if those commissioning decisions are taken at local level, those at that level may not have the expertise, the finances or indeed the capacity to truly understand those highly complex, low volume specific needs. I have some sympathy for the Minister, because the danger that we have seen in the NHS is that everything becomes more and more specialised and the ICBs push it away. I understand why the Government are proposing some of these changes, but we must not throw the baby out with the bathwater. We must ensure that services continue to be commissioned by experts at the national level if they need to be; and that if they need to be commissioned by experts at ICB level or even more locally, it is done through the neighbourhood health schemes that the Government are pushing, which I support in principle. For those reasons, if the Committee is minded to support the shift in responsibility, I suggest that we put in place some robust safeguards to ensure we have transparency, consultation and evidence-based justifications for decisions. Without those safeguards, there is a risk that the centralisation of power on the one hand and the devolution of specialist services on the other will unintentionally make a system that is less transparent and less robust. That is why I support amendment 57 in the name of my hon. Friend the Member for Sleaford and North Hykeham. The powers in clause 12 need to be bounded by checks and balances, because these are not minor administrative changes, but a significant shift in responsibility. We must ensure that decisions to move service commissioning are made as transparently as possible. In those circumstances, it is entirely right that Parliament should be able to scrutinise those decisions. The amendment would achieve that. Subsection (4A) would require the Secretary of State, before making regulations, to prepare and publish a commissioning transition plan and to lay that before Parliament. Subsection (4B) would require the plan to set out, in detail, the services being changed and the reasons for the changes. It would also require clarity on which bodies will assume the responsibility and why they are considered capable of doing so. That level of transparency is essential if Parliament is to exercise meaningful oversight. Subsection (4C) would establish a formal consultation requirement, and subsection (4E) would require the Secretary of State to publish a response to that consultation, setting out how concerns have been addressed. That is vital, because there is no point having a consultation if the Government just ignore it. Finally, subsection (4F) would ensure that no regulations can be made until a defined period has elapsed after that response, thereby providing a time for proper parliamentary and public scrutiny. Those of us who sit on Select Committees, especially the Health and Social Care Committee, often receive responses to our recommendations from the Department that, as my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) said in evidence, give the veneer of acceptance, but then no meaningful action is taken. The amendment would allow meaningful scrutiny and ensure that the Government actually respond to that request. Taken together, the provisions would ensure that decisions are not only made, but made openly, transparently and accountably to those who are elected in this place to represent our constituents.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59. The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing. Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised. I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good. Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency. Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world. Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care. I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out—I will not say what that makes me. What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham— I hope I am not misrepresenting her—is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of “timely adoption and spread of clinically effective innovations”. Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system. By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for innovation to flourish, not one that shuts it down, as some Labour Members have suggested. Crucially, paragraph (d) of the amendment represents a significant and commendable commitment to fairness and inclusion by prioritising equal access to new technologies, medicines and models of care regardless of geography or socioeconomic background. It would help to tackle long-standing inequalities and move decisively towards ending the postcode lottery that we often see in care quality. The focus of the amendment would ensure that innovation benefits all patients, not just those in the most advantaged areas. It would ensure that rural and coastal communities are aligned with the urban. As someone who represents a semi-rural seat, I see those inequalities in service delivery, quality of care and innovation. The large towns in my constituency receive far more money and get far better services than the surrounding villages. I have many concerns about the clause as it currently stands, and I hope that the Minister will be able to clarify some of the Opposition’s questions. I entirely endorse amendment 58.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham. We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector—I know that Labour Members have antibodies against the private sector—or to university research functions? It is very unclear who the prizes will go to. Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to “work done at any time (including work before the commencement of this section).” So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to. Then the clause says that the Secretary of State may set up a committee. I have been in enough Bill Committees to know that civil servants do not write something into Bills unless they have an idea of what they want to do with it. I would be very interested to hear from the Minister what sort of committee it will be, how many people will be on it, how much remuneration they will receive and how they will establish themselves and fulfil the function that the Secretary of State gives them. If we do not know that, the proposal is so open-ended that I would have real concerns about letting it go forward in the manner in which it is currently written. My hon. Friend the Member for Isle of Wight East suggested—I do not think he was joking—that the word “prize” made this sound like a game show. That is part of what we need to understand. Will the Secretary of State set up a competition in various areas of healthcare, technology, disease or treatment? Will they say, for example, “We want to find the best technology for dealing with cataracts”? Will a call go out for people to submit bids and say, “We have produced this amazing new laser treatment,” in order to win the prize? Or will it be entirely open-ended? Will people come into the Department of Health and Social Care to this new committee and say, “We have created this amazing piece of innovation—give us some money for having done so”? It is so unclear in the Bill. As I say, I am absolutely certain that the Minister knows the answer to those questions because this clause and subsection would not be in the Bill if she had no idea what she was hoping to achieve by them.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  My hon. Friend is absolutely correct. I do not want to go down the cataracts route, but she and the hon. Member for Bury St Edmunds and Stowmarket have both mentioned them. Clearly, cataracts are a relatively low-complexity, high-volume type of operation. My hon. Friend is absolutely right to say that some providers can do five or six operations per list, while other places are doing two or three. That is often about the private sector being able to move more quickly, which is obviously better for patients, as well as for clinicians, who want to do the surgery that they have trained for. Unlike the hon. Member for Bury St Edmunds and Stowmarket, I think that competition can play an important role in driving improvement. When providers must attract and retain patients, they have a stronger incentive to deliver timely, high-quality services, and to innovate in how they provide care. In that sense, competition is not an end in itself but a means of improving outcomes and responsiveness for patients. If both sides of the Committee support clause 5, because we are interested in choice and competition, amendment 59 is the logical extension of that. The amendment is also clear about where the new obligation choices would apply. It covers a range of out-of-hospital services, including diagnostics, audiology, hearing-aid care, dietetics, physiotherapy, ambulatory cardiac monitoring and so on. By clearly defining the services in scope, it provides a realistic and workable road map for implementation. As I said, the amendment is not about ideology—I think we all agree about choice and competition—but about ensuring that patients receive timely care and have a meaningful choice about where that care is delivered. By fostering healthy competition, making full use of the capacity in the system and putting patients at the centre of the decision-making process, it offers a practical route to improving access and raising standards of care. For those reasons, I support it and commend it to the Committee.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  What my hon. Friend describes is the real nub of the Bill. If we are to abolish NHS England and move most of its functions to the ICB level or to the Department of Health under a Secretary of State, it would be utter madness for us to, at best, move one set of bureaucrats from NHS England to the Department of Health and therefore gain no extra efficiency, or at worst, as seems to be the case in this clause, not only transfer the NHS England bureaucrats, but create a whole new set of bureaucrats and committees to continue the functions already performed under NHS England. We need to understand whether the Bill is really about making our NHS more efficient by removing levels of bureaucracy, as was the stated intent of the Minister and the previous Secretary of State, or whether it is simply a political power grab where we keep all the bureaucrats and the inefficiency of the current system.

• 23 Jun 2026 · Health Bill (Fourth sitting) · Hansard source

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  I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.

• 23 Jun 2026 · Health Bill (Fifth sitting) · Hansard source

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  The shadow Minister has outlined a couple of hypotheticals for the future, when we have a different Prime Minister and a different Secretary of State. One might go down a route of more privatisation, another down a route of removing the private sector from health service provision. My concern is more practical and for the here and now: if the clause stands part of the Bill, it must be because the Government have some desire to do one of those two things now. Would it not be a good idea to hear from the Minister which of those two options it is?

• 23 Jun 2026 · Health Bill (Fifth sitting) · Hansard source

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  I rise to support amendment 47, tabled by my hon. Friend the Member for Sleaford and North Hykeham, and to ask a few questions about clause 11. I completely understand the thinking behind the clause. The Secretary of State for Health and Social Care is probably the most politically impotent of all Secretaries of State: as my hon. Friend said, they pull levers and not much seems to happen, because they do not have the control over the health service that the public think they do—or indeed, that Members of Parliament think they do, judging by the number of us who stand up and demand that the Secretary of State do things in our local areas. I understand the Government and the Secretary of State’s desire to change some of that, but there is concern about the potential politicisation of NHS leadership. Integrated care boards were established in various forms under the Health and Social Care Act 2012 precisely to remove politicisation to ensure that decisions in our healthcare service were made for the benefit of patients on the basis of clinical evidence and the needs of the local population, not on the whim of any Secretary of State or Minister. More importantly, ICBs were brought in to make sure that local health systems, local authorities, clinicians and communities made decisions based on local need. Those politically independent ICB chief executives were expected to exercise professional judgment, make difficult decisions about priorities and resources and sometimes deliver messages that Ministers, and indeed local Members of Parliament, found uncomfortable. If those leaders know that their continued employment ultimately depends on the confidence of the Secretary of State, there is a real risk that the independence of their judgment will be weakened and that patient safety will diminish. The amendment tabled by my hon. Friend the Member for Sleaford and North Hykeham tackles a core question: should an ICB chief executive focus solely on what is best for patients and the local health economy, or should they have to consider whether their decisions may attract ministerial displeasure? Even if the power is rarely used, and even if, as my hon. Friend said, there are currently some guardrails in the clause, its existence will change behaviour—it must do. Leaders will become more cautious, perhaps more risk-averse and potentially less willing to challenge national policy when local evidence points in a different direction. ICBs have benefited from the ability to speak truth to power. A system in which senior NHS leaders fear dismissal by Ministers risks discouraging precisely that kind of honesty. Do not get me wrong: there are good ICB chief executives and bad ICB chief executives, ones who understand their role well and ones who feel that they do not need to engage at all with their local communities. I have a very good ICB in what is currently Surrey Heartlands, soon to be a larger organisation, and an ICB that does not do the job as well—I will not name it, but any student of geography will be able to work out which one it is. Secondly, excessive ministerial power blurs the lines of accountability. The Minister, in her defence, has argued that Ministers need powers because Ministers are accountable. I get that argument, but one of the most important principles of effective public administration is clarity of responsibility. If the Secretary of State gains extensive powers to appoint and dismiss local NHS leaders, it will become increasingly difficult to know who is actually responsible for outcomes. When performance improves, Ministers will claim credit; when performance deteriorates, local leaders may be blamed. If Ministers possess the power to select and remove those leaders, they will inevitably become more directly responsible for those management decisions, so far from increasing accountability, this might dilute it by creating uncertainty about where true authority lies. Thirdly, there is a constitutional concern. Whether one likes it or not, the previous Act created a balance between democratic accountability and operational independence. Parliament rightly determines the funding, priorities and legislative frameworks, and Ministers rightly set national policy, but operational decisions have been made by healthcare professionals and the statutory bodies established for that purpose. That distinction exists for a good reason. No Secretary of State, regardless of ability or commitment, or indeed their own background in the health service, can personally manage every NHS organisation in England, and I do not think they should. The more powers we concentrate at the centre, the greater the temptation for Ministers to become involved in operational matters that are better addressed through professional expertise and local knowledge. My hon. Friend’s amendment seeks to preserve that distinction in a singular and precise way. It recognises that Ministers should govern the NHS and be held accountable at the top by us as Members of Parliament and our constituents, but should not seek to manage every aspect of it. Fourthly, there is a practical problem. Supporters of ministerial intervention often point to examples of failure and ask what should happen when an ICB is underperforming. That is a fair question, but the answer is not that the Secretary of State must personally possess dismissal powers. A range of mechanisms already exist: ICB boards have governance responsibilities; NHS England has oversight powers; professional regulators oversee the conduct of clinicians; there are provisions in employment law for procedures when it comes to misconduct and capability issues; and auditors and inspectors can identify failings. It would be far better if the Bill strengthened those provisions to ensure that accountability was brought forward, rather than giving the Secretary of State the ability to fire and hire as he or she sees fit. Of course, none of those mechanisms of accountability will disappear if amendment 47 is adopted. The amendment would not create any kind of immunity from accountability; it would simply ensure that accountability is exercised through the established governance structures, rather than through direct ministerial intervention on a chief executive. Indeed, one might ask whether a Secretary of State is really the best person to assess the performance of an individual ICB chief executive. Such judgments often require detailed understanding of local service pressures, workforce challenges, demographic factors, financial constraints and so on. Those are matters better evaluated by individual organisations with operational expertise than by politicians operating at national level. Fifthly, I think the clause as drafted would present a risk to recruitment and retention. The NHS already faces significant leadership challenges. Senior leaders are expected to manage enormous budgets, oversee complex organisations and make difficult decisions under intense public scrutiny. If we create a system in which their tenure can ultimately depend upon ministerial whim, we may deter talented individuals from seeking those positions. As my hon. Friend said, the NHS needs leaders who are willing to innovate, take calculated risks and make difficult long-term decisions. It does not need a culture in which leaders are constantly looking over their shoulder, wondering whether a politically controversial but clinically necessary decision could threaten their position. Strong organisations attract strong leaders when governance arrangements are stable, predictable and professionally driven. They do not attract them through uncertainty and political intervention. Sixthly, we need to consider the precedent being established. Powers granted to one Secretary of State are inherited by the next, as the hon. Member for North Shropshire said. Members may trust the intentions of the current Minister—I certainly do. They may also believe that these powers would be exercised responsibly—and at the moment I think they would be. However, legislation must be judged not on how it is going to be used by one individual, but on how it could be used by any future holder of the office. Therefore, the question is not whether the current Secretary of State or Minister would misuse the power, but whether Parliament wishes to establish a framework in which future Secretaries of State possess the ability to remove local NHS leaders whose decisions, views or priorities may conflict with their political objectives. That is a much more serious question. Finally, we must remember what ICBs were trying to achieve, even if we do not think that they have achieved it or performed in the way that we wanted them to. If we go back to the principle of why they were set up, they were designed to encourage collaboration rather than some sort of command-and-control structure. They were intended to bring decision making closer to patients and communities. They were established to support long-term planning across local health systems. Those objectives, I am afraid, are very difficult to reconcile with a model in which local leaders remain subject to direct ministerial dismissal. Partnership working flourishes when organisations have confidence in their independence and responsibilities. It is weakened when authority is increasingly concentrated at the centre. For all those reasons, I believe that amendment 47 in the name my hon. Friend the Member for Sleaford and North Hykeham raises an important principle. It is not about protecting poor performance or shielding individuals from accountability; it is about ensuring that accountability is exercised through proper governance structures rather than political control. Expanding ministerial powers to hire and fire local NHS leaders risks undermining all of those principles.

• 23 Jun 2026 · Health Bill (Fifth sitting) · Hansard source

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  I want to take the Minister back to her rejection of the amendment of my hon. Friend the Member for Sleaford and North Hykeham on the basis that—I paraphrase—she felt the definition of “patients” was too limiting because it would not count people who had not entered the health system at that point. The clause itself, however, refers to the benefit for the health service. Is the Minister suggesting that the health service, as defined in the Bill, includes what happens before people enter what I would describe as the health service? Is it something before that point? She seems to be saying that our definition is too narrow, but her definition in the Bill must apply to those who have entered some kind of formal setting. Or is the health service wider than that?

• 23 Jun 2026 · Health Bill (Fifth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Roger. I agree heartily with the shadow Minister, and a couple of other things concern me about clause 8. On the one hand, the clause appears to bring more centralisation, but on the other hand it pushes things down to an ICB level at the same time. I am worried that if we have individualisation of ICBs, we will only exacerbate the disparity of services across regions. I would be interested to understand from the Minister how the Secretary of State’s functions will allow the independence of ICBs and, where an ICB understands its local population well, ensure that patients do not end up in a postcode lottery based on which ICB area they happen to live in. The danger here is that if the Bill does not deal with those problems and close regional gaps, it is not immediately clear from the clause how the Secretary of State could intervene to ensure that ICBs have the autonomy to make decisions based on their local populations and ensure at the same time that patients do not receive a worse service just because they happen to live in one ICB area rather than another.

• 23 Jun 2026 · Health Bill (Fifth sitting) · Hansard source

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  I endorse the comments made by my hon. Friend the Member for Sleaford and North Hykeham. I am particularly concerned about subsection (2)(a) of proposed new section 12DA. On examination, this provision raises significant concerns about the control of public expenditure and the efficient use of resources within the health service, and I find it rather vague. There is no definition of the terms used, no indication of scope and no express limitation on how the power is to be exercised. When read together with subsection (1) of proposed new section 12DA, the effect, as I read it, is to allow the Secretary of State to provide funding to an extremely wide category of recipients. That includes not only public bodies and established NHS providers but, as my hon. Friend the Member for Sleaford and North Hykeham has said, private entities, charities, individuals and any person engaged in activities that the Secretary of State considers to be beneficial to the health service. That breadth is not accompanied by a corresponding statutory safeguard. The clause does not set out criteria for eligibility, priorities for funding or principles to guide decision making. It does not impose limits on the sums that may be disbursed, nor does it require any structured process for allocating funds. There is no express provision for transparency, such as publication of decisions or reporting obligations to another body such as Parliament. That absence is significant. Control over public expenditure ultimately lies with Parliament, yet the clause delegates a wide and flexible spending power to the Executive with little direction as to how that power is to be exercised. While it may be said that Treasury rules, audit requirements and general public law principles continue to apply, those are external controls and they do not substitute for clear statutory discipline within the provision itself. The practical consequences of such a broad power need to be considered. The NHS is already under considerable financial strain; as we all know, demand is rising and resources are constrained, and there is a continuing need to ensure that funding is allocated in a way that delivers measurable improvements in outcomes. In that context, certainty, prioritisation and efficiency are essential. By framing this power in such open terms, the clause risks undermining those objectives. It will create the possibility of fragmented funding decisions, with resources distributed across a wide range of initiatives without clear and consistent frameworks, and it may lead to duplication of effort or to supporting projects with benefits that are uncertain or difficult to evaluate. Without clear criteria or structured oversight, it will become more difficult to ensure that funding is directed to the areas of greatest need.

• 23 Jun 2026 · Puberty Blockers · Hansard source

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  My hon. Friend says that we do not know the effects, but a number of children have been put through this process via the now discredited Tavistock process. Why does she think that the NHS will not refer to the data linkage study and use the data that would have been gained from the children who were put through that process, in order to find out what the effects are before deciding to put a whole new cohort of children through what is clearly a damaging procedure?