Gregory Stafford MP: speeches

Speeches

• 2 Jul 2026 · Health Bill (Eleventh sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship again, Ms Lewell. On amendment 71, I ought to declare that I am a supporter of the Countryside Alliance. Although I do not own a shotgun myself, I represent a large shooting community and I have been on a shoot relatively recently, but without a gun, so I did not shoot anything. As I alluded to in my intervention on the hon. Member for Winchester, I spoke on this issue in Westminster Hall some months ago, when it was clear to me that there was a significant level of cross-party support for the idea of mandatory markers for GPs. As mandatory markers for firearms licensing are technically a Home Office issue rather than a Department of Health and Social Care one, the Under-Secretary of State for the Home Department, the hon. Member for Dover and Deal (Mike Tapp), responded to that debate, but he was unable to reassure us that provision would be made. I did not understand the arguments he made, because I think mandatory markers are probably the way forward. Given that they are supported by organisations such as the British Association for Shooting and Conservation and the Countryside Alliance—organisations that one might not have expected to be in favour of them—the Government should look into the idea. There would clearly be a benefit to the proposal in amendment 71. If a patient who holds a firearms licence presents a serious medical risk because of a mental health crisis, suicidal ideation or behaviour that raises concerns about risks to themselves or others, an immediately visible marker would help clinicians to make informed decisions and take the appropriate safeguarding action. But a firearms licence is obviously not a medical condition, nor is it health information in any traditional sense. This goes back to the point I made in the debate on a previous amendment, about how broad the information that we keep on the single patient record will be. The inclusion of such a marker across the single patient record could lead to issues relating, as we talked about in previous debates, to who would want to see that information. For example, there may be people out there who are not in favour of recreational shooting, and someone may hold a firearms license for recreational shooting. Of course, section 2 firearms licences, especially for shotguns, are often held by farmers and people involved in conservation, and for all sorts of other reasons, including the control of pest populations. But if someone has a licence for recreational use, there may be people who, for whatever reason, find that to be against their own beliefs and opinions. That might lead to a patient being subjected to a level of intrusion or bias, or perhaps not receiving the care they deserve, because someone has made an assumption about what they are like based on that information. We need to be careful about that.

• 2 Jul 2026 · Health Bill (Tenth sitting) · Hansard source

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  I will start by addressing Liberal Democrat amendments 9 and 10; once again, I see the impetus and reason behind tabling them. As the hon. Member for Winchester said, new clause 27, tabled by the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon, has a similar but subtly different—in my view, usefully different—impetus and emphasis. I am a member of the Health and Social Care Committee, and we published a report into community mental health in December last year, which laid bare the shocking state of mental health services in this country, especially community mental health services. Mental health accounts for over 20% of the demand for health services in this country, but in the period 2025-26, it is forecast to receive only 8.7% of NHS expenditure. The spend in that period is expected to be higher than in the previous year, 2024-25, but it will actually be a smaller proportion of total NHS spending, decreasing from 8.78% to 8.71%. That reduction also means that 2025-26 will be the first year since 2016-17 in which mental health spending will not rise as a proportion of total health spending, which is in contravention of the mental health investment standard that has been introduced. In fact, on 17 November last year, NHS England confirmed that the proportional increases will not take place over the next two years to 2028-29, and that there will instead be “flat real funding growth”. Overall, although I accept that the Government have increased spending on mental health, the fact that it is going down as a proportion of the total bill is one of the many reasons why we on the Health and Social Care Committee were very concerned about the future of mental health funding. It is also why we supported our Chair, the hon. Member for Oxford West and Abingdon, in tabling new clause 27. The differences between new clause 27 and amendments 9 and 10, tabled by the hon. Member for Winchester, relate to the financial penalty. If we want people to spend more on mental health, it would seem perverse to punish them by taking money away from them, because there might be reasons why they could not meet this requirement. I totally accept what the hon. Member is trying to achieve, because as he said, Claire Murdoch, the national director for mental health, resigned in September over the fact that she did not feel that the Government were spending the right amount on mental health. New clause 27 would put the mental health investment standard on a statutory footing by requiring the Secretary of State to specify an increasing amount of expenditure by integrated care boards on mental health, and then requiring integrated care boards to incur that expenditure. It also differs from amendments 9 and 10, in that rather than increasing the amounts as a total of expenditure—an approach for which I have sympathy—it has the more realistic requirement that it must only go up every year. Over some years, I would like the amount to increase as a total proportion from the current figure of 8% or 9% to 20%, which is the real cost or burden of mental health care in this country. I think new clause 27 is a much more fair and appropriate way of achieving that. I accept the arguments of my hon. Friend the Member for Sleaford and North Hykeham about a potential loss of local flexibility, but I think the new clause is written in a way that gives ICBs at least some flexibility to decide how they spend that money. Also, unlike amendments 9 and 10, there is not a financial penalty if for some reason they do not manage to do so it. In principle, I see merit in new clause 33. Like my hon. Friend the Member for Sleaford and North Hykeham, I represent a semi-rural seat, so I know that understanding delays in accessing mental health treatment is essential if we are to have services that meet patient needs and ensure greater transparency on waiting times. All this can help identify inequalities and inform better policymaking. The requirement to examine the disparities between rural and urban areas is particularly welcome given the challenges that rural communities can face in accessing specialist mental health services. However, it should be noted that the new clause would primarily deliver a reporting mechanism rather than a solution to the problem. Although annual reviews might improve our understanding of treatment delays, they do not in themselves guarantee improvements in access, workforce capacity or service provision. There is also a question as to whether the health service already collects much of this information in other ways, and whether a new statutory review would add significant value beyond the existing reporting arrangements. Better evidence about the scale and geographic distribution of mental health treatment delays could support more targeted interventions and help to ensure that patients are not disadvantaged simply because of where they live. The challenge will be ensuring that the findings of any review actually lead to meaningful action, rather than just becoming another reporting exercise or inquiry.

• 2 Jul 2026 · Health Bill (Tenth sitting) · Hansard source

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  While I agree with the points made by the hon. Member for Winchester, I note the irony that he is talking about how he wants more independence in this clause, whereas the amendments he tabled previously would have taken independence away from the ICBs—but hey, ‘twas ever thus with the Liberal Democrats. On the new powers in clause 43, we have previously discussed the power of the Secretary of State to direct how ICBs use and manage both financial and other resources, impose expenditure limits, require approval of local decisions and compel repayment of funds where directions are not followed. These provisions substantially weaken the operational independence of ICBs, transforming them from organisations that are intended to exercise local strategic leadership, as my hon. Friend the Member for Sleaford and North Hykeham said, into bodies primarily responsible for implementing centrally determined priorities. Such centralisation risks diminishing the flexibility required to respond to local, demographic, clinical and population health challenges. The timing of these legislative changes also raises significant concerns, because they coincide with the abolition of NHS England, the redistribution of its functions and the requirement for ICBs to reduce their operating costs by at least 50%--and, in some cases, even more than that. Collectively, those reforms represent one of the most significant reorganisations of NHS governance. However, there remains little clarity regarding which responsibilities will remain with the ICBs. The clause makes it even less certain which responsibilities will transfer to regional teams or providers, and how accountability will operate across the system. Introducing substantially enhanced ministerial powers before the future operating model is fully defined, as we have discussed with regional mayors and other bodies, will essentially risk creating uncertainty, duplication and potentially gaps in oversight.

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

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  On clause 29 and the relevant amendments, the membership model and the council of governors were originally introduced to give patients, staff and local communities a formal voice in the governance of NHS organisations. I worry that by removing them the clause concentrates power in the hands of the trust board at a local level and, potentially, the Secretary of State at a national level, while reducing opportunities for local scrutiny and public participation. As my hon. Friend the Member for Sleaford and North Hykeham said, there is a real danger that organisations will be independent in name only. That brings us back to the never-ending tension in the Bill between the centralisation of power in the Secretary of State, through the abolition of NHS England and all the other bodies we have talked about, and the Government’s stated desire to have more accountability for decision making at a local level.

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

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  It is a pleasure to serve under your chairmanship, Sir Jeremy. I want to pick up where the shadow Minister left off. Essentially, she said that the cart is being put before the horse in terms of mayoral authorities. As my hon. Friend the Member for Isle of Wight East outlined, many areas have no plans for a mayoral authority; our area of Hampshire and the Isle of Wight is some way down the track. As I expressed last week in Committee, we have a strange anomaly in the new Surrey and Sussex ICB, because Sussex will get a mayor and Surrey will not, so Sussex residents will have representation on the ICB whereas Surrey residents will not. I hope that the Minister has had a chance to reflect on that strange paradox over the weekend and that she will now be able to answer specifically, as she did not last week, how that lack of representation for Surrey residents will work locally. The abolition of the integrated care partnerships and their allied strategies continues a theme whereby the Government, under the veneer of slimming down, are actually decoupling—or weakening or whatever terminology Members wish to use—health and social care. For many years, all parties have regarded the bringing together of health and social care as essential, but the Bill not only looks like it is not trying to encourage that bringing together, but in fact is doing the opposite of that—it seems to be looking to pull them apart and decouple them. That is strange, because it does not appear to be the expressed policy of the Government, but it is the only logical explanation for many parts of the Bill, including the abolition in clause 23. The shadow Minister pointed out that a number of areas will keep the ICPs in some form or other. I ask the Minister, does the Government support that feature? Was it the Government’s intention to remove the statutory footing of the ICPs and strategies in the hope and expectation that they would continue on a non-statutory footing? If so, we come to the paradox: if the Government support local authorities and health services continuing to work together in informal ICPs, why is the Minister trying to get rid of them? If they do not support that, is it now stated Government policy to separate social care and health services?

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

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  I want to touch briefly on clause 39, Government new clause 20, and new clause 26, tabled by the hon. Member for Oxford West and Abingdon in her role as Chair of the Health and Social Care Committee. I recognise the intention behind clause 39. Greater collaboration between the NHS, local authorities and other public bodies has the potential to improve the co-ordination of services and deliver a more integrated approach to population health, which I think we all welcome. However, it sits slightly uncomfortably with other clauses we have debated that appear to draw local authorities and the NHS further apart. In this case, it looks like they may be brought together. As the clause expands delegation and joint working powers, I would be interested to understand from the Minister where the oversight and safeguards for accountability for spending the joint budgets would sit. Would it be with the NHS, local authorities or somewhere else? We hope that everything goes well, but if services fail or financial problems emerge, the public deserve to know who precisely is accountable for those budgets. As I have said in debates on numerous other clauses, I continue to be concerned by the broad powers that the Bill gives to the Secretary of State. I have the same concerns about this clause. On Government new clause 20, bringing health services and wider local government functions together is really important, particularly where combined authorities have responsibilities that affect the wider determinants of health. However, once again, I am concerned about the fact that the new clause further complicates an already crowded accountability landscape. As more functions are delivered through pooled budgets and joint arrangements, it becomes harder to identify who is responsible for outcomes, spending decisions and—hopefully not, but potentially—service failures. I welcome the flexibility, which I think has value, but it must be balanced with transparency and democratic accountability. I am not convinced that the new clause gets that right. On new clause 26, as I have said before concerning amendments and new clauses that have come from the Health and Social Care Committee, it is often difficult to get entire agreement on these things because of the cross-party nature of the Committee. Therefore, new clauses and amendments that come out of the Committee are in some ways aspirational, rather than ones that hit the nail on the head. The new clause suggests that the Secretary of State carry out a review of how effective section 75 arrangements are—the hon. Member for Winchester outlined evidence that in some cases, the use of section 75 arrangements has not always been effective—consult NHS bodies, local authorities and anyone else considered appropriate; consider whether existing powers should be used to improve those arrangements; publish a report and lay it before Parliament; explain whether the Government intend to use their powers to change regulations or guidance and why; and complete all that within 12 months of the Bill passing, which I think is a reasonable timeframe. Section 75 arrangements already play an important role in bringing together health and social care. It is reasonable to ask, as the hon. Member for Winchester did, whether they are delivering the benefits in the most effective way possible. I would potentially say that this proposal does not go far enough. The new clause would require a review, a consultation and a report, but would not require any action to follow that. The Secretary of State need only “consider” whether existing powers should be exercised and explain the reasons for any decision. If the review identified significant weaknesses, there is no obligation in the new clause, as far as I understand it, to implement those changes. I agree that the new clause is well-meaning. It has some good recommendations, and I hope the Minister takes on board its sentiment, but it probably does not have the teeth and the power to make it an effective part of the Bill.

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

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  The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include 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 ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates. The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities. Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care. For as long as I can remember, Governments of all colours have talked about bringing health and social care together. Some have been more successful at that than others, but there should be agreement across the House that much more needs to be done. With this clause, the Government seem to be taking at least one step back—I would say numerous steps—from trying to bring health and social care together. Like my hon. Friend the Member for Sleaford and North Hykeham, I watched the Health and Social Care Committee’s discussions with the Minister for Care yesterday, and I too cannot fathom why the Government are doing it. I hope that it is an oversight and that, once the Minister goes away and reflects on it, she will look to table some amendments further down the line—I am sure that she will vote against ours today—so that we can bring these matters back. I am especially concerned about the removal of local authority representation. We are effectively asking local authorities to continue to deliver vital services while removing their voice in the room where strategic decisions about health and social care are made. That raises a fundamental question about how the integration is intended to work in practice. There is also a broader concern about the direction of travel. We are moving away from place-based representation towards a model that places greater emphasis on these mayoral structures, yet the legislation is not prescriptive about who the mayors appoint, and colleagues within and without this Committee have already raised concerns that there is a gap in the understanding at the centre about how local authorities operate in practice. That brings me to the point raised by my hon. Friend the Member for Sleaford and North Hykeham and the hon. Member for Winchester. I apologise; the Minister said that she did not want a geographic tour of our constituencies, but I am afraid that she will get one now. Part of my constituency sits in Hampshire in the Hampshire and Isle of Wight ICB, and as the hon. Member for Winchester said, we may or may not have mayoral elections in a year’s time. Hampshire county council has launched a judicial review against the proposed local government reorganisation; if that is successful, or even if it delays the process, this Bill will come into effect without our having a mayor, and there will be no representation for anybody on this board. We need clarity from the Minister on who will represent the people on the board if there is no mayoral authority. I would say that local authorities—Hampshire county council in this case—should remain on that board, at least until there is a mayoral authority.

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

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  My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point. That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board. That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham. Reducing the representation to a single mayoral representative is a problem. Reinstating and consolidating the full range of required members and thereby giving the breadth of representation within ICBs that we have all talked about, is essential. It would strengthen the legislative framework, ensuring decision making remains multidisciplinary and balanced and that it incorporates both the clinical expertise, which we are going to lose, and the local authority political input, rather than having a one-sized, over-politicised mayor in charge. By maintaining that membership, the amendments would help safeguard overdominance by a single actor, support a much more informed and locally responsive decision-making process and, crucially, reinforce the collaborative foundation between health and social care that I thought was a given among all parties in this House. I urge the Minister to reconsider what she is proposing in this clause. She should, at least, give us some clarity on what will happen in the interim period or, at best, go back to the drawing board and ensure proper representation of the people who are actually delivering health and social care in our constituencies.

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

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  My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar. I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved. If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.

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

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  Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect. We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences. Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about resources. While I think that we all agree in this Committee that the NHS should be free at the point of use, one of the downsides of that is that patients rarely think about what the cost of their care contributes. I personally think that if people understood how much crutches or medicines cost, they would use them much more usefully. Plenty of times I have spoken to pharmacists in my constituency who tell me that once a patient has unfortunately died, their family then comes to the pharmacy with a sackload of drugs that have never been used. I think that if people understood the cost of those things, they would use them more effectively and with more caution. This is not an isolated issue but indicative of a wider problem across the system. If we were to introduce firm timelines for provision, we would need to ensure that there is a robust process for recovery, reuse and proper management of that equipment. Therefore, while I am not supportive of amendment 35 or new clause 35, I ask the Government to consider how those proposals could be strengthened by embedding clear expectations about the return and reuse of that equipment so that public funds are used as effectively as possible. I will now turn to the two amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham. Amendment 51 is important because, while I understand the Government’s intention in clause 16, as my hon. Friend has mentioned, her amendment will prevent any artificial delays in treatment by ensuring patients are seen as soon as clinically appropriate, rather than being required to wait a minimum period. It simply protects the principle that care should be based on medical need—which I think we would all agree on—rather than some administrative target. It helps avoid situations where waiting times are managed on paper rather than reduced in reality. That ultimately safeguards patient outcomes and timely access to care. Moving on to amendment 52, I add my strong support to this amendment, because it goes to the heart of trust, transparency and patient safety in the health system. I have been speaking to constituents and individuals from across the country who have contacted me after a video I posted on my social media that contributed to the exposure of the removal of 351,000 patients from waiting lists in March of this year. The stories I have heard are deeply troubling. Those include patients who have waited years for potentially life-changing treatment only to receive notification late—or in some cases not at all—that they have been removed from the list. For many it came as a shock, while for some it came after months or years of uncertainty. This is not some trivial administrative matter. I would sum up the Minister, when responding to questions on this point, as: “Nothing to see here, this is what always happens.” There has been such a significant jump over a period of two months that there has to be something going on here. The experiences of patients who have spoken to me about this suggest that that is happening. For those patients it is the difference between treatment and deterioration, between hope and abandonment. It is also undoubtedly affecting more vulnerable and less technologically savvy pockets of society, such as the elderly.

• 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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  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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  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 (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.

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

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  Q Dr Dash, in her evidence, said that—I am slightly paraphrasing, so I hope I have not got this wrong—NHS England has a number of investigatory bodies that it has established recently, and that although they were not perfect, they were much better, and they could be doing this job. What is your response to that? Dr Benneyworth: NHS England has an investigations unit that commissions regional and national investigations, sometimes from private organisations. We work very closely with the NHS England patient safety team. As I said, we have supported their work in rolling out local investigations around the patient safety incident response framework. We have been instrumental in supporting the training and education around that. We are the only safety investigator with protected disclosure. There is no other body that is like us and can do the same type of investigations in this country, and we are internationally looked at. In fact, I am doing a podcast with Canada tomorrow. Numerous countries are looking at us and saying, “We want the same thing.” There is a handful of investigators like us in Finland and Norway, and they have excellent safety outcomes for their patients, but the rest of the world is looking at us and trying to learn from us, and I am frequently asked to speak internationally about this.

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

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  Q What happens if the problem is the CQC? Dr Dash: Well, we then have to deal with that as a problem. That is the same as saying, “What happens if the problem is this organisation or that one?” We have 150 organisations—150. What if the GMC is a problem? What if the Nursing and Midwifery Council is a problem?

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

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  Q Sarah, when we were at the Health and Social Care Committee, you and your fellow panellists seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation. Could you delve into that a bit more and tell us why you think that is the case? Sarah Woolnough: The Government have an incredibly ambitious agenda, which is partly articulated in the 10-year plan. Our ongoing concern has been that some of the biggest-ticket items that the Government rightly want to achieve to fundamentally shift power to patients—delivering a shift towards prevention, moving care closer to home and allowing more digital enablement—do not require this kind of legislation or a reorganisation. I go back to my first answer: what is honestly the opportunity cost of doing some of this at the expense of more focus and attention on, for example, delivering care closer to home? There is a lot of energy and activity in that area, but the Government want to make really good progress over the next few years. To take that example, if you are really serious, you need to understand what the barriers are to delivering more care in the community, closer to people and patients, and wrapping services around patients. It requires you to flow money differently and to have a different incentive scheme, but that is nowhere near this piece of legislation. Our worry has been about what is not in the Bill, and what is the rightly and fantastically ambitious agenda to improve health for people and patients, versus the opportunity cost of a largely technical piece of legislation that reorganises some central functions.

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

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  Q This question is to the Royal Berkshire. In response to my colleague, you talked about the benefits of your council of governors. As a foundation trust, you have significant autonomy. The Bill will allow the Government to cap your day-to-day spend, strip away your FT status and make governance changes. What impact will that have on how your boards can carry out their duties? James Blythe: With a lot of foundation trusts, as the NHS has moved into a period of increasingly tight financial control and as we have needed to recover from the covid pandemic, far closer working has been required between all NHS providers and the centre, to manage both the financial implications and the pandemic’s implications for patient access and patient quality. Having recently moved from a senior leadership, board-level role in an NHS trust to two roles as chief executive in a foundation trust, I do not feel that in the day-to-day relationship with the centre and with our local and regional representatives there is an enormous difference in how we balance quality, finance and performance now. Those foundation trust freedoms were most relevant when we were in a system in which expenditure on health could grow and we were not trying to recover from the challenges that we have had recently. Day to day, the relationship between NHS trusts and foundation trusts feels quite consistent now, so I am not sure that the changes proposed in the Bill will necessarily make a huge difference. As I said in response to an earlier question, it depends entirely on whether the provisions of the Bill are used to set a small number of priorities and let NHS organisations get on with delivering them, or whether they are used more regularly to intervene more directly in our day-to-day operations. A lot comes down to how the regime is operated.

• 19 May 2026 · Jury Trial Proposals · Hansard source

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  On the Secretary of State’s watch, the courts backlog has reached record levels, yet his answer is to weaken one of the oldest rights in our justice system: trial by jury. The backlog was not caused by juries and it will not be solved by scrapping juries. The Bar Council says there is very little evidence for the Government’s approach, while the Institute for Government estimates that it would save at most about 2% of court time, and even that may be generous. Why will the Government not drop this ill-judged proposal and focus instead on the serious reforms needed to cut the backlog and speed up justice for victims?

• 29 Apr 2026 · Community Infrastructure Levy: Homeowners · Hansard source

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  Before the hon. Member moves on, I should correct what he said: CIL was introduced in Waverley in 2019, and the Liberal Democrats took over the council one month later. The idea that the Conservatives brought it in is utter nonsense. The Liberal Democrats have now had seven years to try to fix it, and they have not. I ask the hon. Member to use his influence on his fellow Liberal Democrats to encourage them to operate a system far more like those in other parts of the country that we heard about from my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), which operate with more flexibility.

• 29 Apr 2026 · Community Infrastructure Levy: Homeowners · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) on securing this debate. I have applied for a similar debate twice, but clearly I do not have the touch of a former Chancellor in the Westminster Hall lottery. This is a very serious issue. The community infrastructure levy is meant to be simple: developers contribute and that money is used to fund the infrastructure that communities need. That is the principle, and that is the promise, but in parts of my constituency that promise is being broken. The regulations are clear that CIL is intended to support growth through infrastructure, yet we see millions of pounds collected and sitting idle, with little evidence of delivery. The rules exist but the action does not follow. In Waverley where, as we have heard, CIL rates are among the highest in the country, substantial sums are being collected and left unspent—£30 million when we last checked at the beginning of the year. That alone undermines public trust, but the reality is worse than that. The money does not simply sit there; it accrues interest—£125,000 a month in Waverley’s case. That interest is not ringfenced for infrastructure; it is absorbed into the general council spending. It is equivalent to 10% of council tax in Waverley’s case. Residents are told that the money is for community facilities when in reality it is sitting in accounts, quietly supporting day-to-day council spending. At the same time, inflation is eating away at the value of the original CIL pot, so when the council does eventually spend it, it delivers less than it should. Communities lose twice: the infrastructure does not arrive and the money set aside to fund it is steadily diminished. Worse still, the system is being misapplied. Of course, it is right that developers should contribute, but individual homeowners making changes to their own properties were never intended targets of the regime. Pursuing them aggressively, as Waverley borough council does, is not just heavy-handed; it is plain wrong. Let us call it what it is: a cash grab. CIL may be a national framework, but it is administered locally. The contrast within my constituency could not be starker. In East Hampshire, charging rates outside the regeneration zone in Whitehill and Bordon range from £95.94 to £265.68 per square metre. Even with a manual exemption system, the council actively supports residents, contacting them repeatedly by letter, email and phone to make them aware of exemptions, guiding them through the process and clearly warning them of the consequences of failing to submit the correct forms. That is what good administration looks like. Let us compare that approach with that taken by the Liberal Democrat-run Waverley borough council. There, the CIL rates charged to affected homeowners are among the highest in the country. In Farnham, they stand at £547.17 per square metre, rising to just under £570 per square metre in Haslemere and the surrounding villages. With those high rates comes a very different approach. I have been contacted by a number of constituents who together face CIL liabilities of nearly £1 million. They are not developers; they are ordinary residents who feel blindsided, misled and, in some cases, harassed. They are being charged for exemptions they were never supposed to pay. That is not administration. That is extraction. The response from the Liberal Democrat leadership, supported for too long by the Farnham residents group, has been one of inertia and, frankly, contempt. Instead of being helped to navigate a complex system, residents have been left in the dark and presented with life-changing bills. This is not fairness; it is the politics of envy in action, and my constituents are paying the price. Let me give some examples. One constituent who lives on the Surrey-Hampshire border has an East Hampshire postcode but her property falls within Waverley. She was hit with a £48,000 charge, which has now risen with interest to £60,000. In Haslemere, another constituent received a £94,000 charge because an agent failed to submit the correct forms. He was forced to put his home on the market, with the only alternative to divert the majority of his pension to pay the bill. In Lower Bourne, a couple were issued with a £54,000 charge two days before Christmas in 2024. That led to delays and additional restart costs of between £15,000 and £20,000. Also in the Bourne, a resident faces a charge of £150,000. In Moor Park, another faces a charge of close to £100,000, triggered by a mid-project planning amendment. Even minor administrative issues are treated with zero flexibility. A Farnham resident now faces a £25,000 charge, along with £5,000 in legal costs, following a change-of-use application for a granny annexe. These are not speculative, rapacious developers; they are people improving their homes, supporting their families and planning for their futures. The human cost is real and growing. As has been pointed out, last year my right hon. Friend the Member for Godalming and Ash and I met the Minister to discuss these issues. At the time, he appeared sympathetic, so I ask him today: what progress has been made? At that meeting, we urged the Minister to issue clear guidance to local authorities to prevent further harm while the regulations were reviewed. Unfortunately, that idea was not taken forward. I understand the concern about overreach, but what we are seeing now is not restraint; it is injustice. I support my right hon. Friend’s proposed solutions. With that in mind, I ask the Minister three fairly straightforward questions. First, what progress has been made on reforming the CIL regulations? Secondly, will he issue clear guidance to ensure that councils do not exploit the rules to the detriment of ordinary homeowners? Thirdly, will those who have been wrongly charged be refunded? Under the current system, once development has commenced, there is effectively no right to appeal. It is a rigid and unforgiving mechanism. Most councils choose not to wield it in this way, but Waverley borough council has. The spirit of the law is being ignored, and the balance has been lost. My constituents are being treated not as residents to be supported, but as revenue to be extracted. This is not what the levy was designed to do. It was meant to build stronger communities, not penalise them. The law may permit what is happening, but it was never intended to enable it. It is time we put that right.

• 23 Apr 2026 · Allied Health Professionals · Hansard source

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  May I wish you a very happy St George’s day, Madam Deputy Speaker? It is a privilege to respond to this debate on behalf of His Majesty’s most loyal Opposition and to recognise the invaluable contribution of allied health professionals, especially those living and working in my Farnham and Bordon constituency. Having spent much of my career in the healthcare sector, including time working for the College of Occupational Therapists—before it was granted its royal title, which shows how old I am—I have seen at first hand the critical role those professionals play across health and social care, often without the recognition they deserve. I congratulate the hon. Member for Thurrock (Jen Craft) on leading today’s debate, and the hon. Member for Dudley (Sonia Kumar) , a physiotherapist herself, for her work in securing it. The House is right to give time to those who do so much, often without fanfare. I want also to mention the hon. Member for North Durham (Luke Akehurst), whose experience of care by allied health professionals was both extraordinarily moving and amusing. I have taken to heart his recommendation of a diet of red meat and cheese. If this debate is to mean anything, we must address the central issue, which is workforce. Without a clear and credible workforce plan, warm words about allied health professionals will not translate into better care for patients. The Government’s still-awaited NHS workforce plan, due this spring, will be crucial. It is meant to set out how the ambitions of the 10-year health plan will be delivered. Without it, there remains real uncertainty about how workforce shortages and rising demands will be addressed, as the hon. Member for Thurrock highlighted so powerfully when she summed up the situation as “a crisis”. That matters, because allied health professionals are already helping to unlock capacity across the system. We see that clearly in the expansion of independent prescribing, which we as Conservatives support. By enabling allied health professionals to take on those responsibilities, pressure is reduced on GPs and specialists, and patients receive faster, more efficient care. It is a practical reform that improves outcomes, but one that depends on proper planning and support in order to scale it. The challenge does not stop in the NHS; it extends directly into education and special educational needs and disabilities provision. As the vice-chair of the all-party parliamentary group for SEND, I see the growing reliance on an expanded workforce of therapists and specialists to support children with additional needs. From experience of working alongside occupational therapists early in my career, I know just how critical that support can be in helping children to access education and achieve their potential. However, the pipeline simply does not match the ambition. Training an educational psychologist can take up to eight years and other key roles, such as speech and language therapists or occupational therapists, take many years to develop. Without a clear and actionable workforce plan, local authorities are left trying to bridge that gap themselves, often without the certainty or the funding required to do so effectively. I saw that at first hand in Hampshire, as I am sure you have, Madam Deputy Speaker. Proposed changes to therapy provision raised real concerns among professionals in my constituency, but through consultation, the council listened, protected staff and expanded the specialist roles. That is the difference that practical, locally informed decision making can make, protecting services while improving provision. Unfortunately, by contrast, there is a growing concern that the Government’s approach risks creating uncertainty, rather than clarity. That is particularly striking when we consider the progress that had begun under the previous Conservative Government, rightly outlined by my hon. Friend the Member for South West Devon (Rebecca Smith) in her superb speech. Through the AHP strategy and the long-term workforce plan, clear steps were set out to expand the workforce, increase training places and grow apprenticeship routes into these vital professions. It was not perfect, but it was a plan. What we see now, however, are drifts: no published workforce plan, no clear assessment of the impact of recruitment challenges, and decisions that risk weakening the very structures needed to support AHPs. The requirement for integrated care boards to reduce their budgets has already raised serious concerns. The Chartered Society of Physiotherapy has warned about the impact on leadership roles, and we are already seeing a reduction in senior AHP positions across the system. That is not strengthening the workforce but undermining it.

• 13 Apr 2026 · SEND Provision and Reform · Hansard source

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  Given the time available, I will probably not take too many more interventions. On the hon. Gentleman’s point, it is a strange argument that, because a child has been legally given an EHCP that requires a certain level of support but, for whatever reason—whether through the school, perhaps, or the local authority—that cannot be provided, we should therefore water down their legal rights. When the current system works—and it does work in places—it is transformational. One parent in my constituency wrote: “We are incredibly relieved. I have received the final copy of the EHCP, and the school is now implementing it. It has been a long road.”

• 13 Apr 2026 · SEND Provision and Reform · Hansard source

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  In a minute. Across the country, over nine in 10 tribunal appeals are upheld against the local authority. And while, to be frank, that covers no local authority in any glory, it is evidence that the legal framework works when families are able to challenge decisions. If we remove that safeguard, families will lose their ultimate protection.

• 19 Mar 2026 · Online Harms · Hansard source

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  Unlike the hon. Gentleman, I am very convinced of the need for a social media ban. That is why I welcome the Leader of the Opposition’s stance on that. On his point about communities, schools and parents, if we do not go for a full ban, there are some technologies that could be used. I think of Jason in my constituency, who runs a company called Orbiri. He is looking to set up communities, where a school—maybe a class or a whole school—can set the parameters for usage time and the sites and apps that are used, so parents do not feel that they are alone but are part of a wider community, all working together to limit and control the social media usage of their children. Does the hon. Gentleman agree that something like that would help?