Karin Smyth MP: speeches

Speeches

• 8 Sept 2026 · Health Bill · Hansard source

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  It will not be a surprise to the hon. Gentleman that I do not agree with his proposition, although I commend the work that many people have done in Healthwatch. We want to work with people in the other place to make sure that this is the right way forward. I am sorry that we do not have more time to debate HSSIB, because it requires more discussion, although we had a good debate in Committee. We have heard many discussions today. I have met the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and I hear what he is saying; I will ensure that he gets a response to his letter from the new Minister for Patient Safety—asap, as they say. It is an issue that we need to get absolutely right. We all know, from our experience with patients and families, about the importance of creating a culture in which concerns can be raised without fear and lessons are learned effectively. The Government fully agree with those objectives. Our view is that patient safety, in line with the Dash review, is best served by clear lines of accountability, effective independent scrutiny, and a relentless focus on learning and improvement. We are therefore transferring HSSIB’s functions to the CQC to ensure that learning from investigations can more readily inform improvement activity across the system. We recognise the importance of ensuring that the investigation arm has the autonomy to investigate the qualifying incidents that it deems appropriate free from interference, and I can give the House the assurance that we will work with the executive of HSSIB and the CQC to ensure that their operating model upholds this operational independence. In response to the Chair of the Health Committee, who is not in her place, let me say that there is obviously no one single metric by which to judge the suitability of the CQC. It is usual in the Department’s oversight of arm’s length bodies and independent regulators to look at things like stable leadership, IT capability, governance and operational effectiveness. This is something I am sure the Select Committee can help with.

• 7 Sept 2026 · Health Bill · Hansard source

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  I wish at the start to take a moment to thank the Members on both sides of the House who served on the Public Bill Committee during what was a very hot end of June and July—if we can remember back that far. As part of that process, the Committee scrutinised every clause of the Bill and debated over 195 amendments, and we on the Government Benches are grateful for their diligence. The implementation of the Bill is better for all that hard work. I also welcome the spirit of collaboration that has greeted the main provisions of the Bill from both sides of the House, most notably on Second Reading but also in Committee, and I hope that we can continue in that spirit at this stage. For our part, we remain committed to working with MPs and peers across the House and other stakeholders to ensure that the end result is a Bill that strengthens the NHS. I know that we have a large number of amendments on a variety of topics, so I will keep my remarks short. New clauses 96 and 97 relate to visiting rights. They strengthen the role of integrated care boards and local authorities in promoting visiting, supporting people to have someone with them and ensuring the involvement of family, friends and carers in decisions. They complement the existing legal requirements and the work already under way to drive a change in culture and practice by embedding visiting at the heart of the responsibilities of commissioners. New clause 96 explicitly places duties on integrated care boards to promote opportunities for visiting and accompaniment, while new clause 97 builds on local authorities’ existing wellbeing duties by emphasising the importance of involving other people in decision making, receiving visitors and maintaining opportunities to take trips outside the care home. Maintaining meaningful contact and connection with family, friends and carers is critical to the health and wellbeing of so many people in our health and care settings. They provide invaluable practical help, emotional support and advocacy for their loved ones in accessing care and treatment, and commissioners should do what they can to support these relationships. I turn to Government amendments 60 to 62. The question of who is required to sit on ICBs has raised comments from all across this House. I am grateful to all Members who have raised the importance of local government having a voice in ICBs, including my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) and the other members of the Health and Social Care Committee, who have continually advocated on this issue. We agree. It was never the intention to weaken the voice of local government in the NHS. We recognise that local authority board members are an important voice for commissioning on the ICB, and often provide helpful challenge and a very different perspective on commissioning decisions.

• 16 Jul 2026 · Health Bill (Seventeenth sitting) · Hansard source

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  There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it. I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result. I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—

• 16 Jul 2026 · Health Bill (Seventeenth sitting) · Hansard source

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  I think that was yet another addition to the hon. Lady’s speech. Initially, she asked whether I recognised the cancel culture in this area. I have already alluded to, absolutely, recognising that what occurred in the 2010s at the Tavistock and around was not acceptable. Under the stewardship of the Conservative party of the NHS and so on, it took until 2022 to start rectifying that situation in order to give good treatment to children and young people. She is herself a clinician, so I am somewhat surprised at her. Noting what I set out, I am surprised that she does not recognise that a clinical trial has never—I stand to be corrected—been subject to a vote in Parliament, whereby politicians who are not experts have a say; but we can come back to that.

• 7 Jul 2026 · Health Bill (Twelfth sitting) · Hansard source

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  I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.

• 7 Jul 2026 · Health Bill (Twelfth sitting) · Hansard source

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  Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change. My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body. The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system. We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions. Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated. The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform. Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that. The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition. The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process. Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition. Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost. Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.

• 7 Jul 2026 · Health Bill (Thirteenth sitting) · Hansard source

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  I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it. To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report. The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at. Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape. Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.

• 7 Jul 2026 · Health Bill (Thirteenth sitting) · Hansard source

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  I want to make some points first. I will pick up any outstanding points I do not cover. The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action. Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said: “by bringing HSSIB into the CQC, you can align the work of the two. For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”. –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.] to enable best action. These organisations can learn better from each other. Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.

• 7 Jul 2026 · Health Bill (Thirteenth sitting) · Hansard source

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  The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help. Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action. The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation. A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.

• 7 Jul 2026 · Health Bill (Thirteenth sitting) · Hansard source

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  I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell. I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously. I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different. The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them. The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention. On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.