Karin Smyth MP: speeches

Speeches

• 7 Sept 2026 · Health Bill · Hansard source

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  I will not. We have heard a lot from the hon. Gentleman, and I want to make some clear points to the House this evening. We have heard a great deal of discussion about commercial processes, and Members—including the hon. Member for Newton Abbot (Martin Wrigley)—have raised important points about data security, governance and ethical standards of contracts, and support for domestic suppliers and for voluntary, community and social enterprise organisations. Contracts involving NHS data and digital services must be subject to proper scrutiny. The Government’s approach is to assess risks on the basis of the nature of the data, service and supplier access. Crucially, we already have the tools that we need to carry out appropriate due diligence through legal powers and robust contractual provisions. I agree with the spirit of new clause 108, tabled by my hon. Friend the Member for Liverpool West Derby (Ian Byrne). I fully recognise the importance of ensuring that the NHS does not inadvertently support exploitation or rights abuses. UK legislation already incorporates some international laws: for example, the Human Rights Act 1998 incorporates the European convention on human rights into UK law. Similarly, we can use existing legislation and guidance to exclude suppliers from NHS procurements. Both the Procurement Act 2023 and the provider selection regime allow us to exclude providers when there has been serious misconduct or illegality. For instance, we could exclude a supplier under the Procurement Act for breaches of modern slavery and/or human trafficking laws. We have very high standards and expect all suppliers —including whichever companies go on to provide the single patient record—to meet them. On a related note, the Chancellor has already written to the Secretary of State to ask that the NHS procurement better support British industry. In the light of that, the Secretary of State has commissioned, within the health family, a review of strategic procurement pipelines to find opportunities for the new social value model to support more British jobs, skills and innovation. The First Secretary of State, my right hon. Friend the Member for Sheffield Heeley (Louise Haigh), who is leading work on procurement across Government, would be happy to meet my hon. Friend the Member for Liverpool West Derby as part of this important work as it progresses, and I can assure him that the actions that we take will be fully in line with the principle of international law.

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

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  I think all Committee members can recognise the importance of this issue. An acquired brain injury is a life-changing event for those affected, and for their families and loved ones. Its treatment involves co-ordination between primary, community, secondary and specialist care, and is personalised to the needs and life circumstances of the individual. Its effects are not limited to a person’s health: it can impact their journey through education, their employment prospects and so many other aspects of life. Because of that, they rightly expect coherent, joined-up support from across Government. Therefore, as we have discussed, we are working in partnership with eight other Government Departments, ABI charities, patient representatives and the NHS to develop an ABI action plan. We also continue to work closely with the United Kingdom Acquired Brain Injury Forum, which is the umbrella organisation for brain injury charities, as the plan develops and moves towards publication.

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

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  Indeed. They wanted to work with resident doctors to talk through a way to make progress without resorting to strike action, because that is a sign of failure in any system. On new clause 81, we are committed to reforming trade union legislation to bring it into the 21st century. We want to create an industrial relations framework that is fit for a modern economy, and workplaces that work for everyone. That is why the Employment Rights Act 2025 repealed the Strikes (Minimum Service Level) Act 2023. The previous legislation created a hostile environment, which was not conducive to good partnership working with trade unions or to settling disputes. On new clause 82, although strikes are hugely disruptive, a ban on a doctor’s right to strike is not the answer.

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

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  This is a really important subject, as everyone approaching the end of their life deserves dignified, compassionate and high-quality palliative and end-of-life care. Hospices provide extraordinary care, and hon. Members are right to highlight the issues the sector faces. That is why the Government are committed to developing a modern service framework for palliative care and end-of-life care. The final framework will be published in the autumn. New clause 108 would require integrated care boards to collect and report data on people who died while waiting for end-of-life care. It would also require the Department of Health and Social Care to publish that information nationally. New clause 109 would impose a single statutory three-year funding period on hospice funding. Both new clauses are likely to be answered by work already under way or included in the modern service framework. On funding, we recognise that the sector faces a serious challenge, and the Public Accounts Committee found in March that integrated care board funding ranges from 0% to 80% of an individual hospice’s income, and that commissioning relies on grants and block contracts. There are also wider funding issues, such as the reliance on historic grants. The Government are acting on those issues, and we have provided around £80 million over three years for children and young people’s hospices, or at least £26 million a year to 2028-29, adjusted for inflation. We have also provided a separate £125 million capital boost for both adult and children and young people’s hospices. That is the largest investment in hospices for a generation. The MSF will support commissioning away from grants and block contracts to sustainable contracts based on integrated assessment of population need. It will consider contracting arrangements more widely, including a move away from short-term grant funding as part of the more comprehensive reform that the sector agrees it needs. We are also strengthening data and evidence. We commissioned the National Institute for Health and Care Research’s policy research unit to build the evidence base on palliative and end-of-life care, including on inequalities in access and the identification of need. We also expect the MSF to give us better insight into the performance of the system. Its metrics and accountability framework are being co-developed with people with lived experience and partner organisations from across the sector. It will measure identification, access, quality, outcomes and inequalities. In the context of that ongoing work, the new clauses are not necessary. The MSF will give the House and the public a far more comprehensive picture of access to care than a single count could. It will also do so as part of improving the entire patient journey for people who need palliative and end-of-life care. Because this is a non-statutory approach, there will be more flexibility to adapt and change over time, rather than the system being required to follow requirements set out in primary legislation. I hope that that gives hon. Members the reassurance they need not to press their new clauses to a vote.

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

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  I thank my hon. Friend for that. Across the east of England, where we now have so many Labour MPs, everyone has been trying to rectify the mismanagement that local people have seen, particularly of the capital estate. I will not detain the Committee on the capital estate—one of my favourite subjects—for very long. The hon. Member for Sleaford and North Hykeham is aware that the decision on neighbourhood health centres was announced in the autumn. The decision-making process was supported by a business case to examine the feasibility of developing a new model, learning the lessons of the past on public-private partnerships specifically to build neighbourhood health centres as part of our 10-year plan. That informed the decision to proceed. The business case was a strategic outline case, the purpose of which was to scope and identify the preferred way forward for a new potential model, in line with the Treasury’s five case model. We are now working with the National Infrastructure and Service Transformation Authority to develop this further, and we expect a further round of market engagement in the autumn. I recognise the interest in making the business case available to both Houses, but that must be balanced with the need to develop an effective policy. Publication while policy development is ongoing would limit full, candid and proper deliberation. Civil servants and subject experts need to be able to engage in frank discussion of policy options to expose their merits, demerits and possible implications. Their candour in doing so would be affected by their assessment of whether the content of such discussions would be disclosed. We are committed to building neighbourhood health centres across the country. That is what patients and the public deserve. We will obviously be mindful of public money and subject to the usual processes of the House, including the Public Accounts Committee. We will learn those lessons. We are in full discussion with NISTA. For those reasons, we are committed to developing good estate across our country. That is what our constituents deserve. I therefore ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.

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

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  Well, what was a disaster was the Tories’ management of the capital estate pre-1997 and post-2010, if the hon. Member for Sleaford and North Hykeham wants to talk about disasters on capital planning. I could talk about this for a very long time, but I know the Committee is keen to move forward, and I addressed some of these issues in debate on a previous amendment. I am very proud of, for example, Southmead hospital in Bristol, which is one of the finest examples of a hospital in the country and was built under a PFI scheme. I received treatment there a couple of years ago, in facilities that are good for staff to work and patients to be treated in. It replaced a hospital that was falling down and in shocking condition, despite the best efforts of staff. We can see similar examples across the country. Under the Tories’ management, and for some of the early PFI schemes under the last Labour Government, contracts were poorly negotiated. They had issues with, for example, management of inflation. We have learned lessons from that. The hon. Member for Sleaford and North Hykeham talked about some contracts, including one where, I think, her whiteboard was not working. We know what the lessons are to be learned from that, and we are doing exactly what a good Government do when they take charge—change it. In the 14 years that the Conservatives were in power, they could have started negotiating these contracts differently at any point, but they chose not to. They chose to let the estate atrophy and fall down. That is bad for patients and the public. That is why I was proud last week to launch the Government’s capital plan, building for the future, looking forward and giving nine years of certainty for estates across all our constituencies.

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

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  Like my hon. Friend’s constituency, my constituency of Bristol South has a large tobacco industry legacy, and it is crucial to address respiratory disease in a way that looks at the whole person.

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

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  The Government of course recognise the importance of clarity and assurance as we undertake this significant transformation, including on how functions, governance and the workforce will operate in the future. That is essential for ensuring that our staff and other stakeholders understand the new role of the Department. On new clause 46, we recognise the importance of transparency around departmental workforce numbers and the impact of abolishing NHS England. The Government remain committed to significantly reducing headcount across NHS England and the Department of Health and Social Care, but I put on record my thanks to all the staff and talented professionals working in both organisations; this is a difficult time for them. However, this new clause is not necessary. Workforce information is already published both monthly and through the Department’s annual report and accounts, alongside wider Government transparency publications. Placing a further reporting requirement in legislation would risk duplicating existing transparency data, so it is unnecessary to include it in the Bill. On amendment 37, I reassure the Committee that we will consult on the proposed structure for the new Department of Health and Social Care, and that is also required under existing employment law. The structure will clearly explain what every part of the new Department will do and set out every post we think we need. The target operating model is an internal document that sets out the proposed purpose, role, governance and organisational structure of the future Department. It will be shared internally, following engagement with staff and stakeholders, including trade unions. The chair of NHS England, Dr Penny Dash, has committed to sharing it with the Health and Social Care Committee once it is finalised. The target operating model will be used to guide detailed organisational design and will iterate over time. The proposed design of the new organisation will be subject to consultation. The target operating model does not implement changes that remain subject to parliamentary approval through this Bill. On workforce transition, we will follow TUPE-like principles whether TUPE or any other transfer mechanism applies, in line with the Cabinet Office statement of practice on staff transfers in the public sector. That means that recognised trade unions will be formally consulted and engaged with on measures related to the transfer. No changes to contractual terms and conditions will be made without proper consultation and engagement. We are committed to maintaining an ongoing dialogue with trade unions and staff throughout this period of change, and we are updating them as often as possible. Where appropriate, we are also committed to working with staff networks on the changes, particularly on how we can best support staff. Given those commitments, I hope that the hon. Member for Sleaford and North Hykeham agrees that placing further requirements in the Bill would be disproportionate. On amendment 38, we agree that it is important to be transparent about the costs and benefits of this programme. The Department has been open about the initial estimate of around £1 billion of savings per year, and we published an impact assessment alongside the Bill. The detailed timing and scale of costs and savings from the programme depend on factors such as the take-up of voluntary exit and redundancy schemes, which are under way. We will continue to refine our assessment of costs and savings as the programme progresses and as we move towards the abolition of NHS England. We will continue to be open about those figures. The savings will support continued investment in frontline services. The timescales set out in the amendment would risk delaying the abolition of NHS England and, as a result, would delay the transfer of savings to frontline services and the stability and certainty we need for our staff. On amendment 39, the Government are committed to supporting the integration of health and social care so that people experience more joined-up, person-centred care. Key planning frameworks, including for the better care fund and for neighbourhood health, already stress the critical importance of strong join-up and integration. We expect those frameworks to continue to guide the health and care system following the abolition of NHS England. Most importantly of all, we are committed to developing neighbourhood health approaches as an essential part of reforming the health and care system. That approach will deliver more integrated services across health, local government and wider partners, including the voluntary and community sector. The Bill simplifies existing complex legal frameworks to make collaboration easier and emphasises the role of health and wellbeing boards as a focal point for that collaboration. However, partnership and collaboration take many forms depending on local circumstances, and they cannot simply be prescribed through a centrally developed plan. Instead, we should encourage areas to develop effective, productive relationships in the interests of the people they serve. We have discussed that in this Committee, and hon. Members from all parties have a key role to play there. Turning to new clause 75, we absolutely recognise the need to ensure that critical functions, expertise and organisational capability are identified, retained and effectively transferred during this period of change. That is essential to maintaining continuity of services and supporting the delivery of key health programmes, including vital services such as cancer care. I reassure the Committee that that work is already well under way. We are carefully mapping all areas of current activity across NHS England, assessing what capabilities we need to deliver them in future and putting processes in place to support the retention and transfer of expertise. This includes the phased approach we are taking to workforce changes, alongside a robust and consistently applied process for voluntary redundancies and voluntary exits, to minimise disruption and protect critical skills. We are also committed to ongoing monitoring and oversight through the transition, and as part of our programme of governance, there is ongoing consideration of skill retention, knowledge transfer and organisational capability, and we will take action where gaps are identified. As drafted, the new clause would introduce a new statutory requirement to produce and lay before Parliament a formal transition strategy before the abolition of NHS England and the implementation of transfer schemes, alongside new ongoing reporting obligations. While well-intentioned, it would add another unnecessary step into what is already a complex and carefully sequenced programme. It would reduce the flexibility needed to adapt workforce organisational decisions as the transformation progresses. For those reasons, the Government believe that the objectives of the new clause are already being delivered through existing programme arrangements, without the need to place further requirements in the Bill.

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

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  I will partly agree with the Opposition to start off with: they are absolutely right that osteoporosis is a really important issue, particularly for older women. The hon. Member for Farnham and Bordon outlined some of the economic case, but crucially, it is a strong health issue. I worked and campaigned on this issue in opposition myself, because it predominantly affects older women. It also very much fits into our 10-year health plan regarding prevention. That is why we have also, for example, increased access to DEXA—dual-energy X-ray absorptiometry—scanners. It is rather disappointing, though, for a subject on which there is obviously so much agreement to be used as a political back-and-forth here today. Let me be clear. I think some of the comments show why some of this has got a bit confused, including for people who genuinely care about this rather than just wanting to make it a political issue. Again, it is entirely the Opposition’s job to oppose the Government, and I do not have any problem with that, but there is a serious issue here about how this is monitored. We are absolutely committed to having coverage across the country by 2030, as the Secretary of State has recently said. That is why we are rolling out more DEXA scanners and so on, but with the clustering of ICBs, 92% of the country is now covered across those clusters.

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

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  I am slightly confused, as I suspect other Committee members are, by the Opposition’s approach to the private sector, having had a discussion in relation to the previous new clause about not using the private sector and boosting work and employment opportunities in our country. They do have a slightly odd view with regard to this. As I said, our view is very pragmatic: it is to support the treatment of patients to get waiting lists down. That is what our constituents deserve. Where capacity can be used, we want to make sure that that choice is available.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents. New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry. We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so. As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs. In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it. I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that. New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  I was just moving on to talk about some of the work beyond the legislative framework. Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.

• 9 Jul 2026 · Health Bill (Fifteenth sitting) · Hansard source

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  I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses. Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [ Interruption. ] You started it. On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.

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

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  Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State. NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment. That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals. I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which. To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures. I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it. To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations. The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that. Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.

• 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 happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction. The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies. New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose. Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation. As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight. I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC. The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill. The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material. The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops. Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.

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

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  I will begin with Government new clauses 91 to 95. Many hon. Members will know that the current regulatory framework for medicines and medical devices is seen as overly complicated and difficult to navigate. It is also slow and burdensome to amend, limiting our ability to ensure that it keeps pace with developments. Maintaining the safeguards to public health is central to every decision we make. However, the regulatory framework currently slows down innovation and delays patient access to healthcare products. From a market growth perspective, it also places barriers to the UK market, particularly for small and medium-sized enterprises. These new clauses will deliver a more streamlined regime for making and updating secondary legislation. The ability to make faster and more responsive updates to secondary legislation will enable the Department and the Medicines and Healthcare Products Regulatory Agency to address the current barriers that I have highlighted in the regulation more quickly. New clauses 91 and 92 provide for changes with regard to powers to make “ambulatory references”, which are references in legislation to external documents such as technical standards and lists, which can be updated from time to time. These changes will ensure that the legislation continues to capture updated versions of those documents without the need for further regulations. International and domestic standards are crucial in the highly technical areas targeted by the change. It is important that the regulatory regime remains aligned with the technical, scientific and international framework that is designed to evolve over time. Currently, there are limited powers for medical devices regulations to refer to external international agreements or standards that change over time, and there are no such powers at all for medicines. Without the ability to make ambulatory references to those documents, legislation is needed each time the standards are updated. That is disproportionate and risks unintentional regulatory divergence that creates uncertainty for industry. The new clauses introduce a power for human medicines regulations to refer to external international agreements or standards that are updated over time. For medical devices, the provisions also extend the current ambulatory reference power to make reference to lists of countries subject to mutual recognition agreements, lists of devices or categories of device that are eligible for an international reliance pathway, and lists of British technical standards. Amendment 80 sets out that the extent of new clause 92 will cover England, Scotland and Wales. The provisions of new clause 93 enable a more flexible approach to consultations on regulatory changes related to medicines and medical devices, rather than the current one-size-fits-all requirement. Under the amended powers, the MHRA and the Department will still retain a legal duty to consult relevant stakeholders, and significant regulatory changes will continue to be subject to public consultation. The measure is designed to enable consultations that are proportionate to the scale of the change in hand. That will ensure that regulations can be updated more efficiently and in line with the needs of the health service. New clause 94 will enable certain technical updates to medicines and medical devices regulations to be made using the negative rather than the affirmative procedure. Specifically, it relates to changes that routinely arise as clinical practice evolves—for example, updating detailed lists of medicines or making limited adjustments to the professional groups who may prescribe, supply, sell or administer particular medicines. At present, even minor or time-sensitive changes of this sort can require a debate under the affirmative procedure, which is not always the best use of parliamentary time. New clause 95 is the final measure in the regulatory framework package for the MHRA. It is designed to streamline the process for routine fee updates made using powers under the European Union (Withdrawal) Act 2018 by allowing the use of the negative parliamentary procedure for routine fee uplifts. That will bring the powers in line with those relating to fees in the Medicines and Medical Devices Act 2021, where uplifts to existing fees can be made with the negative procedure. That will also reduce delays in making and communicating such adjustments, while maintaining appropriate safeguards, including the requirement to set out the cost basis for any new uplifts with any legislation—whether it is made under the negative or affirmative procedure. The draft affirmative procedure will be retained for any substantive changes, such as the introduction of a new chargeable function. Finally, there are a number of consequential provisions related to those I have just discussed. Government amendments 80 to 82 primarily relate to the commencement period in which they come into force. In conclusion, the amendments will enable a faster and more responsible reform of the existing legislative framework, while preserving proportionate safeguards and necessary scrutiny. I commend the new clauses to the Committee.

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

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  I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work. I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security. More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience. I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located. That is why the Government’s approach is based on targeted assessment and proportionate control. We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook. That is not an argument for complacency; we should continue to identify risks before procurement begins. A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier. Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly. Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually. As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure. However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary. Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution. I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits. It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose. The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses. Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out. I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.

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

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  As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response. Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee. Question put and agreed to. Clause 66 accordingly ordered to stand part of the Bill. Clause 67 Minor and consequential amendments Question proposed, That the clause stand part of the Bill.