Karin Smyth MP: speeches

Speeches

• 8 Sept 2026 · Health Bill · Hansard source

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  I apologise, but I am going to press on. There is a lot to get through. We are committed to tackling health inequalities wherever they arise. There are strong duties on both ICBs and the Secretary of State to tackle these inequalities, and we remain firmly committed to doing so. We continue to drive forward improvement plans including the national cancer plan and the mental health strategy, which will transform mental health care into a system that responds and intervenes early, reduces waiting times for support, and ultimately supports people to participate fully in education. I note in particular that the Government are already making record investment in mental health. All ICBs are expected to meet the mental health investment standard over the next three years, and all are forecast to meet it for 2026-27. We are also committed to delivering the national cancer plan and focused on driving improvements, including on diagnostic capacity, which is key to addressing waiting times and tackling variation in access to better treatment, as we have heard today from my hon. Friends the Members for Easington (Grahame Morris), whose work in this area I commend, and for Blaydon and Consett (Liz Twist).

• 7 Sept 2026 · Health Bill · Hansard source

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  I am going to move on, because there is a lot to get through. My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) made a powerful speech, based on his own experience and the terrible experiences of his constituents. I will write to him about what we want to do with ICBs to make that situation better. I now turn to new clause 56, tabled by the hon. Member for Mid Sussex (Alison Bennett). I also thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for her ongoing work on, and interest in, carers throughout the passage of this Bill. I can assure the House that the Government fully recognise the importance of supporting carers’ health and wellbeing, including ensuring that they can take breaks from their caring responsibilities where needed. The Care Act 2014 already includes duties to assess and address carers’ current and future needs, and of course, we want to ensure that carers get the full benefit of the single patient record. To achieve this, we intend to use our regulation powers, which are already in the Bill. The topic of inequalities has been highlighted a lot today. We are committed to ensuring that local areas are empowered to make decisions, tackle the specific health challenges they face and make real progress on health inequalities. I want to reassure the House that reducing health inequalities remains a priority for this Government. I know that the Chair of the Health and Social Care Select Committee, and the Committee as a whole, takes a great interest in this issue, and we are committed to working with them. I thank my hon. Friends the Members for Stoke-on-Trent South (Dr Gardner) and for Uxbridge and South Ruislip for their championing of this important issue and for our meeting last week. I am not, however, convinced about new clause 91. Our focus is, and must remain, on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. We already have a wide range of duties from the 2006 Act, and we have a new duty on combined authorities. There was a duty on ICBs in the Health and Care Act 2022, and there is a duty on foundation trusts. We have the public sector equality duty, as well as our commitment in the 10-year health plan. Again, the issue is making it work and empowering local leaders to do just that. I commend the work of my hon. Friend the Member for Lewisham East (Janet Daby) on the APPG on sickle cell and thalassaemia, and I will write to her specifically on the issues she raised. She talked about specialised commissioning, a topic that was also raised by my hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald). We know that this is an ongoing concern across many areas, and I commit to keeping in touch with them and with other Members. Turning to women’s health—including mental health—and maternity services, again, I can assure the House that this is a priority for the Secretary of State. That is why we published the action-focused renewed women’s health strategy. It is why we are undertaking a single national action plan on maternal health, overseen by the national maternity and neonatal taskforce, to drive improvements where it matters to families, clinicians and other experts. I know that many Members of this House are committed to improving mental health, but I take this opportunity to thank my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for all her work in this area as the national maternity adviser. Opposition Members mentioned the Hughes report, and I assure the House that the Government recognise the importance of providing a response. I do not have time to go into all the ongoing work at the moment, but I commit to doing so at the earliest opportunity. [ Interruption. ] The Conservatives had a long time. The hon. Member for Sleaford and North Hykeham (Dr Johnson) says that they were about to do it before the election, but that is not what we found when we came into power. The Conservatives left us a lot of work to do in this and many other areas, but we are committed to doing it. Fertility services and reducing inequalities in maternity services has been raised by my hon. Friend the Member for Stockport (Navendu Mishra) and the right hon. Member for Stone, Great Wyrley and Penkridge (Sir Gavin Williamson), who has been a tireless advocate in this area, as have many others. I have recently written to him. NICE guidelines inform how ICBs should commission in this area, but I know that things are not uniformly implemented. We will continue to work with ICBs to evaluate the next steps. There was a lot of discussion on primary care, and dental access across the country in particular. We are committed to rebuilding dentistry in England, but actions speak louder than words. We are making great strides in improving access, ensuring an urgent care safety net across the country, reforming the dental contract and developing a 10-year workforce plan. More broadly, we think it is right that under this Bill, primary medical services become the responsibility of ICBs. They have the right knowledge of their areas to make commissioning decisions, and that includes on eye care. They have responsibility for all primary medical services, but rightly they will be accountable to the Secretary of State for their performance. The right hon. Member for Godalming and Ash (Sir Jeremy Hunt) is right that we will say that he could have dealt with the issues he raises while he was in power, but we do not always say that, and he is absolutely right about continuity of care. I have also visited the practice he talks about in Horfield in Bristol, and not just because I was on the primary care trust board when the 2004 changes happened. Broadly, Bristol does have different standards on some of these issues, and that highlights our point. We do not need to put some of these provisions in legislation. Exactly this sort of good practice can be shared in local systems through neighbourhood care plans, neighbourhood work and the work in primary care networks. The single patient record is fundamental to the Government’s mission to create a modern, joined-up NHS that puts patients at the centre of their care. On amendments 26, 42 and 43, I assure Members that the overarching purpose of making regulations to create and operate the single patient record is limited to the direct care of patients, and clause 51 is already explicit about that. Crucially, the clause does not create any new data sharing gateways for secondary purposes such as planning and commissioning, so these amendments are not necessary. On data safeguards, the security and privacy of people’s health and social care data are paramount. As Members would expect, we will build the strongest safeguards into the record. On new clause 32, I can assure Members that the SPR will be designed to protect personal data by default, with the highest standards of cyber-security and information governance ensuring that only the right people can access the right information at the right time and only for the right reasons. Finally, I have heard how important it is that the single patient record is accessible and inclusive. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for amendment 87 and the important work she is doing to publicise this hugely important area. I assure her and Members that we are confident that the Bill is drafted to enable information related to support needs and reasonable accommodations to be included in the SPR. The Department will have regard to the accessible information standard as the SPR is developed. We are also committed to tackling digital exclusion. We have considered that as part of the single patient record equality impact assessment, and work is already under way to help address barriers around connectivity, skills and confidence. I heard what my hon. Friend the Member for Middlesbrough and Thornaby East said about the need to engage him and others about the single patient record as we go forward. On the federated data platform, decisions about public contracts must be made through fair, open and non-discriminatory processes. That is governed by UK procurement law, which recognises certain international treaty obligations. NHS England is reviewing the federated data platform contract to determine whether it should continue with standard contract management processes. It will look at evidence of delivery and the impact of the platform, and that should be the basis on which a contract continuation is decided.

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

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  I appreciate the intention behind new clause 87, but the Government cannot support it. The Medical Training (Prioritisation) Act is designed to support a sustainable medical workforce that can meet population health needs and deliver the best patient care while reducing the UK’s reliance on an unpredictable international labour market. By creating a clear pathway for medical school to speciality training, we also strengthen domestic talent and improve retention. What matters is where a doctor is trained, not where they were born. Data shows that domestic graduates are more likely to stay in the country they trained in than those trained internationally. Doctors trained primarily in the UK are also likely to be better equipped to deliver healthcare that is tailored to the UK’s population, because they have a stronger understanding of UK-specific epidemiology and NHS practice. In addition, the Government set UK medical school places based on future health system needs. Student intakes and graduate outputs of overseas campuses are not included in our domestic workforce planning. If we prioritised British citizens for foundation training regardless of where they studied, it would undermine our aim to build UK-trained capacity while ensuring that we do not provide more foundation programme places than we need. I would like to emphasise—this is an important point—that prioritisation does not mean exclusion. Non-prioritised applicants can still apply for the foundation programme and will be offered places if vacancies remain after prioritised applicants have received offers—I understand that is already happening for the 2026 recruitment round. For individuals who do not secure a foundation post this year, there remain alternative routes to pursuing a medical career in the UK. Those include obtaining GMC registration through the established pathways, such as completing an approved internship in the country where they trained and entering the UK healthcare system through a locally employed doctor role or other non-training posts. I ask the hon. Member for Sleaford and North Hykeham to withdraw the new clauses.

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

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  May I put on record my thanks to all the excellent managers in the NHS? I am not sure whether I raised the bar, as the hon. Lady said, but it was a great career and one that I enjoyed very much. It is a difficult job, and we want to support managers in future. We cannot deliver our 10-year health plan without them. That is one of the reasons why we have already established a leadership college to support their development, as we committed to doing.

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

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  This is an area of some discussion, some of which we have heard, but we do not think it is necessary, where we are now, to put such a measure in primary legislation. The Medical Training (Prioritisation) Act establishes a statutory process for prioritising certain groups for training posts; it is not intended to change eligibility for training or the high standards that applicants must meet. Embedding some of these provisions in primary legislation would leave them inflexible to future workforce needs or standards of education and training. If Parliament wishes to change how recruitment processes themselves operate, that is best done outside legislation through established routes. The preference-informed allocation system was introduced in 2024 following stakeholder engagement, because the previous system was felt to be unfair and stressful for applicants, with a lack of standardisation across schools. Since its introduction, as I understand it, 82% of applicants have been allocated their first choice of foundation school this year, up from 71% in 2023. NHS England has committed to a review of the system, which will commence later this year. Prescribing the allocation method in legislation would pre-empt that review and limit our ability to make future changes to ensure that the system remains fit for purpose. On that basis, I ask the shadow Minister to withdraw the new clause.

• 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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  I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee. I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible. New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time. Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child. To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.

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

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  I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals. The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.

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

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  May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.

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

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  I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country. That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms. Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why. There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, 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 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 thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy. I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that. More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it. I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning. New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer. Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services. The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities. For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.

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

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  I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health. My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel. In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking. The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages. Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.

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

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  I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system. There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.

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

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  Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners. On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work. NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions. As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice. On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities. At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee. There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals. The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.

• 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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  Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities. At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers. This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners. As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change. Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.