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Showing every spoken contribution, including 12,832 under 12 words. Hide short remarks
I am going to move on. Noting what I have set out, having such a vote would set an uncomfortable precedent that would be likely to significantly compromise the value and reputation of UK research, as well as creating an inequity unique to individuals with gender incongruence or gender dysphoria. For those reasons, I ask the hon. Lady to withdraw the new clause.
Welcome to another rerun of the 2010s —happier times for the Opposition. Sometimes they do not remember what happened, and I have to remind them—and every now and then, they remind us. This is a really important issue, not only for the hon. Member for Guildford, who tabled new clause 72, and the hon. Member for North Shropshire, who moved it, but for all our constituencies. It has been a huge priority for this Government. The Secretary of State will continue to have a duty to promote a comprehensive health service in England. In addition, clause 4 provides for an amended duty for the Secretary of State to reduce inequalities in access to services across England. However, we also recognise that practical action is needed to secure access to urgent and routine NHS dentistry care. As the Committee has discussed, that is why the Government have prioritised a number of improvements over the past two years. Last year, ICBs commissioned additional urgent dental care appointments, and there is now an urgent care safety net across the country. In April 2026, we introduced a requirement for NHS dental practices across England to deliver a set proportion of their contract as urgent care. Supported by increased payments for dentists delivering that care, that made it easier for patients to get prompt support through the NHS. We are committed to reforming the NHS dental contract by the end of this Parliament—something that could have been done at any point in the past 14 years. As a first step, the package of reforms we introduced earlier this year will address some of the pressing issues that dentists and dental teams have been experiencing. Those reforms will help to prioritise those with the greatest need, supporting a shift away from clinically unnecessary check-ups. The Government are already making progress on improving access to NHS dentistry across England, including in Surrey and East Hampshire. I hope that hon. Members can see how legislating for one area in particular conflicts with the Secretary of State’s duties to promote a comprehensive health service for England as a whole, and risks creating health inequalities in other regions. For that reason, I ask that the hon. Member for North Shropshire withdraw the new clause.
The hon. Member has brought up an important topic. The Government absolutely recognise that inaccurate information can undermine confidence in vaccines, which are so important. We are already taking a multi-pronged approach to addressing that through national communications, support for healthcare professionals and the ongoing monitoring of emerging narratives. The evidence is clear that, although it is a risk, misinformation is not a primary cause for people not to take up the offer of vaccinations. Rather, practical barriers such as access to services, socioeconomic factors and levels of awareness play a more significant role. We are already acting to reduce those barriers, with targeted action to improve access, strengthen communications and support frontline staff. A new statutory strategy focused solely on disinformation would risk narrowing our approach when a broader, evidence-led response is required. For those reasons, we do not consider the new clause to be the right approach. I recognise much of what the hon. Member says about access to information, but we want to maintain a wider approach. On that basis, I respectfully ask her to withdraw the new clause.
There have been interesting discussions on these new clauses. I recognise that the intention behind them is to reduce the impact on patients and NHS budgets when doctors take industrial action. That is an objective that we all support, but I do not agree that the new clauses are the best way to achieve it. I respect the shadow Minister’s professional background and the strong moral case she set out to explain why she does not feel it is appropriate. For a long time, as she says, doctors did not go on strike, but something changed in the industrial relations landscape roughly 10 years ago to start that process, that change of culture and that frustration that led doctors to strike. I listened with interest to the former Health and Social Care Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), reflecting on this issue recently—we’re all subject to podcasts these days, aren’t we? He spoke about those relationships at the time, and I think we should learn from that; it is very helpful to have those recollections. But something changed, and this has been the result. I pay tribute to my hon. Friend the Member for Bury St Edmunds and Stowmarket and many others of his vintage, if I can say that—
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.
I thank my hon. Friend for bringing his experience to bear on this matter. I absolutely agree. New clause 82 stems from that resident doctors dispute. One of the first things that we did was to agree the 10-point plan with regard to the management in trusts. I have said before how truly shocking the working conditions are in many trusts not just for resident doctors, but for other doctors and professionals. There is no ability to take a break, have a rest or get away. Some of the equipment that they are dealing with is also shocking, as are the levels of the estate. Those are some of the many things that have driven and continue to drive poor industrial relations, along with the fact that there is no one to speak up for them.
I think I said that it is a failure of representatives on both the management side and the union side to agree a solution. That is what I meant by a failure of the system. Ultimately, strike action, as my hon. Friend the Member for Lichfield would attest, is a sign of the failure of good, conducive relationships and partnership working. That is why we never want to see it.
With new clause 83, I think the hon. Member for Sleaford and North Hykeham would like to exempt organisations that receive public funding to provide health and social care services from the public sector equality duty. I do not agree with the intent of this measure. The duty under the Equality Act 2010 was designed to ensure that public authorities “have due regard to the need to…eliminate discrimination…advance equality of opportunity” and “foster good relations” in the exercise of their functions. That includes when designing and delivering services. It is not an unnecessary addition but part of good service design and delivery. The duty is not there to dictate a particular outcome or set of priorities for the decision maker; it is there to help decision makers understand and take account of the consequences of their choices. It ensures that issues of discrimination, equality of opportunity and good relations between different groups of people are not overlooked during complex decision making. That is why it is important for publicly funded providers of health and social care to have due regard to the duty. The public sector equality duty should always be applied in a proportionate way. It should not create an administrative burden. If a provider of health and social care is taking a decision that has little or no consequence to equality outcomes, it needs only to note that. It is for that reason that I ask the hon. Member to withdraw her new clause.
I am grateful to the hon. Member for Sleaford and North Hykeham for bringing this discussion before the Committee again today. The safety recommendations are an important mechanism for improving services and securing better outcomes for patients. We support the aim of bringing greater clarity to the recommendations landscape, and we are already taking forward work in this area. The Dash review of patient safety across the health and care landscape found that a very high number of recommendations have been made to the NHS that often lack any cost-benefit analysis, which is why the 10-year health plan committed to giving specific responsibility for reviewing, analysing and taking forward recommendations to the national quality board. In line with the Dash review, work is progressing on a recommendations hub that will sit within the Department. The hub will include a repository to hold all national-level recommendations relevant to care quality, including safety, effectiveness and patient experience. It will provide an efficient system for co-ordinating, prioritising and overseeing recommendations made by the national quality board. The hub will record responsibility for implementing prioritised recommendations and, once fully operational, strengthen transparency and accountability for how they are taken forward, which is something I think we all welcome. This new approach will enable the NHS to focus on the actions most likely to enhance patient outcomes. Where reviews or reports commissioned by the Secretary of State make recommendations to local bodies, those recommendations will remain subject to local governance arrangements within the overall co-ordination retained by the Department. Our existing plans meet the intention behind new clause 85; in fact, they go further by prioritising national-level recommendations for the NHS in a proportionate way, without being bound to specific timescales. They will provide the greater clarity that the new clause seeks without the need for legislation. On the specific question, I am sorry to disappoint the many campaigners on this issue and Opposition Members by saying that we will not be announcing anything in the next two hours, but the point has been well made. I responded to a Westminster Hall debate myself, and the Minister responsible for patient safety has previously responded to the commissioner and made public the work that the Government are doing. Due to the cross-Government nature of the work, we cannot give exact timelines. We have heard the calls for clarity, speed and decisive action, and we have committed to setting this out at the earliest opportunity. I have not had a chance to speak directly with my right hon. Friend the Member for Makerfield about this issue, but I am sure many conversations on many subjects will be coming our way soon. As both my right hon. Friend and the Prime Minister made clear during Tuesday night’s debate on the Hillsborough law, redress and patient trust are important aspects of rebuilding the confidence of the public and those who have been wronged in all parts of the state. We are committed to getting this out as soon as is credibly possible. For that reason, I ask the hon. Member for Sleaford and North Hykeham to withdraw her new clause.
As someone who previously set up a referral management service, I feel the need to join in this interesting clinical discussion while everybody else watches us for the next hour and a half, but I am not going to do that. Some interesting points have been raised. To add my two pennies’ worth to the point made by my hon. Friend the Member for Bury St Edmunds and Stowmarket, the change in practice is partly due to increased specialism among consultants, which makes it harder to refer. When we set up a referral management service in Bristol, two issues were the pressure on general practice and the use of locums, who were perhaps working temporarily in the area and did not know the full range of available community services. That was some 12 years ago, so greater support on advice and guidance is long overdue as we roll this out. At the end of the day, the aim is to support patients getting the right clinical care in the right place as fast as possible. We want patients to have timely assessment of their care needs and clear next steps in the right settings. GP referrals and support for GPs in making those referrals is crucial. The advice and guidance model, which allows GPs to seek rapid specialist input into a patient’s care without an initial face-to-face appointment, and the single point of access model, which will be rolled out in October, support GPs and hospital specialists to work together and make the best treatment plans for patients while reducing unnecessary referrals and increasing waiting lists. Trusts and integrated care boards must ensure that local GPs, GP leaders, local medical committees and interface groups are involved in the design and ongoing refinement of elective single point of access pathways. In my experience, that is important because we gain their expertise and there is more buy-in to making the pathways a routine part of their work. Advice and guidance is already a routine part of much GP practice. GPs continue to be able to make clinical decisions to refer for specialist care where that is in the patient’s best interests. Advice and guidance and the single point of access do not alter the clinical threshold for a referral, and a GP’s clinical decision to refer remains unchanged. All requests for advice and guidance will receive a response from a named consultant with clear accountability and oversight. We are clear that GPs should continue to make a clinical decision to refer to specialist care where that is in the patient’s best interests. The model is intended to support decision making, not override it. To be clear to the hon. Member for Sleaford and North Hykeham, the intention was never to mandate. There is a difference, which I think was made clear in subsequent guidance on the system. The diversion rate, as she calls it, is an estimate of the potential of patients who are not referred to the right place in the first place. It is not compulsory. What the new clause proposes already exists and does not need to be set out in primary legislation. For those reasons, I ask her to withdraw it.
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.
We largely agree with new clauses 96 and 97 and the comments of the hon. Member for Isle of Wight East. He cited some organisations: Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK; hon. Members across the House have worked with them, and many other organisations in this field, and value the work that they do. The hon. Member rightly notes the work that they do to support the friends, families and carers of people with this disease, which is increasing in prevalence. He also commented on the importance of getting diagnosis earlier, and we are moving forward but we need to do so as fast as we can; I think we would all recognise that. I completely understand the rationale behind the new clauses and the urgency with which people want to have sight of the sort of information outlined in them, but we do not think that the new clauses are necessary. I will highlight why. Some of the data that would be requested by new clause 96, such as details of research in the NHS and reports of lived experience, is already available and often provided by our charity partners, as well as by others. The new clause would therefore lead to a duplication of work. Provision of the other pieces of requested information and the data collection required to produce the report required by the new clause would likely be very onerous, placing additional stress on an already overstretched sector, and would distract from the core task of improving dementia care. It would be especially difficult to get consistent and comparable information from across the adult social care sector, where data can sometimes be fragmented. Instead, we think that the modern service framework for dementia and frailty is a more helpful vehicle for setting national standards of dementia diagnosis and care, and will serve to hold the sector to account. Additional reports, such as those requested by the new clause, would distract from that and result in duplication. The framework is still in development and work is ongoing to review the relevant data, metrics and targets to inform it. The framework will also set new national standards, which will help to inform meaningful analysis in the future—something that we are all very keen to see. For those reasons, I ask the hon. Member to withdraw the clause.
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.
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.
I thank my hon. Friend for her work on and commitment to this issue, as was highlighted by the shadow Minister. I thank her also for her work on the APPG and with organisations such as Headway, to which we pay tribute for its work supporting patients and the public, and for her work with Members of Parliament and the Government on getting this right, which is legion. My hon. Friend has made similar comments in the House. The Minister responsible is continuing to work on the action plan, which I will talk about as we continue our consideration. The new clause raises the issues of prevention, identification, acute treatment, rehabilitation, long-term support, care planning, workforce capability, data and research, all of which are being considered in the work being done across the eight Departments. The Government agree that there should be a plan, and the relevant Minister, to whom I will of course pass my hon. Friend’s comments, will be working on that. The question is whether the proposals in the new clause are best placed to ensure that any plan will be robust, sustainable and timely for the patients it is designed to serve. I say gently to the shadow Minister that I think they are not. First, setting an arbitrary 30-day timeline for publication risks causing either an unnecessary delay or a duplicate plan. Secondly, as I hope she will appreciate, we have engaged more widely than with just the three Departments named in the new clause. As I have said, as many as eight Departments are contributing, which reflects the wide range of areas that are impacted by brain injury. Let me give the shadow Minister the assurance that I believe she is seeking, as are others: a plan will be published as soon as possible. That plan is being developed with the breadth, rigor and pace that the issue demands and is receiving input from across the health system, as well as from other Departments responsible for supporting people with acquired brain injuries and sector-specific stakeholders and organisations. I hope that she will work with us to support the plan once it is published, in the interests of our constituents, who desperately require a new approach to ABI prevention, care and support. I ask her to withdraw the new clause.
On new clause 105, I can assure the hon. Lady that the Government are committed to supporting self-care. Community pharmacies already play a vital role by offering accessible advice and, where appropriate, over-the-counter medicines for minor ailments. Through Pharmacy First, patients can walk into a pharmacy or be referred by NHS 111, a GP or A&E for expert support, including access to treatment under the seven clinical pathways. That helps people get the right care quickly while easing pressures on other parts of the NHS. However, we do not think that it is necessary to specify health literacy and self-care in neighbourhood health plans. The neighbourhood health framework is clear that ICBs and local authorities should work together through health and wellbeing boards to develop locally led neighbourhood plans to improve local population health and reduce health inequalities. The framework sets out what should be included in those plans, and is clear that neighbourhood health plans should be informed by local joint strategic needs assessments. If local areas think they would benefit from having a greater focus on self-care and health literacy, they are of course free to do so. However, that is for them to decide, based on their understanding of the local area’s needs. That permissive approach recognises that local leaders know their communities best and are therefore best placed to determine how to meet the population’s needs. We are not setting a ceiling on what local areas can deliver, and that approach will drive progress more than dictating an overly prescriptive national approach would. For those reasons, we do not think it is helpful or appropriate to define the contents of a neighbourhood health plan in legislation. Moving to new clause 106, the Government recognise the important role that medicines reclassification can play in supporting self-care, improving access to treatment and helping patients manage their health more effectively, where it is safe for them to do so. There is already an established, evidence-based, proportionate framework for medicines reclassification in place, which is overseen by the Medicines and Healthcare products Regulatory Agency. The UK is already a world leader in medicines reclassification, and the MHRA has reclassified more than 140 medicines over the last 30 years across varied therapeutic areas, including pain and inflammation, and continues to approve new reclassifications each year. The Government have taken proactive steps to support further reclassification. The MHRA has worked closely with industry partners in recent years to streamline and improve the reclassification application process to ensure that it is as efficient as possible for applicants, while maintaining high clinical standards. Creating an additional statutory reporting requirement would not improve the assessment of individual applications, and nor would it accelerate access to medicines for patients. Instead, it risks duplicating activity undertaken in recent years and diverting resources from the effective operation of the current system. For that reason, I hope the hon. Member for Sleaford and North Hykeham has the reassurance she needs and will not press her new clause to a vote. Question put, That the clause be read a Second time.
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.
On new clause 110, the Government are proud of the courage and dedication of our armed forces. We must all play our part in upholding the armed forces covenant, including for our armed forces veterans. The original covenant was under a Labour Government; I was proud, as part of my commissioning duties in Bristol, to work with the Royal British Legion to implement that more than a decade ago, and the work continues. I am therefore sympathetic to the intention to promote the health and wellbeing of our armed forces veterans, but I can assure hon. Members that the new clause is not necessary. The Government’s vision for veterans is clearly set out in the veterans strategy, which recognises veterans as one of the UK’s greatest strategic assets. Furthermore, the existing armed forces covenant duty already places a legal obligation on integrated care boards to give due regard to the unique obligations and sacrifices of the armed forces when carrying out their statutory duties.
I thank the hon. Lady for referencing that service in her constituency. I am not aware of the complications in the funding, but I will commit to getting back to her to understand that better, and I will see what the responses are from the commissioning function—I suspect it is a specialised one that falls between many different people. I am sure it has a long history, but I am afraid I am not directly aware of it, but I commit to getting a satisfactory response to her. The covenant duty is underpinned by two core principles: first, that disadvantages arising from membership of the armed forces community should, where possible, be removed; and secondly, that special provision may be appropriate for those who have given the most, such as the injured and bereaved. Beyond that, ICBs have a range of inequalities-related duties relevant to the circumstances of veterans. They include a duty to have regard to the need to reduce inequalities between persons in accessing health services and in outcomes achieved from those services; a duty to have regard to the wider effect of decisions, including inequalities relating to health and wellbeing and to the benefits obtained from the provision of health services; and the public sector equality duty, with which all public sector bodies must comply. Therefore, there is already a range of legal duties on integrated care boards to promote the health and wellbeing of veterans as part of the community the ICB serves. It is precisely because those duties already apply that we do not consider it necessary to replicate them in relation to neighbourhood health plans. On new clause 112, a requirement on the Secretary of State to publish an annual report on compliance with the armed forces covenant duty would be wholly unnecessary. Legislation already requires the Secretary of State to lay a covenant annual report before Parliament each year covering the effects of membership, or former membership, of the armed forces on service people in the fields of healthcare, education, housing and the operation of inquests. Under that legislation, the Ministry of Defence must obtain the views of relevant Government Departments, including the Department of Health and Social Care, when preparing the report. Any annual report on compliance with the armed forces covenant duty produced by the Secretary of State for Health and Social Care would cover precisely the same subject matter and would be a duplication of information already publicly available. New clause 111 relates to providing service personnel with their medical records within one month of discharge. The Government agree entirely that it is important that a patient and their care providers have access to their medical records. Primary healthcare for serving members of the armed forces is the responsibility of the Ministry of Defence and is provided by the Defence Medical Command. As a result, such care would be outside the scope of the amendment. There are established processes to allow for the safe transfer of relevant medical information to the service leaver and their new GP when that person leaves the armed forces. Service personnel receive a medical care summary, and are advised to register with an NHS GP and share the summary with their new GP. Existing data protection legislation also allows an individual to request their full record on discharge. We recognise that, in some instances, the process does not work as well as we would like, which is why the Defence Medical Command is already working towards greater interoperability with NHS systems and the electronic transfer of medical records from Defence Medical Command to NHS GPs. As hon. Members know, the single patient record will, wherever possible, draw on and connect relevant information in source records, such as GP IT systems and hospital electronic patient records, and allow the patient to see their record in the NHS app. That innovation further renders the measure unnecessary. For those reasons, and because the objectives are already being delivered through existing duties and ongoing reforms, I ask that the new clause is not pressed to a Division. Question put, That the clause be read a Second time.
I will respond to the hon. Gentleman in a moment, but first I will address clauses 68 to 72, as well as amendment 77, which was tabled by the hon. Member for North Shropshire. Clause 68 will allow the Secretary of State, by regulations, to make provision that is consequential on this Bill. Amendment 77 would amend that provision. The Government recognise the importance of parliamentary scrutiny of the significant changes proposed in the Bill. While the Bill contains some new regulation-making powers, the majority are existing powers that have been amended in the light of the abolition of NHS England. They will therefore be uncontroversial and consequential, so we consider it proportionate for the same parliamentary scrutiny arrangements to continue to apply in respect of those powers. However, where we are introducing new regulation-making powers, we have carefully considered what parliamentary scrutiny arrangements should apply. For example, any regulations that are made to facilitate the single patient record will be subject to the affirmative procedure, because we understand the importance of debating that issue in both Houses. Furthermore, any statutory instruments made under clause 68 that amend, repeal or revoke provisions made by primary legislation will be subject to the affirmative procedure and will need to be debated and passed by both Houses. I hope that the hon. Member for North Shropshire agrees that a blanket requirement for the affirmative procedure would be disproportionate. She said that she will not press amendment 77 to a vote, but I hope that what I have said provides her with the reassurance she was seeking. Clause 69 is a standard clause that appears in Bills that provide for the expenditure of public money. It simply provides for any expenditure incurred by the Secretary of State as a result of changes made under the Act, once it has received Royal Assent, to be paid out of money provided by Parliament. Clause 70 sets out the territorial extent of the Bill. While most of its provisions extend only to England and Wales, some are UK-wide. The clauses in the Bill largely apply to England only, and in previous sittings we debated the consequences for Wales, Scotland and Northern Ireland, and any issues relating to devolution, as and when they have arisen. Amendments to other legislation made by this Bill will have the same territorial extent as the legislation that will have been amended. Clause 71 sets out when provisions in the Bill will come into force once it has received Royal Assent. As is usual, the clause provides the Secretary of State with the power to commence the majority of the Bill’s clauses on a date to be set out in regulations. It may also be appropriate to bring different provisions in the Bill into force at different times, and the powers in clause 71 will allow for that. The powers will also enable the Secretary of State to make saving or transitional provision in connection with the coming into force of any provision, which will enable the commencement of the Bill to operate smoothly and efficiently. Under clause 63, as the Committee has heard, the Care Quality Commission will be able to take action to bring proceedings against a health and social care provider for a serious breach of regulations. However, that provision will apply only to new offences. To ensure that we can act to prevent cases falling through the gaps, we are committed to bringing in the measure as soon as possible after Royal Assent, while respecting the routine two-month window, as is set out in the Bill. Clause 72 is self-explanatory and provides that, once passed, the Bill may be cited as the Health Act 2026. I commend the clauses to the Committee. Before I conclude, I put on record my thanks to you, Ms Lewell, and to the right hon. Member for Herne Bay and Sandwich (Sir Roger Gale), my hon. Friend the Member for Ealing Central and Acton (Dr Huq) and the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), for guiding this Committee—[Hon. Members: “Hear, hear.”] I also thank the Clerks for everything that they have done behind the scenes. This is the first Bill that I have taken through a Public Bill Committee, and the work really is quite legion. The Clerks’ expertise is second to none and a delight to see closely. Equally, I thank the officials in the Department of Health and Social Care and the lawyers, some of whom have worked on several Committees over the years. Again, I have learned so much from them and their expertise. It is a dedicated team, and their hard work and expertise on Bills over many years is good to see. I thank them for their support in making this Bill go forward. I thank the hon. Members for Farnham and Bordon and for Sleaford and North Hykeham for their kind comments and good wishes. I also thank members on both sides of the Committee for their contributions over the past few weeks. Despite the heat, I, too, have enjoyed our discussions. I think that we have given the Bill a very good airing and there has been constructive engagement and scrutiny. They have given us lots of food for thought, which we have taken careful note of, regardless of whether we have taken up the amendments.
I thank the hon. Member for her kind comments. As the former Minister, the right hon. Member for Melton and Syston, recognised, I have been on the other side when considering a previous Bill. Opposition is hard work—the process is quite hard work on this side—and I commend Opposition Members for conducting that important scrutiny. I thank Members for their contributions and I think the Bill is stronger for those efforts.
It is a pleasure to serve under your chairship, Sir Alec. I thank my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) for securing the debate and for all his work in championing the rights of disabled people. He is tireless in what he does. I also put on record that Changing Places toilets were first introduced in Nottingham, where my constituency of Broxtowe is. I am proud that Nottinghamshire carries that legacy of innovation. In previous roles, I have been a champion for disabled people, and many people have spoken to me about the need for Changing Places toilets. Many people with profound, multiple and severe disabilities and neurological conditions have complex needs, and a standard accessible toilet is insufficient. Many require a Changing Places facility equipped with a hoist, an adult-sized changing bench and adequate space for carers to provide sufficient support safely and with dignity. Without those facilities, everyday activities that many of us take for granted become impossible—a family day out, a trip to the high street, visiting a museum, going shopping or meeting friends. Many of us take those things for granted, but those ordinary experiences are denied to too many people because they do not feel confident that their needs will be met once they leave home. According to the Office for National Statistics, there are 10,000 disabled people in my constituency of Broxtowe who require a Changing Places facility, but there are only two such facilities there, meaning that people in Eastwood, Awsworth, Stapleford and Beeston do not have access to suitable provision. Only one of those facilities is modern enough and regularly open. Disability rights charities and organisations across the country talk about disabled people and their carers restricting their journeys or avoiding going out altogether because they cannot find suitable toilet facilities or be certain that facilities will be open and accessible. Isolation, loneliness and poor mental health are often attributed to low social interaction, which can lead to anxiety and depression—that is what such facilities being missing can mean for disabled people. Parents of disabled children frequently report to me avoiding going out on outings altogether, not because they want their children to be excluded but because they cannot be certain that they will find a changing facility. As a result, people become isolated from their communities and excluded from socialising. No child should be excluded from public spaces because there is nowhere suitable for them to change when necessary; no parent should have to choose between taking their child out and preserving their dignity; and no adult should be prevented from participating in social activities because the basic infrastructure that they require is absent. The last Government rightly addressed some of this by making changes to building regulations that will increase Changing Places provision in new, large non-dwelling buildings. That is a welcome step and will improve access over the long term. However, disabled people cannot wait for a future development to solve today’s problems. Capital funding is needed now. The reality is that there are still large gaps in provision across the country, particularly in our transport corridors, town centres, tourist destinations and rural communities. I urge the Government to look at how Changing Places provision can be embedded with current and future urban planning and within the Government’s high street strategy, with capital funding attributed to it. Accessible toilet facilities should form part of any strategy to create genuinely accessible high streets, ensuring that disabled people can confidently visit their towns, cities and public attractions without fear of being left without appropriate facilities. Capital investment in Changing Places toilets is not simply an investment in buildings or facilities themselves; it is an investment in an inclusive society where disabled people can enjoy the same opportunities, freedoms and quality of life as anyone else.
I thank the Minister for his statement. The option taken for Nottingham and Nottinghamshire sees Broxtowe borough council split in two; Eastwood and Brinsley will sit in the county and the rest of the borough will form part of the Greater Nottingham authority. What consideration has he given to the additional difficulties that splitting up an area will cause for our public services and electoral services?
Members will have seen that we are a bit pressed for time, so after this speech I will be reducing the time limit to three minutes.
I call the Liberal Democrat spokesperson.
I call the shadow Minister.
Like many in Cannock Chase, I am glad that this reorganisation, which no one asked for and no one voted for, is finally nearing its conclusion. It is fair to say there was not a whole lot of consensus on council boundaries in Staffordshire, but there is consensus on wanting a combined authority, so that we can seize the opportunities open to other parts of England and turbocharge growth in our incredible county. Will the Secretary of State give me some reassurance that we can get on with this as quickly as possible, for the benefit of the people of Staffordshire and Stoke-on-Trent?
Like many colleagues who have spoken, I pay tribute to Sir David Amess. Today, I make a speech that I never thought I would have to make, to pay tribute to a good friend, Councillor Shanika Mahendran, who passed away on 1 July at the age of just 28. I met Shanika in 2022 on the Next Generation programme run by the Local Government Association’s Labour group. Although I wondered why I was among such an incredibly talented cohort, it was plain to see why Shanika was. Despite being a relatively new councillor, she was clearly destined for an outstanding career in local government, and anything that she put her mind to. She was particularly passionate about planning, placemaking and her beloved home city of Milton Keynes. As a young woman of colour in politics, Shanika faced condescension and sexism that no one should, particularly given that she was outstanding in all the roles she held. Despite that, Shanika carried a lot of self-doubt, but one of the joys of knowing her was seeing her confidence gradually blossom into a realisation of the enormous contribution she made. That is why we were devastated to hear, towards the end of June, that Shanika had been diagnosed with a rare and aggressive brain tumour. Such is the cruel speed at which this condition can move that Shanika was with us for just one week after we heard that news. I do not think that Shanika’s loss has really sunk in yet, but I wanted to make this speech because, above all, she was someone who believed in doing things, not just saying things. I hope that sharing her story can shine a light on the experience of thousands of others. Brain tumours remain the biggest cancer killer of children and adults under 40, yet fewer than 13% of adults diagnosed with a high-grade tumour will survive beyond five years, and the condition accounts for just 3.2% of national cancer research funding. There are more than 120 types of brain and central nervous system tumours, making them particularly difficult to identify quickly. The Brain Tumour Charity found that 41% of patients visited their GP three or more times before receiving a diagnosis. I welcome the Government’s commitment to improve outcomes through the national cancer plan, including by investing in the national Brain Tumour Research Consortium. Researchers are developing new approaches, from immunotherapies to personalised medicine, but many promising breakthroughs have yet to reach the bedside and we need to do more to support that. In Shanika’s memory, we can back earlier diagnosis and more research to ensure that every patient has access to the best possible care. Before I completely go to pieces, I will finish with a few words from a poem by David Harkins that was sent around our Next Generation cohort by Councillor Lorna Fielker: “You can shed tears that she is gone, Or you can smile because she has lived. You can close your eyes and pray that she will come back, Or you can open your eyes and see all that she has left”.
The European Commission has confirmed that member states may partially suspend EES checks for up to 90 days at peak times, extendable for a further 60 days. Can the Minister confirm whether there have been conversations with European counterparts about applying that flexibility at Dover, Folkestone and St Pancras this summer?
Our energy, defence and railway sectors depend on steel. Does my hon. Friend agree that steel made by British workers, in Britain, and owned by the British people, is not only in our infrastructure interest but in our national interest?
I thank the Secretary of State and his officials for all their hard work. I lobbied hard for a single unitary in Warwickshire, and I know that is not the decision that he has been made. There is pretty much near unanimity among politicians and officials at Rugby borough council and Warwickshire county council. Will the Secretary of State ensure that he looks at the disparities around tax income in the north of the county versus the amount of expenditure on services? Will he also ensure that towns and parish councils get a proper role, and that the role of MPs is protected, because it sometimes feels as though our role is diminished in this new ecosystem of government?
I apologise to the Minister; I am hopping between two different debates in two different Chambers. I told my constituents that I would make this point about planning policy in my area, which has fought for decades to protect the green belt. The introduction of the concept of the grey belt means that developers are now turning green belt into grey belt by dumping, cutting down trees and despoiling the area, and then applying for planning permission for development. The concept of grey belt has undermined all that we have spent decades campaigning for.
Four years ago, we welcomed many new residents into a number of new homes in my constituency. Despite saving up, getting themselves on the property ladder and paying anything between £300,000 and £500,000 for brand-new leasehold properties, those living at the Bluenote apartments have found themselves living in a nightmare. Bellway Homes was the developer, and Bellway-appointed directors control the residents’ management company. When the residents moved in, they found that the boiler was not fit for purpose and they regularly went without any hot water or heating for days. The car park gates were constantly breaking down and trapping vehicles inside the car park. The patio slabs were uneven and dangerous, leading to injury, and there were leaks from the roof into individual apartments. Very quickly, service charge bills far exceeded the estimates provided by Bellway, and Bellway and its directors refused to engage. Four years on, the scale of the problems has grown. Over £100,000 of residents’ funds remain unaccounted for, including money from the heat supply and reserve funds. Service charge demands have doubled in four years, and residents have been charged for fixing defects for which the developer is responsible. Residents have been refused basic financial information, including the end-of-year accounts, receipts and invoices that they are entitled to see under the Landlord and Tenant Act 1985, even though they have gone through every appropriate route. The dangerous patio slabs remain. Bellway has refused to transfer the freehold to leasehold, even though it is contractually obliged to do so. It has allowed the property management companies— Premier Block Management and Gateway Property Management —to act with impunity in sending out grossly inflated and incorrect service demands, and it has put my constituents under intense pressure to take over the property management companies and expose themselves to significant personal liabilities. Bellway has been able to get away with this because it controls the management, has control of the freehold and has the resources to bully my constituents, including by instructing top law firms to send them threatening letters. All I am doing is calling on Bellway to be transparent about the building’s finances, to resolve the outstanding issues and the physical problems that the residents are facing, and to transfer the freehold, as it is contractually and morally obliged to do. I welcome the Government’s draft leasehold reform Bill. However, this case exemplifies the fact that the Bill needs to be much more robust, particularly in relation to service charges and the management transfer process. I do not want to experience this again with other constituents. As I have said, the residents have gone through a living nightmare because of the unaccountability of this development and the management company.
I wish you, Madam Deputy Speaker, and all colleagues throughout the House a very restful recess. Can the Leader of the House give us an update on the progress of addressing the backlog of civil service pension scheme cases, particularly those affected by the McCloud judgment? I am extremely concerned that one of my constituents has been retired for two years now and has still to receive their pension scheme benefits.
I welcome today’s decision, which brings an end to decades of destabilising indecision across Warwickshire, and I thank the Government for being decisive. The decision, which has cross-party support from four of the five districts in Warwickshire, will empower North Warwickshire to focus on growth, investment and funding to meet the needs of our communities, and allow us to be the masters of our own destiny. A previous report raised concerns about sustainability—this was before the Government’s generous settlement under fair funding—so can the Secretary of State reassure my residents that financial assessments were done in full before considering the options?
I refer the House to my entry on the Register of Members’ Financial Interests. I have grave concerns about the Nottingham and Nottinghamshire proposal, under which there will be an extreme deficit of a predicted nearly £150 million. Most of our areas, because of the demographics in our post-coalfield communities, are band A with high social care needs. I cannot see how this proposal will cover those costs. The Secretary of State has talked about a rebalance; I perceive it as an imbalance. A city solution will sacrifice my communities, who are an hour away from Nottingham, and will not solve the problems that left-behind communities have experienced for far too long. I ask the Minister to meet as soon as possible the six Labour MPs who have expressed severe concerns about this proposal.
Thank you, Sir Desmond. I am pleased to be here to present the Culture, Media and Sport Committee’s report “Protecting built heritage” and I am grateful to the Backbench Business Committee for allocating time for this statement. I also thank the Chair of the Culture, Media and Sport Committee, the hon. Member for Gosport (Dame Caroline Dinenage), for handing on the baton to a fellow Committee member. The Committee launched its inquiry into the state of our built heritage back in December 2024. Over 12 months, we held five sessions, heard from 26 witnesses and received 113 pieces of written evidence. We also visited the National Gallery, the Southbank Centre, Buckingham Palace and V&A East Storehouse. I thank all those who gave evidence and welcomed us on visits. Our report, published on Monday, is the product of extensive evidence from heritage organisations, local authorities, faith groups, businesses, community organisations and individuals from across the country. This inquiry is particularly important to me. Before returning to Parliament, I oversaw Leigh Spinners Mill, a grade II* listed former cotton mill in the heart of Leigh in my constituency. There I saw at first hand both the challenges and the opportunities that come with preserving historic buildings. I was involved in efforts to restore and repurpose the site so that it could support heritage, enterprise, arts and culture while serving our great community. That experience reinforced my belief that our historic buildings are not simply reminders of the past, but assets that can contribute to our future prosperity and wellbeing. Built by previous generations with confidence in the future of their towns, they should continue to be valued, preserved and invested in as part of our future. That is one of the central messages of this report. Built heritage plays a vital role in the identity of our towns, villages and cities. Historic buildings support tourism, provide community spaces, create opportunities for economic growth and contribute to a sense of place and belonging. However, we heard concerning evidence that many of these assets are under growing pressure from rising costs, workforce shortages and a planning system that is too often inconsistent and difficult to navigate. Yet alongside those challenges lies a tremendous opportunity. Historic England estimates that up to 670,000 homes could be created through the reuse of vacant or underused historic buildings. That is almost half of the Government’s 1.5 million homes target. We were struck by an initiative in Italy where homes can be sold for as little as €1, so long as they are neglected heritage assets that are successfully transformed into homes. We should demonstrate similar ambition. Too often, policy treats reuse as an afterthought rather than a priority. Our report argues that that must change. We therefore recommended the development of a national “heritage-to-housing” approach, and a broader strategy that puts the reuse and adaptation of existing buildings at the heart of regeneration policy. We also believe that there is merit in establishing a dedicated programme to support the repurposing of underused town centre and high street buildings, helping local authorities to unlock opportunities for housing and economic development. Our Committee also found that a one-size-fits-all approach to high street regeneration does not work. Communities face different challenges and opportunities. We therefore recommend better tools and frameworks to help local authorities to identify the interventions that are most likely to succeed in their area, and to ensure that investment is targeted effectively. The Committee also heard consistent concerns about the operation of the planning system. Owners, developers and community organisations told us that lengthy waits for planning and listed building consent can discourage investment and delay projects that would otherwise bring historic buildings back into use. We heard evidence that many listed building consent applications are ultimately approved, but decisions are often delayed, creating uncertainty and additional costs. Although recent reforms are welcome, the Government must go further to streamline processes, encourage the wider use of the local listed building consent orders, strengthen conservation capacity in local authorities and promote earlier engagement between applicants and planning authorities. Financial barriers remain a major obstacle to the preservation of built heritage. Witnesses repeatedly highlighted the fact that the current VAT regime often makes repairing and reusing existing buildings more expensive than demolishing them and starting again. While works on residential buildings and some conversions are zero-rated for VAT, owners of listed buildings are still required to pay VAT at 20% on construction and alteration works. We found that that creates a difficult incentive that runs counter to heritage protection and wider environmental objectives. We also heard of the pressures that that regime places on historic high streets and the businesses that occupy heritage buildings. We therefore urge the Government to review and reform that tax framework so that it better supports retrofit and reuse, conservation and the future of our high streets. We also heard compelling evidence about the challenges facing churches and other listed places of worship. England has over 370,000 listed buildings, almost 15,000 of which are churches and religious buildings. Many are not only important heritage assets but vital community spaces, providing support, activities and services far beyond their primary religious function. However, many of those buildings face significant financial pressures. Witnesses raised concerns about the reduction in support previously available through the listed places of worship grant scheme, and the potential impact of its replacement with a new grant scheme, the places of worship renewal fund. Although targeting funding at areas facing the greatest challenge is an understandable objective, we concluded that there is a real risk that places of worship of exceptional historic and architectural significance could be disadvantaged if heritage value is not given sufficient weight. We therefore call on the Government to ensure that the new funding arrangements provide adequate support for repair and conservation works and properly recognise the national and local importance of those irreplaceable buildings. The loss of an historic church is not simply the loss of a place of worship; it is often the loss of a key part of a community’s history, identity and shared heritage. The future of built heritage depends on people. One major risk identified in our inquiry was the shortage of specialist skills across the sector. From traditional crafts and conservation skills to planning, expertise and heritage management, there is an urgent need to attract and train the next generation. I was particularly impressed by an innovative heritage skills programme in the north-west, offered by the Hopwood Foundation and implemented at His Majesty’s Prison Thorn Cross, which can create pathways into employment while helping to address workforce shortages. The Government should build on those successes and work with the sector to expand opportunities for training and careers. We also heard that many small and specialist heritage buildings struggle to make full use of existing arrangements, despite being responsible for passing on many of the traditional skills that the sector relies on. Greater flexibility in the apprenticeship system would allow businesses to pool apprentices, share training costs and collaborate more effectively. If we are serious about safeguarding our built heritage, we must ensure that the next generation of stonemasons, joiners, roofers, conservators and heritage specialists have clear pathways into these careers. Ultimately, our report makes a simple argument. Heritage should not be viewed as a constraint on growth; it should be recognised as an enabler of growth. The Government now have an opportunity to adopt a more ambitious approach that will secure both the protection and potential of our built heritage for generations to come.
The hon. Member is absolutely right to mention councils and local authorities, which are trying to do so much work in the country. The report points out that every place will be different; it is about pulling on the expertise of local authorities and town councils to find what fits within particular areas. The hon. Gentleman has made a good point, and it is now up to the Government to read the report and look at best practice throughout the UK.
My hon. Friend makes an important point, which goes back to the previous question. The report has highlighted schemes that have worked for particular areas, such as the community ownership fund and heritage action zones, something we had in my area. These things pull on the expertise of partners, including local authorities and the community, by getting them around the table. Getting everyone around the table to make sure that funding goes where it is needed is an important factor that we are trying to lead on with this report.
The right hon. Gentleman is a great contributor to the Culture, Media and Sport Committee, and it is an honour to sit alongside him there. I agree that there is significant scope for heritage buildings to play a bigger role in providing such things as hotel accommodation. One of our findings was that the best way to protect many historic buildings is to ensure that they remain occupied, economically viable and actively used. The report focuses on a reuse-first approach, rather than a housing-only approach. Where hotel accommodation can provide a sustainable future for historic buildings, it can support tourism and create local jobs and is an excellent way of bringing our heritage back into use.