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1. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   I beg to move, That the clause be read a Second time. Advice and guidance services were an improvement. Previously, if a general practitioner wanted to refer someone to hospital, a consultant would triage the referral. Sometimes, the referral was not needed, so a message would be written to the GP saying, “I wonder if you’ve tried this” or “Could you give more information, please?” Improving that process was the advice and guidance service, which in many ways is beneficial. I am, however, concerned by the suggestion earlier in the year that advice and guidance will become a compulsory feature, and that only after advice and guidance has been received will there be potential for referral. Instead of a GP being able to refer to a consultant and a consultant being able to accept that referral, advice and guidance will have to be sought first. That will cause a delay in patient pathways and flow. It may mean that the date on which the person is added to the waiting list for an appointment is a couple of days later. That may slow things down and improve the figures, but I cannot see any clinical benefit from mandating it. There is also a concern that there would be what is called a diversion rate of at least 25% by March 2027 for at least 10 high-volume specialties. I am concerned about that. If someone gets to the point of being given a hospital appointment, that is because the clinician who saw them in primary care used their clinical judgment to decide that the patient needed that appointment, and the consultant triaging the referral used their clinical judgment to decide that the patient needed to be seen.

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2. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   I think we are all getting busier. As such, it is harder for clinicians in primary care to phone the consultant and speak to them, because both are busy and potentially seeing patients. I am not criticising the ability to have an advice and guidance service, because it is helpful. We do the same with specialists in tertiary centres, for example. One might send them a message asking a question. Advice and guidance is a good principle. My concern is that it would remove the ability for consultants to refer directly, introducing an unnecessary delay in the system. Are we questioning the judgment of clinicians? Why do we want to reduce the number of patients who get put on the list by a quarter? I recognise, as I am sure the hon. Member for Bury St Edmunds and Stowmarket does, that sometimes referrals could be better directed. There is a mechanism already for doing that, but new clause 86 reflects the fact that general practitioners should still be able to refer patients using their clinical judgment to a consultant. That may be someone who the patient has chosen to see or who the GP believes is right for the patient’s condition.

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3. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   If they are, they can use the advice and guidance service. The point is that when a general practitioner wants to refer his or her patient to a consultant on the basis of their clinical need, they should be able to. That is the purpose of the new clause.

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4. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   If the hon. Lady is correct, she will not be perturbed by the new clause, which simply says that general practitioners must be able to directly refer patients to consultants when clinical need requires it. I would like to press the new clause to a vote. Question put, That the clause be read a Second time.

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5. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   I beg to move, That the clause be read a Second time.

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6. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   New clause 87 would amend the Medical Training (Prioritisation) Act 2026 so that British citizens who have studied at international branch campuses of UK higher education institutions can be prioritised for foundation programme training places. Prioritising British students in the selection process would have been the right thing for the Government to do, but way the Medical Training Act has been drafted places British students who studied at international branch campuses of British universities at a disadvantage. On Second Reading of the Act, a Member spoke of a constituent who had been given “a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus.”—[Official Report, 27 January 2026; Vol. 779, c. 801.] Another Member said that he had “representations from all quarters, both in the UK and in Malta, about the impact on Malta of this.”—[Official Report, 27 January 2026; Vol. 779, c. 802.] My right hon. Friend the Member for South West Wiltshire (Dr Murrison) asked about “British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service”. —[Official Report, 27 January 2026; Vol. 779, c. 803.] The hon. Member for Uxbridge and South Ruislip (Danny Beales) spoke of a constituent who was schooled and grew up here and was “given a guarantee by the university that she would face no disadvantage compared with students on the London campus.”—[Official Report, 27 January 2026; Vol. 779, c. 842.] These concerns are shared across the House. Young British people who have trained at a British or London-based university and gone to study in Malta, perhaps in an adventurous spirit—it is a beautiful place to go—and have graduated with a British degree have found themselves at the back of the queue, unable, round after round, to get jobs in the foundation programme in their home country. That will not just be the case for students who are due to start their degree; it is the case for students who have just completed their degree. They have done the five years of training, they have worked really hard and they have passed their exams, but suddenly they cannot get a job on the foundation scheme in their home country to complete their full registration with the General Medical Council. Our new clause would ensure that British citizens who studied at international branch campuses of UK higher education institutions can be prioritised. I invite Members to do right by our constituents and the NHS and to vote for it.

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7. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   There are fewer than 100 students who are British citizens studying in Malta this year. Many of them have struggled to get a role on the foundation scheme. The Government have created a situation in which a British student doing a British degree at a British university with an overseas campus is put into the foundation scheme behind a foreign student studying here, or indeed in the same prioritisation group as a foreign student studying at a foreign university. That cannot be right, so I would like to push the new clause to a vote. Question put, That the clause be read a Second time.

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8. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   I beg to move, That the clause be read a Second time. Under the Government’s preference-informed allocation scheme, when a doctor is applying for a foundation post, they are allocated randomly to a job. They get to express a preference, but there is no work they can do to make them more likely to get where they want to be; there are no certificates they can earn, there is no research they can do, and there are no exam results they can get that would improve their chances. That is fundamentally wrong. The Government say that many people get their first choice, which is true. That is great for them, but it is not great for the people who do not get their choice and have no control over their future. We had a very good debate on this subject, attended by many people in this room, in January, and there was widespread agreement on both sides of the House that it was the wrong thing to do. The Minister said at the time that the Government would keep the system under review. Has the Minister reviewed the system? Does she believe that we should prioritise medical graduates with the most relevant qualifications, clinical experience and skills? Does she think that doctors should have the opportunity to have control over where in the country they work and what jobs they do? Should doctors be able to work harder, aim for better results or do additional activities in order to get themselves the job they want, or does she think it should all be done by a computer? I would be interested to hear the Minister’s thoughts. The new clause makes clear our position that meritocracy should prevail and people should be rewarded for the work they do and the results they get, and that we should be hiring the best clinicians who apply for the jobs.

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9. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

   Health Bill (Seventeenth sitting)

   Correct.

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10. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    It would amend the relevant part of the Medical Training (Prioritisation) Act 2026, so that when people are put forward for these jobs in the foundation programme, it should be done on the basis of merit. At the moment, as the hon. Member is aware, it is done on the basis of random allocation—preference-informed allocation—which I think is wrong. I would be interested to know the Minister’s thoughts on the subject.

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11. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    The new clause deliberately says that applicants would be prioritised based on merit, and it gives examples of ways in which merit might be judged. I understand what the Minister says about some people getting the job of their choice, but the people who do not have no control over the process, and no ability to influence it through their own hard work and effort. That is fundamentally wrong in principle. Although I recognise that the current method was brought in as a result of consultation, I feel confident that the same consultation, done now, would reject it. We would like to vote on the new clause. Question put, That the clause be read a Second time.

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12. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    I beg to move, That the clause be read a Second time. During a Westminster Hall debate in December, a Government Minister said: “In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan”.—[Official Report, 4 December 2025; Vol. 776, c. 472WH.] We are now in the second half of 2026. Members may be familiar with the charity Headway UK, which does phenomenal work to support people affected by brain injury, including people in my constituency. Headway has called for the Government to treat the plan as a priority, reiterating that every delay has real consequences and that survivors need support now. The all-party parliamentary group for acquired brain injury, which the hon. Member for Blaydon and Consett has done a great deal to support, has called for the Government to take action. So why is action not forthcoming? Why have the Government failed to deliver another policy on time? It is part of a pattern. The Government spent a year writing a 10-year plan. They spent another year working on a workforce plan, which still has not been published. It is simultaneously “imminent” as of 30 days ago and non-existent today. They are behind on the Hughes report, the modern service frameworks, universal 24/7 mechanical thrombectomy, fracture liaison services and more. The new clause would simply commit the Government to delivering on their promise to the 1 million people living with the effects of acquired brain injury. I struggle to see how the Assistant Whip can compel Members to vote against that.

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13. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    The Minister said that the plan is being developed with the pace that is needed, but it is not. It was due to have been published already, but it has not been. It was due to have been published, then a later promise was made, and now she is making another promise with an uncertain date. I just do not think it is good enough. A theme of our consideration this afternoon has been all the different things the Government have promised but have failed to deliver.

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14. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    Yes, I accept that it has taken too long, and that is the point. I assume that it must be ready to go, because the Minister has been working on having it published by the end of June, and we are in the middle of July. The Minister can inform us whether that is the case. We have reached a point where the Government keep saying “later”, “soon”, “imminent”, “in due course” and “working at pace”, but that is not helping to get this done. The new clause would force the Government to get on with it. That is what I think needs to be done, and that is why I will press it to a vote.

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15. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    I beg to move, That the clause be read a Second time.

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16. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    The Government’s 10-year health plan says that reducing hospital admissions is a key goal for the neighbourhood health service. These new clauses could help, because they would require the Secretary of State to support self-care and health literacy in neighbourhood health plans and to conduct a safe and proportionate reclassification of some medicines. Pressure on GPs continues to grow, with the total number of GP appointments reaching almost 377 million in 2025. The new clauses are designed to relieve pressure on the healthcare system and allow people to take back control of their healthcare. There are medicines that could be considered for reclassification from prescription-only to being available from pharmacists without a prescription, in the way that medication for migraines, for example, previously had to be prescribed but can now be bought with supervision from a chemist. How might measures to increase self-care or pharmacy care square with the Secretary of State’s duty to improve health inequalities outlined in the Bill? In addition, the new clauses might help neighbourhood health centres in rural communities to increase availability of medicines closer to people’s homes. I will stop there, because I know that we are running short of time. The principle is to give people the ability to take control of their own healthcare and to more easily access medications that are currently under a higher classification, where it is safe to do so.

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17. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    New clause 109, tabled in my name, is very simple, requiring hospice funding to be provided in three-year blocks. Hospices are struggling under the weight of the national insurance rise in the Government’s first Budget, so they would benefit greatly from having a bit more certainty over how much their funding will be from year to year. I am interested to hear the Minister’s response to the new clause.

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18. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    I would like to move the new clause. We see hospices in huge financial distress at the moment, and we need to get their funding on a more certain footing. New Clause 109 Hospices revenue funding “The Secretary of State must ensure that any funding for hospices is allocated for three-year periods.” This new clause places a duty on the Secretary of State to ensure that funding allocations for hospices is made on a three year basis.—(Dr Caroline Johnson.) Brought up, and read the First time. Question put, That the clause be read a Second time.

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19. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    I beg to move, That the clause be read a Second time.

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20. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    Under the previous Conservative Government, the NHS constitution was updated with a commitment to guarantee that “those in the armed forces, reservists, their families and veterans are not disadvantaged in accessing health services in the area they reside.” The previous Government also introduced the veterans’ strategy action plan, committing NHS England to providing millions of pounds for specialised support services. Ministers also introduced a single point for veterans to access mental health services and support. The previous Conservative Government also created an armed forces covenant duty. Today, we need to see the principles the covenant brought to life at all levels of Government. Only last week, I received an email from a constituent who has moved around because of her husband’s service in the armed forces and who was struggling to access specialist services for her child’s health as a result. That is why we need new clause 112, which would require the Health Secretary to report on how they are meeting the duties under the covenant. Members will know that I am cautious about mandating any more paperwork, but veterans are being let down. We need some accountability. That report would hopefully achieve that, so I commend the new clause to the Committee.

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21. 16 Jul 2026·Parliament·Conservative·Dr Caroline Johnson

    Health Bill (Seventeenth sitting)

    I echo the Minister’s thanks to the Clerks, House staff and others, as well as members of the Committee. Leaving aside the heat, I have also enjoyed our exchanges. I hope that the Minister has a good recess and that she does well in the upcoming reshuffle.

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22. 16 Jul 2026·Parliament·Conservative·Dr Ben Spencer

    Road Congestion

    The A244 has always had too much traffic and too many heavy goods vehicles on it. It goes through Oxshott in my constituency, and following the roadworks on the M25 and A3, increasing numbers of cars and large vehicles are using it as a shortcut between the A3 and the M25. We need that to stop. Will the Secretary of State meet me and work with our local community to improve and reduce traffic on the A244?

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23. 16 Jul 2026·Parliament·Conservative·Dr Ben Spencer

    Sir David Amess Summer Adjournment

    I would like to raise a deeply troubling case that highlights serious concerns about the integrity of DNA testing within the Child Maintenance Service and questions surrounding the existing safeguards in place to protect families. I want to share, as was recounted to me, what happened to my constituent Ms Chelsea Millar, her fight for justice and the serious questions that it raises. Ms Millar separated from her former partner Mr Brown shortly after the birth of their son in March 2022. When she applied to the CMS for child maintenance a few months later, paternity was disputed and the CMS arranged DNA testing through Cellmark, an independent private company specialising in forensic and relationship DNA testing. Ms Millar attended an approved testing clinic. However, her former partner requested that the DNA sample be taken at Woodlawn medical centre, a location that was not on Cellmark’s approved list of collection sites. Despite that, the testing kit was sent there. Crucially, Cellmark did not verify that the centre was authorised or capable of conducting CMS DNA testing, and neither was my constituent informed of the change. The result came back stating that Mr Brown was not the father. Ms Millar knew the result was wrong; she knew Mr Brown was the dad. Through her own determination, Ms Millar persuaded Mr Brown’s mother to participate in private DNA testing. That test established that the child was her biological grandson—Mr Brown’s mother was grandma—and as Mr Brown is an only child, it confirmed that the official CMS result could not be correct. Subsequent investigations by the Department for Work and Pensions and the police confirmed what had happened. An employee of Woodlawn medical centre, Robert Patel, had conspired with Mr Brown and tampered with the DNA testing process. Both Mr Brown and Mr Patel were subsequently convicted and sentenced to prison for fraud. My concerns regarding this case are not limited to individual wrongdoing; it raises fundamental questions and concerns regarding the security of the chain of evidence relating to DNA testing and the process as a whole. Why was the DNA testing kit sent to an unapproved collection site without proper checks being carried out? What assessment or oversight of the company and its practices did the CMS undertake before and after the commissioning of DNA testing? Most importantly, what lessons have been learned to ensure that no other parent or child has to endure the same ordeal? People need to have confidence in paternity testing, whether in child maintenance or other forensic uses. The chain of evidence needs to be secure. Will the Government urgently review that, and meet me and my constituent to discuss this case and the measures that can be taken to strengthen oversight, accountability and safeguards within paternity testing? Families must be able to trust that decisions that affect their children are based on processes that are secure, reliable and beyond reproach.

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24. 16 Jul 2026·Parliament·Conservative·David Mundell

    Bus Services

    Does the Minister hold any sway with the bus operator Stagecoach? If so, can he convey the concerns of my constituents about the reliability of the X74 service, which operates between Dumfries and Glasgow? Stagecoach has put older buses on this route, leading to poorer reliability and more cancellations. Given that most of the route is along a motorway, I am sure he understands how unsatisfactory breakdowns are.

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25. 16 Jul 2026·Parliament·Conservative·David Mundell

    Business of the House

    Last summer, the Prime Minister and his family holidayed in my constituency. Now that he has more time on his hands, he would be very welcome back—as are all hon. Members. If the Leader of the House finds himself unexpectedly with some spare time towards the end of the month, may I invite him to join me on the last Friday in July in the muckle toon of Langholm for the common riding, where he will see Cornet Hope presented with the burgh standard and, accompanied by hundreds of riders, ride around the town boundaries, as well as hear the crying of the Langholm fair by Rae Elliot not once but twice on horseback?

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26. 16 Jul 2026·Parliament·Conservative·David Davis

    Sir David Amess Summer Adjournment

    Last month’s sentencing of Nicola Sturgeon’s husband exposed the real reasons behind the Scottish Government’s persecution of Alex Salmond. From 2010 to 2022, Peter Murrell abused his position to embezzle almost £500,000 from the SNP to buy luxury items. He used SNP money to buy a £33,000 Volkswagen Golf. Then he stole £57,000 to buy a Jaguar car. Further luxuries included handbags, an £850 gold pendant, four separate coffee machines costing £9,000, luxury kitchenware, at least 26 fountain pens costing nearly £21,000, and two £350 Dyson hairdryers—for a man with no hair. Really? Then, of course, there is the infamous £124,000 motorhome. Did Sturgeon not wonder where he got the money for all the vehicles, the kitchenware, the handbags, the pens, the pendant she loved? After all, who used the Dyson hairdryers in that household? My view on Sturgeon’s denial is clear: she is lying. She knew full well what her husband was doing and how those luxury purchases were funded. That Murrell was a thief was obvious in the 1980s, when he stole from Alex Salmond. Salmond told Sturgeon it was deeply unwise to keep her husband on as chief executive, but she kept him in place, enabling his crimes for years. Eventually, in March 2021, three members of the SNP’s finance committee withdrew and resigned, blaming “chaotic” and “incompetent” financial management. In their own words, they were on the receiving end of a “hostile” backlash, driven by Sturgeon’s “toxic culture”. They resigned in protest and were later followed by the treasurer of the organisation. Sturgeon told colleagues at the meeting where those first resignations happened: “There are no reasons for people to be concerned about the party’s finances”— no reasons. And when the treasurer resigned, she ignored it. Sturgeon was part of a cover-up, using her position to suppress justice. She behaved dishonourably and dishonestly, but her most evil act was stitching up Alex Salmond to hide the truth. When he was considering going on the national executive himself, the risk to the conspirators was clear: here is a numerate man who could not be silenced. So what did they do? In Salmond’s own words, there was “a malicious and concerted” attempt to remove him from public life in Scotland by “a range of individuals within the Scottish Government”. Senior Scottish Government figures created a procedure for dealing with sexual harassment allegations that deliberately targeted Salmond. The procedure was so biased that a judge ruled it “unlawful” and “tainted by apparent bias”. Having lost that, senior figures brought prosecutions against him, but Salmond was acquitted on all charges by a majority female jury, before a female judge. It now appears clear that those actions, to destroy a man’s reputation and life, were motivated by a desire to hide their own crimes. There are many unresolved questions. What happened with the £60,000-worth of items that were dropped from the indictment: the hair stylers, the lingerie and the books by Sturgeon’s favourite authors? Murrell was clearly protecting Sturgeon by removing items that incriminated her. In the investigation, the police had further questions for Sturgeon, but prosecutors stopped them from putting them. Those prosecutors worked for the Lord Advocate, the principal legal adviser to the Scottish Government—a clear conflict of interest. There is a clear pattern of secrecy, obstruction and power used to protect power—a pattern started by Sturgeon. Scotland needs a fresh start. That starts with a judicial inquiry into this entire sordid scandal, because it is a scandal that cost Alex Salmond his life.

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27. 16 Jul 2026·Parliament·Conservative·David Davis

    Thirlwall Inquiry Terms of Reference

    This is my third debate on the general issue of Lucy Letby, and I remind the House of what I have said before: justice must never be sacrificed for institutional self-preservation. We are awaiting the publication of the Thirlwall inquiry’s findings into the deaths at the Countess of Chester. When the inquiry was established, it was tasked with examining three areas: the experiences at the Countess of Chester and the parents named in the indictment; the conduct of the hospital’s staff with regard to Lucy Letby; and the effectiveness of NHS management and culture in safeguarding babies, and recommendations for reform if relevant. Every question stems from the assumption that Lucy Letby is guilty beyond doubt. Since her trial and conviction, a growing body of distinguished scientific opinion has challenged the supposed evidence on which they rest. Prominent experts—heads of royal societies and royal colleges, and leading voices in medicine, statistics and forensics—have raised concerns about Miss Letby’s convictions. They have come forward in extraordinary numbers, calling for the inquiry’s scope to be revised. If the case against Miss Letby is straightforward, why have so many people with nothing to gain, but their reputations to lose, publicly challenged it? At the outset of the inquiry, I warned the chair that by failing to broaden its terms of reference to examine credible alternative hypotheses, we risk protecting a conclusion rather than conducting a forensic search for the truth. The Post Office Horizon scandal highlighted the institutional instinct to find a convenient scapegoat. Innocent people paid the price, while the institution sought to protect itself. If the Thirlwall inquiry asks too narrow a set of questions, systemic NHS failures will go unexamined. More innocent children will die, more innocent parents will be put through agony, and another hospital will find another scapegoat—that is the consequence of getting this wrong. So what should the inquiry’s terms of reference include? There are at least three lines of inquiry that deserve examination. Each is supported by substantial evidence. Each almost certainly contributed to what happened. Each risks being overlooked. The first is the staffing crises: this was a neonatal unit stretched beyond its limits and operating under relentless pressure. The second is poor clinical management: the unit was repeatedly tasked with caring for babies requiring the highest level of specialist capacity—capacity it did not have. The third is environmental risks: there were serious contamination problems within the hospital. Two damning reviews of NHS maternity services more generally have now been published. The Ockenden report exposed failures at Nottingham University hospitals NHS trust that mirror those at the Countess of Chester: infections, overcrowding, under-resourcing, sustained pressure and overstretched staff—different hospitals, but strikingly similar failures. Baroness Amos has also published her final report on NHS maternity and neonatal services. Its conclusions echo with remarkable consistency the concerns raised about the Countess of Chester. Baroness Amos concluded: “the maternity and neonatal system is not set up to deliver consistently safe, high-quality and compassionate care... It is fragmented, overly complex and too slow to…improve.” She highlighted “unsafe and unacceptable” hospital buildings, “excessive workload pressures” and staff who felt “ignored… when they raised concerns about whether they could provide a safe or joined-up service”. She also highlighted “dangerous clinical environments”, senior leaders who “were not accountable” and, of course, staff who were “fearful of being blamed when things went wrong”. If the Thirlwall inquiry was unwilling to heed the growing concerns of experts, it cannot dismiss the conclusions of two Government reviews. As far back as 2004, senior neonatal staff at the Countess of Chester were warning management of a “staffing crisis which...shows no signs of abating”, highlighting that the unit was operating 30% to 40% below the staffing levels recommended by the British Association of Perinatal Medicine. They described stress that “exceeded tolerable levels”, reinforcing that such conditions “could increase the risk of unintentional professional negligence”. But how did management respond? To cut costs they abolished the advanced neonatal nurse practitioners, the most highly trained specialists in their field, upon whom the entire safe working of the unit depended. One of the nurses let go later described it as “the decimation of the Nursing and Midwifery service”, adding that “eight registered nurses...were replaced with nursery nurses...unqualified staff are replacing qualified staff”. She described a trust blighted by “inefficient managers...managers to manage managers, people to tick boxes...inefficient computer programmes”, all “at the expense of the registered nurse/midwife”. If management’s response was to bury the problem, what does that tell us about the state of the Countess of Chester by 2015? A system repeatedly warned to be unsafe cannot merely be treated as the backdrop to the events of 2015 to 2016—it is at least part of the explanation. By 2012 the hospital was recruiting newly qualified nurses, often straight from university. One of them was Lucy Letby. During the years Lucy Letby is alleged to have committed her crimes—specifically 2015 to 2016—the neonatal unit was still functioning under dangerous pressure. Notably, one nurse working on the unit during this period recalled: “2015 and 2016 were horrendously busy... They were probably the worst years I can remember in more than twenty years... Everybody was absolutely stretched to the limit... You were expected to look after the maximum number that you could—sometimes over the number that you should.” The inquiry ought to ask, if concerns had been raised for over a decade, to what extent did those unresolved staffing failures contribute to the tragedies that followed? Were those failures addressed before responsibility was placed on Letby? There are three levels of care in neonatal units, depending on the complexity of care that a unit is equipped to provide. Appropriate grading of a neonatal unit is fundamental to patient safety. Level 1 units accept babies with low care needs. Level 3 units accept babies needing the highest level of medical care. The Countess of Chester was a level 3 unit throughout the early 2000s, but in 2005 it was downgraded to level 2, an admittance that the unit could not handle level 3 babies. But the unit continued to operate under immense strain, worsened by management’s decision to get rid of its hugely experienced advanced neonatal nurse practitioners. Years later, when Lucy Letby started at the Countess in 2012, conditions remained poor. There was little space, cots and incubators were stored in corridors, and mothers struggled to find somewhere to breastfeed their babies. Susan Gilby, the hospital’s chief executive between 2018 and 2022, later described the unit as “dark, dingy and cramped”, providing a “less than ideal” environment to work in. Remember, this was a level 2 neonatal unit tasked with providing short-term intensive care for fragile babies. Indeed, the deficiencies were so serious that the trust launched a £3 million public fundraising campaign to pay for a new neonatal unit because the necessary capital funding was not available through the NHS. This was an acknowledgment that the unit was not fit for purpose. The inquiry ought to ask: was the unit being asked to deliver a level of care that it was not capable of providing? Staff at the time certainly thought so. One nurse warned the unit manager, “something awful is going to happen here...we can’t carry on like this”. In late 2015, one consultant said the unit was so busy that it was running out of vital equipment, adding: “This is now our normal working pattern and it is not safe. Things are...at breaking point. When things snap, the casualties will either be children’s lives or the...health of our staff.” The spike in baby deaths was that breaking point. The Royal College of Paediatrics and Child Health report from November 2016 confirmed that the unit was “non-compliant on nurse and medical staffing levels” when assessed against service standards for a level 2 unit. It ought to have been downgraded further, to a level 1. Indeed, it is often claimed that babies on the unit stopped dying as soon as Letby was removed from the ward. That assertion ignores perhaps the most critical fact. In July 2016, when Letby was removed from the ward, the neonatal unit was finally downgraded to a level 1. In that moment, the risk profile changed. Fewer of the sickest babies were admitted at the Countess. The 2016 Royal College of Paediatrics and Child Health report is clear that since the redesignation from level 2 to level 1, the pressure “has reduced and the unit is operating more in line with BAPM staffing standards. The consultants also reported that in the two months since the change infants have been sick but recovered as expected.” The report highlighted deficiencies in staffing levels, leadership and communication, but, in the trial, it was not shown to the jury—they knew nothing of it. In July 2016, the unit was downgraded and Lucy Letby left the ward. It is irrational to assume that one of those two events was entirely responsible for the sharp reduction in deaths without testing the other event properly. The inquiry must examine both changes to determine which made the difference. During 2015 and 2016, when the neonatal mortality rates spiked, the hospital faced infection control problems. One nurse described the unit as her “worst nightmare”. Pseudomonas aeruginosa had colonised taps in the nurseries of the neonatal unit. Pseudomonas forms a biofilm—a layer that allows the bacteria to spread within a water system—and can kill newborns. In 2012, at Belfast’s Royal Jubilee maternity hospital, three premature babies died from it. In an effort to mitigate the risks of Pseudomonas, the Countess of Chester installed filters on the taps, but the filters kept falling off. Another of the babies Letby is said to have murdered was found to have Stenotrophomonas maltophilia in their breathing tube—a bug responsible for some of the deaths at Glasgow’s scandal-hit Queen Elizabeth University hospital. Of the 17 babies Lucy Letby is said to have murdered or attempted to murder, at least 14 babies either had an infection or were suspected to have an infection. Professor Shoo Lee’s panel identified that 10 infants were receiving antibiotics, and court proceedings identified another three. The fact that at least 13 babies were treated with antibiotics suggests that the clinicians considered infection to be a real possibility in these cases. On top of that, MRSA, C. difficile and MSSA were detected across the trust; it is not known whether they were present in the neonatal intensive care unit. While giving evidence at her own trial, Miss Letby told jurors that the neonatal unit had problems with “raw sewage” coming from sinks. That was not an invention in the hopes of abdicating responsibility; contemporaneous messages between staff show that these concerns were raised at the time. Remember: this was a neonatal intensive care unit. One nurse suggested that an infection on the unit could be to blame. Letby agreed, describing sewage coming from the sink and overflowing toilets. She added: “The unit needs properly assessing, I don’t think the equipment gets cleaned properly…we haven’t got the space, facilities…to maintain hygiene.” Those messages predate any criminal investigation, and the hospital’s plumber confirmed under oath that human waste was backing up into handwashing basins. On top of the other microbiological concerns, human waste contains E. coli—another hazard to vulnerable new-born babies. Professor David Livermore, a professor of medical microbiology, is right to say: “Infection was such an obvious cause of a spike in deaths. What investigation did they do [into this?] I’m yet to see any clarity on this.” Even the parents themselves had initially assumed that if something had gone wrong, it was likely because of the hospital’s failings. One mother giving evidence against Lucy Letby during her trial admitted that “I thought, the hospital’s old, it’s not very nice. It was dirty, and I thought it was along the lines of medical negligence. It never entered my mind that there was somebody intentionally harming babies”. That is the hospital we are talking about—old, not very nice, dirty—and it does not look as though the medical management of the hospital did anything to mitigate the risk arising from those problems. A mother of three triplets who moved to Liverpool Women’s Hospital said she “noticed a different level of cleanliness compared to the Countess” as there were “clear hygiene protocols” at Liverpool, where, she said: “We were told to wash our hands before entering the Unit and then again before entering the room”, which was not the case at the Countess of Chester. One father of a baby born at the Countess of Chester in May 2016 described the unit as “chaotic” and “failing”. He described an atmosphere of tension where “it wouldn’t take much more” for the unit “to blow up.” His daughter had had a difficult delivery and could not breathe at birth. He and his wife discovered three years later that she had been the sickest baby on the unit for over 24 hours. Not a single doctor spoke to them about this, while nurses repeatedly told them that their baby was “fine”. Against that backdrop, he recalls that Lucy Letby stood out as the only staff member who took time to explain his baby’s condition. The hospital itself later told him that Lucy had “saved” his daughter’s life and had gone “above and beyond the call of duty.” He stated bluntly that the jury in Miss Letby’s trial was not given the full picture—the systemic problems, lack of communication and overall disorder. History judges institutions not by how confidently they defend themselves, but by whether they had the courage to confront uncomfortable truths. The Thirlwall inquiry now faces that test. An inquiry that refuses to ask difficult questions is not fearless—it is formulaic. An inquiry that overlooks credible evidence is not comprehensive—it is compromised. A major failure of the trial was that the jury was not shown evidence from authoritative sources such as the Royal College of Paediatrics and Child Health that offered a credible alternative explanation for the spike in deaths. The inquiry must not replicate that failure, and it must not lend its authority to what may be a major miscarriage of justice. It owes the parents who lost their babies, and future parents of future babies at risk, the absolute truth. It must follow the evidence and fear no conclusion. If facts are left unexamined, lessons are left unlearned. The inquiry should heed the warnings of Ockenden and Amos, and the countless voices emerging in Miss Letby’s defence. Structural failure, institutional failure, and medical incompetence or even malevolence—every one of those explanations must be dragged into the light, and the unvarnished truth exposed.

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28. 16 Jul 2026·Parliament·Conservative·Damian Hinds

    Protecting Built Heritage

    I commend the hon. Lady for her clear and excellent presentation of this report. Sadly, there is not time for me to list all the very many great heritage assets in East Hampshire. The hon. Lady talked about the importance of heritage to tourism and the possibility of using some underused heritage assets for housing. Does she think there is also a case to be made for looking at how we can best use some of those assets for hotel and holiday accommodation?

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29. 16 Jul 2026·Parliament·Conservative·Damian Hinds

    National Planning Policy Framework

    It is a great pleasure to see you in the Chair, Sir Desmond. I congratulate the hon. Member for Wells and Mendip Hills (Tessa Munt). I will try to cover four aspects of the NPPF in just short of four minutes. The first is what the NPPF says on intentional unauthorised development. I welcome the move towards stronger wording in that area. I should stress that I am not talking about a house extension or somebody accidentally not complying with regulations, but entire new dwellings and wilful non-compliance. I welcome the move from material consideration, as it is known, to substantial weight, but I fear it does not go far enough. As I said in my submission to the consultation, it should be set out very clearly that “wilfully ignoring planning consent requirements will not result in retrospective planning permissions being granted”, and that this cannot in normal circumstances be overridden by personal circumstance arguments. Other things could be done in support, such as making sure that stop notices are easier to issue, and restrictions on things like delivery of construction materials and mobile homes to unlawful sites. The Minister and I have discussed the NPPF housing formula many times across this Floor. He is a very diligent Minister and, although he always robustly defends the Government line, which is kind of annoying, he always does it with great courtesy. I thank him for that. The problem is that this formula has meant a massive increase in housing numbers for the countryside. It is not a north-south thing; it is an urban to countryside shift. Whereas the numbers have gone up by 50% for the country overall, in East Hampshire they have doubled. When that happens overnight, no one has a five-year land supply that can deal with it, so we get speculative developments. That has been brought into sharp relief by the issue of water supply, which has particularly come to prominence since South East Water’s submission to the Basingstoke and Deane local plan. The Basingstoke area that it talks about—zone 4, as it is known—extends to Alton and around my constituency. The Environment Agency has stopped the extension of the abstraction licence at Greywell Fen because of the degradation of that globally rare site of special scientific interest. I met South East Water recently to discuss this. There are questions outstanding, particularly regarding parts of my constituency. Clearly, action should have happened before now, but a doubling of the housing target hugely exacerbates the issue. Large- scale development should not go ahead unless and until this issue is resolved.

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30. 16 Jul 2026·Parliament·Conservative·Damian Hinds

    National Planning Policy Framework

    I agree. There is no practical limit on what we can learn from one another in the home nations of the United Kingdom. I want to come on to what is known as policy L3, which concerns the minimum density requirements for areas around train stations. I have written about this in my submission to the consultation. I fear that a policy that is, on the face of it, sensible—“Let’s have people living close to train stations where they can commute to work or whatever it might be”—is really designed for urban town areas. But it will also have an impact on market towns in places like East Hampshire and in villages that just happen to have a train station. The sorts of densities discussed in the NPPF would be wholly inappropriate for market towns like Alton in East Hampshire and rural villages like Bentley or Rowland’s Castle. Finally, I want to address how the NPPF interacts with local government reorganisation. I am totally opposed to the Government’s top-down reorganisation of Hampshire local government for multiple reasons, including the fact that it splits up an area with an identity—namely, East Hampshire. It puts the lower parts into a new Portsmouth super-council area and the rest of East Hampshire into this vast new Mid Hants unitary. Local plans have been built around existing district council geographies. For councils that are part-way through the process and about to have this enormous reorganisation thrust upon them, what is the guidance from the Government on how they should proceed?

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31. 16 Jul 2026·Parliament·Conservative·Damian Hinds

    Business of the House

    In support of the Government’s drive for economic growth and export earnings, may we have a debate in Government time on the role and potential of international inbound tourism? We have a lot of strengths in that sector, but we have lost cost competitiveness, and the introduction of an overnight visitor levy would make that worse.

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32. 16 Jul 2026·Parliament·Conservative·Dame Harriett Baldwin

    Business of the House

    Could the Leader of the House make a commitment that the new Chancellor of the Exchequer will come to the House on the first day we are back from recess? The current Chancellor has raised taxes on payrolls, and we have fewer payroll jobs; she has raised taxes on businesses, and businesses have closed; and she has raised taxes on non-doms, and millionaires have fled the country. The reality in the world outside is that, with a new Chancellor, we are going to have a whole summer of speculation about other tax rises in the run-up to the Budget. During that period, hiring and investment decisions are going to be put on hold, so I think the Leader of the House can see how important it is that we hear from the new Chancellor at the earliest opportunity.

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33. 16 Jul 2026·Parliament·Conservative·Dame Harriett Baldwin

    Local Government Reorganisation

    With a stroke of his Whitehall pen, the Secretary of State has just abolished Malvern Hills district council, Worcester city council, wonderful Wychavon district council and Worcestershire county council. He said in his statement that this is about making “real improvements to people’s lives and…communities”. Can he explain how it will help with the situation faced by my constituents, in which two major highways in west Worcestershire have collapsed and the council has no plan to repair them? This chaos is surely going to slow that down.

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34. 16 Jul 2026·Parliament·Conservative·Charlie Dewhirst

    Business of the House

    Despite the recent successes of two new dental contracts in Bridlington and the decision to postpone the closure of the care unit at the hospital, I am sure the Leader of the House is aware of the challenges of optimising health services in coastal towns, particularly in Bridlington and Hornsea in my constituency. Can we have a debate on this issue in Government time? Can the Minister come to the House and update us on the implementation of the recommendations made by Chris Whitty in 2021 on health inequalities in coastal communities?

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35. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Business of the House

    I call the Liberal Democrat spokesperson.

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36. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Business of the House

    I call the Chairman of the Backbench Business Committee.

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37. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Business of the House

    With a birthday business question, I call Claire Hazelgrove.

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38. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Local Government Reorganisation

    I call the shadow Secretary of State.

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39. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Local Government Reorganisation

    I call the Liberal Democrat spokesperson.

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40. 16 Jul 2026·Parliament·Conservative·Caroline Nokes

    Local Government Reorganisation

    Before I come to Back Benchers, let me say that, as Members will be aware, a lot of you wish to get in. It would be very helpful if questions were succinct.

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