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12,868 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them
The hon. Member calls this an “ideologically anti-prison Government”, but in 14 years of Conservative Governments, there was a net increase of 500 prison places. In the very first Division post the King’s Speech in this Parliament, I remember voting to deal with that problem, and we had to vote to reduce sentencing times to deal with that mess; otherwise the criminal justice system would have collapsed. Does he not agree?
It is a pleasure to serve under your chairship, Mr Efford. I heartily congratulate my very good and hon. Friend the Member for Carlisle (Ms Minns) on securing this debate on the anniversary of the Settle-Carlisle railway, and I thank other Members for their contributions. I am grateful to my hon. Friend for her continued advocacy on behalf of her constituents. This is a moment of celebration of our railways, but it is also a time to reflect on the present and the future. I welcome the opportunity to address some of those points today. The Settle-Carlisle railway, which is celebrating its 150th anniversary, is, of course, one of the most historical and spectacularly scenic lines in the UK, with a long and colourful history of innovative engineering and dogged determination by the rail visionaries who fought to keep the line open against all the challenges it has faced—a legacy that my hon. Friend is certainly working hard to continue. I am delighted to assure my hon. Friend that the future of the line is indeed secure. The introduction of the Yorkshire Dales Explorer has brought thousands of new visitors to the line, investment at Horton-in-Ribblesdale station and secured the line’s invaluable role as a support route for the west coast main line. These all demonstrate the line’s ongoing importance to our network and this Government’s commitment to its future. I am pleased that there is such a strong community rail involvement with this historical line. Community rail is all about connecting communities to the railways, and at the heart of the community rail concept are community rail partnerships. The Settle-Carlisle Railway Development Company has done some wonderful work in this area. It has been an accredited community rail partnership for more than five years, working to support the local economy and benefit communities along the line. Its work includes organising station open days and art installations, running projects to support access to the railway and environmental initiatives with community organisations, as well as providing a range of services and products that benefit locals and visitors alike. The company achieves so much for the benefit of communities along this historical line. I congratulate it on its most recent reaccreditation, awarded in recognition of its community-centred projects and services provided across the Yorkshire dales and Cumbria. I also pay tribute to the work of the Settle and Carlisle Railway Trust, which does so much valuable work in helping to restore, preserve and maintain the historical buildings and structures along the route, sparking the imagination and engagement of the public. The railways, of course, have changed so much since the first passenger trains on the Settle-Carlisle line, and I think it is appropriate to raise where this Government see the future of this railway. Rail reform will put passengers and customers back at the heart of the rail network. The Railways Bill, of which I know my hon. Friend is a keen supporter, is progressing through Parliament and will create Great British Railways, which will bring track and train together under one publicly owned and accountable body to reduce fragmentation and improve decision making. GBR will work closely with local mayors and local authorities to make sure that services meet the needs of their areas and better integrate with other modes. I now turn to Northern Trains and its performance as the main operator on the Settle-Carlisle line. I am pleased with the introduction of the Yorkshire Dales Explorer, which links Greater Manchester and Lancashire to the Settle-Carlisle line and the dales. I also hope that my hon. Friend’s constituents are able to partake in Northern’s offer of discounted tickets between Leeds, Settle and Carlisle, in honour of the 150th anniversary. But that does not mean there is not more work to do. Northern’s performance leaves room for improvement. We have an improvement plan that outlines the steps that the operator will take to improve reliability, with a target of 90% of all its trains arriving within three minutes of timetable and cancellations below 2%. I am pleased that the latest rail period results show that cancellations on the Leeds-Carlisle route were only 1.24%, but we need to work to improve punctuality, with 77% of trains arriving within three minutes of timetable. I look forward to working with my hon. Friend to improve services for both tourists in her remarkable area and her constituents. Northern is also in discussions with train manufacturers to procure new train sets to replace the oldest trains in its fleet. The procurement of up to 450 new train sets will offer increased capacity as well as more accessible trains for passengers. In January and April this year, the Settle-Carlisle route played a critical role in supporting passengers during several closures of the west coast main line for engineering work. To avoid lengthy replacement bus journeys, Avanti West Coast operated its bi-mode Evero trains over the historical route—the first time in more than a decade it has been used for that purpose. Feedback was incredibly positive, underlining findings from the rail watchdog, Transport Focus, that passengers prefer to stay on trains than take replacement bus services—that is certainly my preference, too—even if it involves a longer journey. Avanti hopes that the Settle-Carlisle route can continue to play an important role as a diversionary route over the next decade, especially when a significant volume of renewal activity is required on the northern section of the west coast main line. On infrastructure, Network Rail recently installed a footbridge with lifts at Horton-in-Ribblesdale station, allowing the closure of a high-risk level crossing and enabling a rail connection to the nearby quarry. The scheme was a mix of public and private investment, including a contribution from the quarry along with the Access for All fund. Connecting the quarry by rail safeguards the future of the facility while reducing carbon emissions by taking lorries off the road. The 150th anniversary of the Settle-Carlisle line is an opportunity not only to celebrate extraordinary railway heritage, but to recognise wider investment to ensure that rail continues to support communities, connectivity and economic growth for generations to come. That investment includes the £323 million west coast north modernisation programme, which is the biggest improvement programme on the northern section of the west coast main line in decades. Network Rail and industry partners are working together, in the spirit of Great British Railways, to keep passengers moving while replacing ageing infrastructure, particularly the overhead line equipment that powers electric trains. Over the past two years, Network Rail has renewed around 200 km of overhead wires on the northern sections of the west coast main line. The work will improve reliability and deliver a more resilient and better-connected railway for passengers and freight. From the Settle-Carlisle line to the west coast main line, rail remains a vital part of connecting people, places and opportunities across the north and Scotland. My hon. Friend will recall the Department’s investment of £13.5 million as part of the £38 million Carlisle station gateway project, part funded by the borderlands inclusive growth deal and delivered in partnership between Network Rail and Cumberland council. The scheme provides a new public square to the rear of the station, an enhanced Court Square to the front, new lifts and increased car parking capacity. Works are on site and the Scott & Brassey public house has now opened in the restored first-class waiting room, with passengers enjoying a selection of great local ales. I often travel up to Glasgow, and I will avail myself of those great local ales as soon as I make contact with Carlisle station. To conclude, I assure my hon. Friend that the Government are firmly committed to honouring our railway heritage and improving services for passengers in rural communities across the north. She continues to be a resolute champion of the Settle-Carlisle railway, and the Government are committed to supporting her and her constituents as she continues to do so. Here is to the 150 years to come. Question put and agreed to.
My very first experience of employment was waiting at a van to try to get a day’s work, cash in hand, at the berries, which was what people usually did when they were aged 13 or 14 and looked a wee bit older. I hope the Minister is not proposing a return to those days, because I kind of got the impression from the shadow Minister, the hon. Member for Grantham and Bourne (Gareth Davies), that that was the exact type of employment he was looking to return to.
I pay tribute to my hon. Friend on his work before he came to this place; he was an international leader on this matter. This Government have put Britain back into leadership on international climate change. Last week, we welcomed 75,000 people to London, because our city is a leading mix of science, innovation, technology and investment. It was great to see Imperial College London, which is in his constituency, attending many of those events.
I agree with my hon. Friend’s comments on public support. Ultimately, pretty much everybody in this House cares about the people and places that we love. This issue comes up time and again at every school I visit, and I know that is the same for people from all corners of this place, because I get letters from people from all corners of this place. The Climate Change Act was campaigned for by David Cameron, introduced by the last Labour Government and championed by every single Conservative Prime Minister, because it is a sensible way of doing grown-up politics and policy. It is a long-term framework with flexibility to meet the moment. Serious leaders support serious policy in politics, and that is what you get from a Labour Government.
My understanding is that the Peak Cluster needs to develop the project itself; it is not a Government-backed project. This Government have made more progress on carbon capture and storage than has been made in the last 20 years. If the right hon. Lady’s colleagues and constituents want to hear more about it, please feel free to write to us, as we will be happy to look at it further.
The Secretary of State will publish an energy resilience strategy later this year. Last week, alongside the Minister for Energy Security and Net Zero, I launched a first-of-its-kind taskforce with external experts from security, the military and academia, to boost preparedness for climate change and nature loss.
As I am the one answering the hon. Member’s question, I cannot comment on those decisions. The OBR has put forward various reports to look at the impacts of climate change on our economy, and the value of investment versus the cost of inaction. The OBR has been incredibly helpful, as have various parts of our financial architecture across the City, which is looking at where the risks are. The taskforce that I mentioned will also look at the impact on finances and the economy.
I thank my hon. Friend for her contributions on climate change in the debate last week on carbon budget 7. The recent heatwave showed us for the first time the implications that we face across our country. For parents up and down the country, when many schools closed—not to mention other workplaces and hospitals—it had a catastrophic effect. We are looking at the issue across the board. We have an energy resilience strategy coming forward, as well as a wider taskforce, and I am working across Government with colleagues to ensure that any advice is updated, because this is sadly the new normal.
I thank my hon. Friend, who contributes to many of these debates. We want to ensure that we have a system that supports reductions in emissions, while also maintaining supply. I do not think that what my hon. Friend says is the case, but we do see a future for Grangemouth, and we look forward to continuing to work with him on that.
I would like to highlight three things that this Government have done to tackle climate change. First, we have brought forward carbon budget 7. I pay tribute to many Members of this House for the excellent discussion we had, with contributions from Members from Darlington to Devon, via Derby. Secondly, we have secured massive investment; since this Government came to power, we have secured more than £100 billion of private investment. Thirdly, we have been looking at where there is friction in the system, and at how to remove that friction, whether through working with communities to energise Britain—I was out in Manchester and Bradford yesterday—or by reordering the queue for our energy projects, to ensure that we are at the forefront of tackling climate change, are managing the risks, and are taking advantage of the opportunities.
I will absolutely congratulate Winchester city council on leading on this. Councils play a hugely important role, and I am looking forward to meeting many of them to discuss this issue when I visit the Local Government Association later this week. We have £1 billion of funding for community energy projects, and we are bringing forward more measures to accelerate progress, because this really is an opportunity to tackle the climate crisis, bring down energy bills and contribute to energy security.
I thank my hon. Friend, who has raised this issue on many occasions in this House, and who is a friend of mine from across our great city. It is really important that we work at international, national and local level. Across our country, we all have a responsibility for the words and phrases that we use, and a responsibility to tackle misinformation and be honest about the challenges. That is not to say that we cannot disagree, but we could do so far more agreeably.
I thank my hon. Friend—another fantastic speaker in the carbon budget debate the week before last—and Ranelagh school students for presenting their ideas. They are not alone; this issue is raised at most schools that we visit, and we have to reassure students that the Government are taking action at international, national and local level. It is important that their voices are heard, which is why we are launching a youth scheme in the Department for Energy Security and Net Zero.
Clause 58 is about the time period for compliance with NICE recommendations on health and social care provision. As we have heard, it will enable that period to be determined by NICE or the Secretary of State. NICE’s technology appraisals and highly specialised technology guidance play a vital role in ensuring that patients in England can access treatments that are clinically effective and a good use of NHS resources. When NICE recommends a new treatment, the NHS is usually required to make funding available within three months. That means that patients can consistently benefit from innovative treatment. That said, there are cases where the three-month timeframe is just not realistic. That might be because of affordability pressures or practical challenges such as a stretched workforce. In those situations, a longer implementation period is needed to ensure that complex new treatments can be introduced in a safe way that does not disrupt services for other patients. For example, the period for NICE’s guidance on the drug Paxlovid for the treatment of covid was extended to 12 months to allow time for the NHS to put the necessary routine testing systems in place and train healthcare professionals. I do not think the hon. Member for Sleaford and North Hykeham raised this issue, but the opposite is sometimes true, and the NHS issues guidance that provides swifter access to medicines and medical treatments. For example, cancer medicines can be funded from the point of a positive draft recommendation. At present, NHS England decides whether a NICE treatment is funded more quickly or in a shorter timeframe, while NICE determines whether the funding period should be extended, typically following a proposal from NHS England. The abolition of NHS England means that those roles and responsibilities will need to be reconsidered. The clause provides flexibility for the final decision on funding timelines to sit with either NICE or the Secretary of State, but it will not mandate which. To the point raised by the hon. Member for North Shropshire, the Government intend to set out further details of these arrangements in regulations using the enabling power granted by this Bill. Importantly, the clause will not reduce NICE’s independent role in assessing the clinical and cost effectiveness of new treatments, nor will it weaken the NHS’s obligation to provide timely treatment. Instead, it will ensure that decisions on funding timelines remain flexible and sustainable, and that the system is equipped to respond effectively to future pressures. I will now speak to amendment 78, which was moved by the hon. Member for North Shropshire. I recognise the vital role that NICE guidelines play in improving quality and consistency of care across the NHS. NICE’s guidance is developed by experts on the basis of rigorous assessment of the available evidence and provides an important benchmark for best practice, including for patients with myalgic encephalomyelitis. I know that the hon. Member intends to withdraw the amendment, but if she were to press it, the Government would not accept it. To be clear—again, partly to the point of the hon. Member for Sleaford and North Hykeham—it is a long-standing and deliberate position that NICE guidance is not mandatory, which reflects the role it plays in supporting patient care. Crucially, guidelines do not override the professional judgment of clinicians, and it is essential that clinicians retain the flexibility to determine the most appropriate course of treatment for individual patients based on their specific circumstances. It is also important to recognise that NICE guidelines are often complex frameworks for care that must be adapted to local service configurations and patient need. Requiring full compliance with the NICE guideline would remove the ability of local service providers to ensure that ME services are appropriate to the needs of their local populations. The hon. Member for North Shropshire made some important points about treatment of ME over the years, and many of us have encountered constituents with similar stories. I pay tribute to the hon. Member for Farnham and Bordon for his work supporting constituents with the condition. To be clear, the Department fully recognises the need for more consistent implementation of the NICE guidelines on ME. That is why we are already taking forward practical measures. In particular, the Department and NHS England are developing a service template specification, aligned to NICE’s guidelines, to support commissioners and providers in delivering appropriate services for people with ME. We will continue to work with stakeholders, the industry and the NHS in doing that. Those steps will help to drive improvement in care without undermining clinical judgment or imposing inflexible statutory requirements. With that, I commend clause 58 to the Committee.
Clause 59 provides for the abolition of the Health Services Safety Investigations Body and the transfer of its functions to the Care Quality Commission. Under the new arrangements, the Care Quality Commission will assume responsibility for carrying out investigations into incidents that have or may have implications for patient safety. It is really important to stress that the core purpose of that function remains unchanged: to identify systemic risks, support learning and drive improvements in the safety of health services, rather than determine blame or liability. It is a central measure in strengthening the framework for patient safety investigations and ensuring a more coherent and effective system for learning from incidents across health services. With more than 70 types of channels or organisations through which patients or users can share feedback, the current landscape has led to fragmentation between investigation, regulation and improvement activity, thereby diluting the impact that insights from investigations might otherwise achieve. HSSIB has been isolated, undermining its efficacy. We will bring HSSIB into the mainstream as a core but distinct part of the CQC. That will enable HSSIB to use its functions more strategically, working in partnership with the national quality board. Clause 59 achieves that by conferring responsibility for those investigatory functions on to the Care Quality Commission through the provisions set out in schedule 8. In doing so, it embeds a comprehensive investigatory framework with an established statutory regulator. The CQC will be one organisation with separate functions—a regulatory function and an investigative function—to preserve the integrity of each. Within the CQC, HSSIB will continue to operate as a discrete unit and retain its independence from providers, allowing it to identify learnings and take a no-blame approach.
I thank my hon. Friend for that point. I have met HSSIB and others on this issue, and it is a concern that staff are fearful of speaking up. That is obviously unacceptable, but we understand that it happens. That is absolutely the culture that we need to drive out, and we need to ensure that HSSIB’s learning about making sure there is a safe space to speak out, which I will come on to, is a core part of future work.
Of course, patient safety is what we need to get right. I will come on to that point, but there is a lot to get through with this clause. We can see its importance from the number of organisations and channels that exist. I have said that before, and I am sure we have all struggled as constituency MPs to support our constituents—either patients or staff—through the system and to understand the best route forward on patient safety. We all have the same aim, and we should be clear that the issue is how best to achieve that aim. My hon. Friend is absolutely right. The test is about impact, learning and making the system and the culture change. My hon. Friend the Member for Lewisham East asked me about confidence, and the fear that staff sometimes have about speaking up, which is obviously an important part of that landscape. We want to make sure that we take forward the learning on both those points into the new body. The new framework ensures that the essential characteristics of safety investigations are preserved. The commission will have a flexible power to investigate qualifying incidents that have or may have implications for patient safety, with a clear statutory purpose of identifying risks and improving systems and practices. We are maintaining the principle of safe space and introducing strong safeguards in the process, so that staff and the public can trust that they can speak of their experiences openly, without fear or favour, to provide learnings for the system. We have included protections for safe space materials and restrictions on disclosure, including within the regulatory functions of the CQC, and limits on the use of reports in legal proceedings. That is designed to support openness and candour, and to provide confidence in the impartiality and independence of patient safety investigations. There are clear mechanisms for transparency and accountability, including the publication of reports, requirements to respond to recommendations, and oversight through a statutory review of the commission’s investigatory functions. Clause 59 also provides the commission with the necessary powers to carry out investigations effectively, including powers to require information, enter premises and co-ordinate with other bodies while maintaining appropriate protections such as legal privilege and safeguards against self-incrimination. Although the commission will decide which incidents to investigate, the clause preserves a power for the Secretary of State to direct it to investigate a specific qualifying incident or category of incidents. That ensures that where issues of significant public concern arise, or where urgent scrutiny is needed or there is particular risk, there is a clear mechanism to ensure that issues are investigated. The struggles of the Care Quality Commission have been well documented. We will only commence these provisions when we are satisfied that the CQC has improved. The CQC has been supported and held to account to recover its effectiveness, and we will continue to support it and work closely with the newly appointed chair on its journey to rebuild. We will work closely with the CQC to ensure its readiness to receive the investigations functions from the Health Services Safety Investigations Body. Maintaining a centre of excellence for investigations will be integral to the CQC’s culture. Without the clause, the opportunity to deliver the ambitions of the 10-year health plan would not be realised, nor would the broader patient safety landscape, as set out in the Dash review, be fully addressed. It is therefore a necessary and integral reform. Clause 60 makes provision for the transfer of property rights and liabilities from the Health Services Safety Investigations Body to the Care Quality Commission in connection with the abolition of the former and the assumption of its functions by the latter. It is a key technical provision to ensure an orderly and legally complete transition between the two bodies. Where functions are transferred between public bodies, it is essential that all associated assets, obligations and legal arrangements are also transferred in a way that ensures continuity and legal certainty. The clause provides the statutory mechanism to achieve that. The clause provides a flexible framework to enable the continuation of HSSIB’s actions and ongoing matters, including legal proceedings, and ensures that references to HSSIB in existing documents are treated as references to the Care Quality Commission to avoid legal uncertainty. The clause provides for staff protections equivalent to TUPE and allows for shared ownership or use of property where needed, supporting a smooth and effective transition. The overall effect of the clause is to enable a smooth, comprehensive and legally robust transfer of HSSIB’s property rights and liabilities to the Care Quality Commission, ensuring continuity of function and avoiding disruption to ongoing operations. Without the provision, there would be risk of legal uncertainty and operational disruption during the transfer process. Clause 61 is a necessary and practical provision. At its core, it provides a power through regulations for His Majesty’s Treasury to ensure that transfers made from HSSIB to the CQC are delivered smoothly and on a tax-neutral basis. Like the equivalent provision for the NHS England transfer in clause 3, it allows the Treasury, by regulations, to vary the way in which relevant tax legislation applies in relation to anything transferred under a transfer scheme or anything done in connection with such a transfer. That will ensure that the tax consequences of the transfer can be properly aligned with the policy intention of a smooth and orderly transition. Importantly, the scope of the clause is limited to specified “relevant taxes”, including income tax, corporation tax, capital gains tax, VAT, stamp duty and stamp duty reserve tax. As with clause 3, without this power there is a risk that the transfers could trigger unintended tax liabilities that would divert public money away from frontline services and undermine the policy intent of the legislation. Clause 61 therefore protects value for money and ensures that organisational change does not come with avoidable fiscal cost. Clauses 59 to 61 and schedule 8 are necessary to strengthen the framework for patient safety investigations and ensure a more coherent and, crucially, effective system for learning from incidents across health services to make all our constituents and patients safer. I therefore commend them to the Committee.
It is a pleasure to serve under your chairship, Ms Lewell. This morning, we had really good and detailed exchanges about patient safety and learning the role of HSSIB. Often politics is confrontational and divisive, but I want to be clear that I take at face value that every single Member who has spoken and who I have met with, including people who do not want to see this change, have the best of intentions. They want to understand patient safety—in the long term we can talk about safety and quality of service, but let us focus on the safety aspects here—and they are trying to navigate something. They are seeing a change, which is always difficult, and we need to ensure we get that right. It is absolutely right that we do that in Committee, on Report and in the House of Lords. We will continue to take note of all the points made and seek to address them. I fortunately had the lunch break to reflect and do that a bit more carefully. For people here and those reading our deliberations, what is difficult about the Bill—we understand this as legislators—is that we are abolishing an organisation and moving functions. That stands within a wider framework of changes to the safety and quality landscape that the Government are seeking. When one focuses on things that are being abolished, it is very binary. I will try and locate some of that without veering too far from the matter in front of us. Among all the discussions, there are a couple of key questions that I want to address, including why I do this. Through the passage of the Bill, many people in the wider landscape have said to me, “Why are you bothering having a row about this?” I find that quite shocking as a riposte, because the answer is simple in the context. It is too important to not attempt to get this right and make changes to something that clearly is not working. I do not think I have heard anybody say that the current system is working. As the right hon. Member for Melton and Syston noted, I said during the passage of the Health and Care Act 2022 that the functions of HSSIB are really important and must be built to the highest standard. I absolutely stand by that. It is not working; that is why we are changing it, but also why we are preserving the function within a new system, which we will seek to improve.
I am going to try to go through these points because I have listened carefully to everybody’s contributions. If there is something outstanding, I will be happy to come back to it. To answer some of the direct questions that were put to me about the Dash review, I do not recall anybody particularly disagreeing with its findings when it was published or when we put it forward in our 10-year plan last year. I do not expect everyone to agree with every single recommendation or point made in that review. To an earlier point that was made by the Opposition, it was informed by a broad range of evidence and perspectives from across the health and social care system, including engagement with commissioners, providers, patients, families, and people harmed by poor-quality care, as well as charities, academics and national organisations. It looked really closely at what has not worked and why. I encourage hon. Members to go back to the work that Penny Dash was asked to do and the wider report. The hon. Member for Farnham and Bordon and the right hon. Member for Melton and Syston asked why the review covered only six organisations. The then Secretary of State authorised the Dash review to look at six organisations in this space that were directly overseen by the Department. Many other organisations in this space are not directly overseen by the Department, so they were not in scope of that review as they had their own regulatory landscape ecologies and so on. That is why those six organisations, which we oversee, were looked at. Last night at the Dispatch Box, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the rationale for this change is not based on cost. It is not based on the recommendations being too expensive. Rather, as I am sure colleagues will agree, we have seen far too many recommendations regarding patient safety but too little action. Inaction is not helping to improve the patient landscape. Opposition Members referenced the view from the longest-serving Health Secretary, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), that the NHS will not change or adopt the recommendations. That is a profoundly depressing prospect. We cannot predicate our laws and the health landscape on the basis that the culture in the NHS cannot and will not change. This is not a party-political point, but because of what has happened in the last decade, we must move from a defensive culture into a culture of learning while keeping a safe space in which people can speak up. We have heard a lot about “perception” today. I accept that there is a perception of negativity that is damaging to patient safety and people speaking up, but that is what our wider reforms are seeking to address.
I thank my hon. Friend for that. He and others on both sides of the House with clinical experience, including the hon. Member for Sleaford and North Hykeham, have shared live examples that can shock the layperson. It is important that those practices are changed clinically, and it is up to Government to make sure that the overarching legislative framework enables that.
I want to make some points first. I will pick up any outstanding points I do not cover. The abolition of HSSIB and the transfer of its functions to CQC is being done to strengthen the link between patient safety investigations and the action being taken on the frontline to simplify the patient safety landscape. We want to align the recommendations with action. Hon. Members quoted evidence that Dr Dash gave to the Committee. Let me remind the Committee of something else she told us, about how HSSIB’s functions can be better aligned as part of the CQC. She said: “by bringing HSSIB into the CQC, you can align the work of the two. For example, if the CQC is going round the country and spotting a particular problem with the way in which anaesthesia is being given or with managing patients post-surgery, the CQC could then say to HSSIB—that team of people with specific expertise—‘Can you go in and take a look at this? Can you do a detailed focus review of this particular area of care that we are spotting through our visits and which seem to be a particular challenge?’ It is that bit about enabling the CQC to identify a problem and then asking HSSIB to review it in detail, and HSSIB bringing its expertise in investigations into the CQC to enable the CQC to go deeper and then come back to the NHS”.––[Official Report, Health Public Bill Committee, 16 June 2026; c. 7, Q8.] to enable best action. These organisations can learn better from each other. Transferring investigation powers to the Care Quality Commission is an opportunity to strengthen the CQC. We have to move away from a defensive culture to a culture of shared learning if we are to improve patient care. The CQC can learn and improve from HSSIB best practice and take a more holistic approach to patient safety. Those executing the regulatory and investigatory functions can learn from each other and exchange skills, which would strengthen the links between learning, oversight and improvement, leading to real and sustained change across the system, driven by the CQC.
No. There will be no barrier to investigating whether CQC inspections are causing unintended harm. If they are, and the investigator feels that a recommendation for change should be made, they will make it. The insight gained from investigations will continue to inform recommendations concerning the CQC’s regulatory functions, and the Bill allows for the investigation function to make recommendations to the CQC in its report. The CQC would be legally required to respond to such recommendations. There will be no need for litigation through the courts. That is an important point. Again, I am addressing the points made by Opposition Members. We will continue to set this out more clearly for Members. I am happy to find different ways to do that. I now turn to the wider point about whether both an investigatory and a regulatory function can reside in the same body. Many organisations have different functions and responsibilities that they have to discharge simultaneously; we have also heard a lot about the safety body, which of course is part of the Department for Transport. It happens across a lot of bodies. I totally accept that it would be helpful for the debate if we were clearer on what some of those bodies are, and we will come forward with more information on that.
I am going to persist on some of these arguments. I think I have addressed all the points made by the Opposition. It is the job of effective leadership to manage those interests and responsibilities, and that is what we expect of the CQC’s leadership. I will now turn to the amendments on this topic, which I thank the hon. Members for Sleaford and North Hykeham and for North Shropshire for tabling. Amendment 55 would make provision for the Secretary of State to disapply investigation powers in certain circumstances. I recognise the importance of ensuring that investigatory powers are not exercised in relation to sensitive Crown or Government premises where there is a national security interest. I want to be clear: the Bill already provides for that. The Bill already amends section 96 of the Health and Social Care Act 2008 so that it applies to the new CQC investigatory function. Section 96 makes provision for the application of CQC legislation to the Crown, which means that the mechanism that the amendment is seeking to introduce is already in place within the existing legislative framework. Additionally, the Bill already provides for a power which enables the Secretary of State to disapply these investigatory powers in relation to Crown premises when it is in the interest of national security. The amendment would therefore duplicate an existing provision and would add unnecessary complexity to the legislation without delivering any additional benefit. Amendment 56 would allow the Care Quality Commission to recover charges that are higher than the actual costs it incurs when providing assistance to anyone other than an NHS body or the Secretary of State. I understand the intention behind the amendment—to give the commission greater financial flexibility—but the Government do not think that it is necessary. The charging framework in the Bill is based on the clear principle of cost recovery. Removing subsection (9) of proposed new section 51R of the Health and Social Care Act 2008 would mean that the commission could charge more than it actually costs to provide a service, shifting away from recovering costs and towards allowing the commission to make a surplus through its charging powers.
I am happy to get back to the hon. Lady on that specific point, if that is the case. The charging framework is about recovering costs, not making a surplus, which is what the amendment would result in. If that is not the case, I will make sure that she receives a proper correction. The Government do not think that there is a good case for the amendment, because, as I have said, the aim of the provision is to provide for fair and transparent cost recovery, not to raise extra income beyond cost. I am not sure whether the hon. Lady is suggesting that it might be good for the commission to create additional funding, but if that is not clear, I am happy to get back to her on it. The provision makes the recovery of costs more predictable and consistent for those who have to pay them. That is usual for public bodies. New clause 42 relates to funding provisions for the CQC’s new investigation function. The Department already provides grant in aid to the CQC to provide adequate funding for investigations and special reviews; similarly, HSSIB’s budget is provided through grant in aid and is set each year. When the CQC takes on HSSIB’s functions, the funding streams will remain distinct, and the CQC will have to assure the Department that the amount allocated to the new investigation function is being used for that purpose. Funding decisions for the investigation function will continue to be captured in wider departmental budget-planning processes and considered centrally. That provides assurance that business and strategic priorities for the investigation functions can be met. Robust financial oversight will require the CQC to demonstrate that grant in aid is used appropriately, and solely to support the investigation function, without the need to prescribe funding arrangements in legislation. As there is already an operational mechanism for the Secretary of State to provide adequate funding and resources for investigations, the new clause is not needed. It would also be inappropriate to prescribe the form or level of funding in legislation. The new clause would reduce the Department’s ability to manage funding through the established spending review and estimates process; introduce unnecessary rigidity as the merged function evolves; and risk creating binding funding expectations that may not align with future fiscal constraints. A non-legislative approach ensures flexibility, scale and adaptive function while maintaining robust oversight. I agree with the intention behind amendment 5, tabled by the hon. Member for North Shropshire, which is, as I understand it, to ensure that the Health Services Safety Investigations Body functions that are transferred to the CQC retain a high level of operational independence and continue to command the confidence—the Committee heard that word a lot this morning; I completely agree on its importance—of patients and their families, healthcare professionals and the wider public. Similarly, I understand that the objective of the amendment is to maximise the perception—again, that is a word I am coming back to; I tried to address the issue earlier—of independence in the CQC. The Government have protected safe spaces in legislation, and we agree that operational independence of the investigation function is required, but our plans support and enable that. For that reason, we cannot support the amendment, which would impose a highly prescriptive governance structure on the CQC by requiring the creation of a separate statutory committee and setting out in primary legislation detailed requirements for its purpose, membership appointments and operational arrangements. While the Government fully agree that effective safety investigations must be conducted independently and objectively, we do not consider it necessary to put such detailed organisational arrangements in the Bill. The Bill already provides a clear legislative framework for the transfer of those functions and enables the CQC to discharge them appropriately, within its broader statutory responsibilities. Furthermore, the CQC already operates within a robust statutory framework and is capable of establishing governance arrangements that support the effective delivery of its functions, including appropriate safeguards to protect investigative independence and the handling of safe-space material. The amendment would reduce organisational flexibility by mandating a specific committee structure, and would constrain the CQC’s ability to adapt its governance arrangements over time in response to operational experience, changes in circumstances or future improvements in best practice. Under the amendment, governance arrangements would be fixed in statute, rather than having the capability to evolve as the organisation learns and develops. Those additional administrative and governance requirements would increase bureaucracy and complexity, which the Government are looking to reduce. I re-emphasise that, in addition, a statutory committee would weaken the important links between learning and the action that the transfer of this organisation is intended to support. One of the key benefits of bringing these functions into the CQC is the opportunity to strengthen strategic oversight and ensure that learning from investigations can more readily inform improvement activity across the system.
We are probably not going to agree on this point. I have made the point several times—and we made it in the Dash review—about bringing these organisations together. As I said again in my opening comments, it is about the opportunity to get this right and share that learning and experience. It is not about the cost but about aligning the recommendations and the actions that follow through from them. That learning, and the opportunity to push that through, is something we should grasp. Coming back to amendment 5, creating a separate statutory committee risks introducing additional layers of separation that could slow the flow of intelligence and impede timely action in response to emerging patient safety concerns. We believe the integration of investigatory functions can be secured through clear statutory functions and appropriate safeguards, rather than through organisational structures set out in primary legislation that are too rigid. Establishing detailed governance requirements in statute may also make future improvements more difficult to implement without legislative change. I understand and respect the concerns that underpin the amendment, but the Government believe that the Bill already provides the necessary framework for the safe and effective delivery of health services’ safety investigations following their transfer to the CQC. We will of course work closely with both the CQC and HSSIB on their transition arrangements through a transition board, whether on the issues of ensuring operation independence of the investigation function and the ways in which that learning is shared, or, further to the Opposition spokesperson’s point, how we make sure that learning is shared and creates an impact, and where that is felt most clearly. For those reasons, I ask hon. Members not to press their amendments, and I commend clauses 59, 60 and 61 to the Committee. Question put, That the clause stand part of the Bill.
Clause 62 underscores the importance that we place on special reviews and investigations, and it will maintain the Care Quality Commission’s ability to conduct them by ensuring that the CQC’s investigatory role remains properly aligned with its original statutory purpose. The CQC is the independent regulator of health and care providers, and in the case of commissioners, it has the powers to undertake a special review or investigation when requested to by the Secretary of State. On 30 January 2024, the then Secretary of State, the right hon. Member for Louth and Horncastle (Victoria Atkins), commissioned a section 48 review into mental health services in Nottinghamshire following the tragic events of June 2023. As we know, that revealed serious and systemic failings and led to strengthened oversight and a clear improvement plan. With NHS England being abolished and its functions being transferred to the Department and across the wider system, this clause will remove NHSE from the scope of section 48 and allow Ministers to set out, through regulations, the future scope of section 48. NHS England’s commissioning functions will mostly transfer to the integrated care boards but, as we discussed previously, NHSE’s most specialised commissioning functions will transfer to the Secretary of State. In future, regulations will set out the specific commissioning functions that the Secretary of State will be responsible for and that the CQC may review or investigate. The scope of the special reviews and investigations will continue to apply only to commissioning functions under the National Health Service Act 2006 or section 117 of the Mental Health Act 1983, which is the CQC’s existing remit. This approach will ensure that the CQC’s investigatory powers will not be automatically extended to departmental functions, which would fundamentally change the relationship between an arm’s length body and a Government Department and would not align with the original intention of section 48 reviews. For that reason, the Bill will provide for scrutiny through secondary legislation. That will set out a transparent and accountable way to specify which commissioning functions are in scope, enabling parliamentary scrutiny and CQC oversight where it is genuinely relevant to patient safety and care quality. This approach will also provide important flexibility: as commissioning arrangements change, the right function can be brought into scope without unnecessary delays. Taken together, this clause will protect the CQC’s independence, maintain accountability and provide a sensible framework for scrutiny where it adds real value for patient safety and care quality. I commend the clause to the Committee.
My understanding is that the clause will not change that particular power, but I will get back to the hon. Lady if I am wrong. Question put and agreed to. Clause 62 accordingly ordered to stand part of the Bill. Clause 63 Time limit for bringing proceedings Question proposed, That the clause stand part of the Bill.
The 10-year health plan reaffirms the Government’s commitment to families affected by bereavement or serious harm, ensuring that lessons are learned from their experience and that more cases are fully reviewed and acted on. Families seek closure following serious harm to or the death of a loved one by wanting to understand what went wrong and what could be done to stop other families experiencing similar trauma, and by wanting to hold someone to account. Families often turn to the Care Quality Commission for help. Clause 63 will extend the CQC’s power to bring proceedings against a health and social care provider for a serious breach of regulations from the existing limitation of three years from the date of the offence to five years. Let me be clear: extending the three-year limitation from the time of the offence will not alter the first requirement that the CQC should act within 12 months of sufficient evidence of a serious breach of regulations becoming available. That 12-month window for action once the regulator is aware of the offence will remain unchanged. Extending the limitation period to five years from the date of the offence will mean that fewer events that should be considered by the regulator will effectively time out and go beyond the reach of the regulator’s action. The CQC is not the only body with an interest in investigating serious breaches of regulations that result in unnatural death; there are other investigatory bodies, such as the police, with equal interest and powers to investigate deaths for the purpose of pursuing criminal prosecution. The coronial process serves a different purpose. A coroner’s role is to establish facts surrounding an unnatural death rather than to find fault. In a complex case, a police investigation or a coroner’s inquest—sometimes both—can take time to conclude. Those independent processes are a useful source of information for the CQC to form a full picture of a breach of regulation. A culture of learning from investigations, inquiries, errors and poor care should be the norm in the NHS. It is therefore expected that a service provider may also commission its own internal investigation to learn from an unnatural death. Furthermore, there are cases where the CQC is approached late with information after an offence may have been committed. For example, the CQC may only receive information about an offence two and half years after it was committed, leaving little time in the remaining six-month period to investigate. Extending the period to five years would help mitigate such circumstances, and that is why we are extending the statutory limitation period. This will ensure that the CQC has the ability in far more cases to address the serious regulatory failings that it should and must address, without risking falling foul of a time limitation. I therefore commend the clause to the Committee.
Apologies—I missed the exact question as to what needed to be changed. Could the hon. Lady repeat that?
Put simply, the answer to the hon. Lady’s questions is that we are not seeking to change other aspects. The CQC wants to get to points as soon as possible, so the 12-month period has not been changed. The function of clause 63 is merely to recognise the issues around the three years and to change that to five years. We are not seeking to alter anything else in that regard. On her point about the commencement date, that is merely recognising what is considered to be parliamentary convention. Question put and agreed to. Clause 63 accordingly ordered to stand part of the Bill. Clause 64 Abolition of Healthwatch England Question proposed, That the clause stand part of the Bill.
This is a popular clause, Ms Lewell—and rightly so. I recognise that this provision has elicited a lot of interest among our constituents and the wider public. I look forward to hearing Members’ contributions.
I think that the record will show that I have taken several interventions in recent days, and I will continue to do so. I have been very clear that we have some fundamental disagreements on philosophy and approach. I will desperately try not to veer into the next groups, but it may be tricky. I am sure that you will steer me through, Ms Lewell. I want to pick up on some good, helpful points that have been made. I pay particular tribute to my hon. Friend the Member for Lichfield for the comments he made. I appreciate that certain areas, particularly Mid Staffs, have elicited a lot of debate and concern. I commend him for following that through on behalf of his constituency. I know that other Members in Staffordshire want to understand how the Government’s future plans will address their very real concerns. That is also true of other areas that have experienced shocking scandals, as we call them. I take that very seriously. I will pick up on the question of independence that we veered into before, which was mentioned by the hon. Member for Sleaford and North Hykeham. She highlighted her concerns and the issues raised by my right hon. Friend the Member for Makerfield, and I heard what she said. Independence was also raised by the hon. Member for Winchester and my hon. Friend the Member for Lichfield. We therefore return to that point about independence and, as my hon. Friend said, about being in the room, making those decisions and changing the entire culture of the organisation to do something different. The question is then whether bringing the functions of Healthwatch to the national level is the right method. Again, I commend work on that and the individuals involved in it. Hon. Members mentioned Jacob Lant of National Voices and the King’s Fund, which have worked with us very well to challenge us and try to make this legislation better. I really appreciate their work, and we will continue to talk with them. The hon. Member for Farnham and Bordon mentioned GIRFT. I cannot help but respond to his point, because he suggested that being inside NHS England has somehow made it less effective, and I could not disagree with him more. It is not because he has left and is here; his presence is obviously missed at GIRFT and welcomed here. To be serious, every meeting I have with NHS England and everything we are attempting to do in reforming outcomes for patients on the ground involves GIRFT. It is now at the very heart of what NHS England does. By coming inside the organisation, it has done exactly some of the things we want to do: drive cultural difference and change inside the organisation, rather than being outside of it. As I said before, this is a slightly philosophical argument and political argument. I appreciate that there are views on either side, but that is absolutely our intention. On the patient experience directorate, we recognise that public trust will be crucial. We need to ensure that there is system learning across the piece. The patient experience directorate has to earn the trust of the public and parliamentarians, so we will design it to operate transparently and sit at the centre of decision making rather than at its margins. Ministers will be accountable for and answerable to Parliament on the work of the patient experience directorate. It has to focus on the voices that are too often overlooked. The central priority of the directorate will be to reach under-represented and seldom heard groups and to ensure that engagement is accessible, inclusive and proactive, so that the experiences of vulnerable people help inform and shape the decisions that affect their lives.
I thank my hon. Friend for making the intention of her comments clear to the Committee. It is right that we need to build trust in patient voice and experience. We will pick up on that in our debate on local healthwatch branches, because that is perhaps where Members of Parliament are particularly important. At a national level, there are many voices and organisations continuing to review the issue and challenge the Government, including through reports, meetings with Ministers and in Parliament, highlighting the good work that they do and numerous Committees. Health Ministers appear before the Public Accounts Committee, the Health and Social Care Committee and Lords Committees; I have appeared before the Science, Innovation and Technology Committee. That is an important way of ensuring that the Department and the new experience directorate will be accountable. I recognise the important contribution that Healthwatch has made in capturing patient insight and informing the design and delivery of services, but we do not believe that new clause 78 is necessary. It is inconsistent with the purpose of the Bill. I am aware of the views of the hon. Member for North Shropshire, but the Government’s policy is to abolish Healthwatch and ensure that patient and public voice is more directly connected to decision making. It would therefore not be appropriate or consistent to legislate for a specific funding level for organisations that would no longer exist, or to constrain how funding is deployed to support the new arrangements.
I am just computing that in my brain. Can I seek clarification on that?
I understand. I am grateful to the hon. Member for that clarification, but her new clause represents an incomplete picture of Government funding for Healthwatch. A £14.15 million grant has been provided to local authorities for local healthwatches, and that is only part of the overall funding; a larger proportion is rolled into the wider local government financial settlement, and because that is not visible as a distinct line, headline figures often understate the total funding available. All of this funding is not ringfenced.
Clause 65 and schedule 10 will abolish the current local healthwatch arrangements and place responsibility for gathering the views of local people firmly with the bodies with the clearest levers to act: integrated care boards and local authorities. At present, many organisations are gathering views, running engagement exercises and raising issues, often with the best of intentions, but the result can be duplication, variable coverage and uncertainty about who is accountable for responding. We can end up with lots of feedback but too little clarity on the action that follows. By placing those duties on integrated care boards and local authorities, we are ensuring that insight from patients, service users and communities feeds directly into where commissioning and service planning decisions are made for both health and care. As my hon. Friend the Member for Lichfield said, the people are in the room. It makes it easier to connect lived experience to priorities, quality improvement and the tackling of inequalities, rather than leaving intelligence at arm’s length from decision makers. This is about strengthening impact, not silencing criticism. Integrated care boards and local authorities will have a statutory duty to demonstrate how they have engaged with all people in their area, including seldom heard groups, and will be expected to have clear routes for people to raise concerns. We expect transparency about what people have told the system, what the system has done in response and how learning is shared across partners. As I said in my evidence, many constituents in my Bristol South constituency are said to be hard to reach. They are not hard to reach, in my view. We know exactly where they live, who they are, how old they are and what sex they are. We know largely what diseases they have. We know their level of income. We know their levels of education and attainment, and how they impact their health outcomes. They are not hard to reach; the system is not set up to listen to them. That is what we are determined to change. Dr Penny Dash’s review of patient safety described a cluttered landscape, with overlaps in how user experience and advocacy are organised. It described the burden that that can place on the frontline, producing multiple, poorly co-ordinated asks with limited impact. Bringing the patient and community voice closer to the organisations responsible for improvement—it is actually their job as commissioners—will help to make feedback more actionable, reduce confusion and support better services. I commend the clause to the Committee.
Again, we have had an important discussion, particularly around the issue of independence; I accept that it is difficult and that there are arguments on both sides. We have heard a lot about Professor Croisdale-Appleby’s evidence on behalf of Healthwatch. I made this argument on Second Reading: we have had this arrangement for 52 years, and I think we can all agree that the situation is not good. It has not worked. As I said earlier, 20,000 reports add a lot of work. There is a lot of work in this landscape—well-intentioned work by good people. We can argue about whether Healthwatch was set up appropriately to do the job it has been asked to do. I was pleased to hear the three examples from the Lib Dems and other individual examples of where light has been shone upon a closure, for example. It is good that that has been valued by local Members of Parliament. I would argue that nobody should be closing services without fully engaging with the local population and setting out clearly why that is being done. That is a failure of those local organisations, and we need to address the cause of that failure. I am struck by the oral evidence to the Committee on those 20,000 reports in 52 years. It was suggested that it takes six months, as I think the hon. Member for Farnham and Bordon said when quoting the evidence, for somebody to “go out”—that is the phrase that is used: “Let’s go out and talk to people in these far-flung communities. What do they think? What is their experience? Who are they?” It constantly surprises me, as it did when I worked inside the system. These are not remote people. We know who they are and what is wrong with them. We know how remote they are from the system. That goes to the heart of why the taxpayer is so alienated in this country from public services and their poor functioning. That is what the Government want to change. It is not a matter of ICBs adding a new function; the Opposition have fundamentally misunderstood that. It is about rewiring these organisations to do something very different. Their function as strategic commissioners is to understand and to use all the data and evidence, including direct voice. We can argue about how that direct voice is taken in, but that is fundamentally what a commissioner is—I say that, having been a commissioner. It is not being done well, and that is why we are changing the legislation. Under previous legislation, ICBs had multiple functions. We are changing that to force them to be commissioners, but it is not an add-on; it is fundamental to the commissioning process. It is a complete rewiring of the organisation to listen to patient voice, patient experience and the reality of health inequalities. In my constituency, I am afraid have not seen examples of the independent voice really speaking on behalf of the people I serve—some of whom have the worst health inequalities in the country, largely as a result of the tobacco industry and its legacy—whereas their experiences and their health outcomes are very well known and should drive the necessary changes. That is why we are driving all the changes in the 10-year health plan: to meet the needs of communities. We will continue to have this debate, but I wanted to make that absolutely clear. We assume that the independent voice is always clear, but it is not. We have heard that it is variable and fragmented. That is not the fault of anyone trying to provide it, but that is where it is. The system is supposed to listen and improve services, and it does not. Things need to be changed in order to achieve that, and that is what we intend to do. The changes will be supported by scrutiny, transparency and oversight arrangements. The alternative, which is maintaining a separate structure with limited levers to drive change, has not delivered, and it cannot continue to try. We are not removing patient and user voice; we are embedding it at the heart of the new system. ICBs will be expected to carry out proactive, inclusive engagement, particularly with so-called seldom-heard groups, including carers, those who do not have access to digital platforms, those less proficient with technology and people for whom English is a second language. Crucially, ICBs will be accountable for demonstrating reach and impact, not simply how many reports or engagement exercises they have done. Impact is what we will be looking at. As I have said, this is about moving from a model where voices can be collected but overlooked to one where they must be heard and acted upon. The new patient experience director in the Department will work closely with local systems to identify national themes and significant concerns, ensuring that patient experience informs policy and improvement at the national level. To answer a previous question, the Secretary of State will have the power to issue directions to ICBs and local authorities if they are failing to exercise that function. As I have said in debates on previous groups, I understand that it is difficult when we are debating the abolition of something outwith the wider framework of the 10-year health plan, the Dash review, the patient experience directorate in the Department and changes to the national quality board. It is incumbent on the Government to make that architecture clear and to build confidence and trust. That is what we intend to do, and that is how this body will be taken forward. All comments have been noted. There is a fundamental difference of approach. We are making those bodies fundamentally different and rewiring them to do something different. I understand the bumpy road—I have been part of that, with community health councils and links to Healthwatch, and it has been a long one. I think we will keep returning to this theme. Those organisations have not been changed to do what they are supposed to do, and that is the ambition of this Government. Question put, That the clause stand part of the Bill.
As the UK resilience action plan sets out, we are living through a period of profound change. Ensuring that our institutions are clear in what they must do to prepare for, respond to and recover from emergencies is essential. With that mind, the clause is necessary. It clarifies the existing duties on NHS trusts under the Civil Contingencies Act 2004—the legislation that sets out how the UK prepares for, co-ordinates and responds to serious emergencies. Since the Civil Contingencies Act came into force, NHS trusts have been included as category 1 responders. That means that they have had specific legal duties to assess risks, plan for emergencies, maintain business continuity, warn and inform the public, and work together to co-ordinate an effective local response. Due to changing policies by the previous Government, references to NHS trusts were removed from the Civil Contingencies Act, yet under transitionary powers in other legislation, they remain category 1 responders. This has meant that their role has seemed unclear for some other responders and the public. I want to be clear that the clause does not change the position of NHS trusts, nor their duties or functions under the Civil Contingencies Act; instead, it simply clarifies the legislation, making their place and role clear. That is vital so that NHS trusts and other responders know exactly what is required of them during and after an emergency. I commend the clause to the Committee. Question put and agreed to. Clause 66 accordingly ordered to stand part of the Bill. Clause 67 Minor and consequential amendments Question proposed, That the clause stand part of the Bill.
These are minor and technical amendments. Government amendments 20 to 22 make changes to the Armed Forces Act 2006 to remove references to NHS England, reflecting that NHS England will be abolished. Those amendments are consequential to the Armed Forces Bill 2026. Government amendment 83 makes changes to the Children’s Wellbeing and Schools Act 2026 to remove reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Government amendments 23 and 24 both amend the NHS Act 2006 by removing unnecessary consequential amendments to that Act. Clause 67 inserts schedule 11, which makes minor and consequential amendments that are required as a consequence of the provision made in other clauses of the Bill. They mostly result from the abolition of NHS England, the conferral of NHS England’s functions on others—primarily the Secretary of State and integrated care boards—and the changes made to the NHS provider landscape. Those minor and consequential changes are made to a large number of enactments, but notably a significant number of such consequential changes are made to: the Mental Health Act 1983, the NHS Act 2006, the Health and Social Care Act 2008, the Health and Social Care Act 2012 and the Medicines and Medical Devices Act 2021. The changes are necessary to ensure the proper operation of the statute book and reflect the substantive changes being made elsewhere in the Bill. I commend clause 67 to the Committee. Question put and agreed to. Clause 67 accordingly ordered to stand part of the Bill. Schedule 11 Minor and consequential amendments Amendments made: 20, in schedule 11, page 140, line 16, at end insert— “91A The Armed Forces Act 2006 is amended as follows.” This amendment and amendments 21 and 22 remove a reference to NHS England from section 343AZB of the Armed Forces Act 2006 (to be inserted by the Armed Forces Bill). Amendment 21, in schedule 11, page 140, line 17, leave out “of the Armed Forces Act 2006”. See explanatory statement for amendment 20. Amendment 22, in schedule 11, page 140, line 18, at end insert— “92A In section 343AZB (inserted by the Armed Forces Act 2026), in subsection (5)(a) omit sub-paragraph (i).” See explanatory statement for amendment 20. Amendment 23, in schedule 11, page 144, line 5, leave out paragraph 118. This removes an unnecessary consequential amendment to section 12E of the NHS Act 2006 (that section is replaced in its entirety by clause 10 of the Bill). Amendment 24, in schedule 11, page 148, line 9, leave out paragraph 139. This removes an unnecessary consequential amendment to a heading that is replaced by clause 11. Amendment 83, in schedule 11, page 191, line 35, at end insert— “Children’s Wellbeing and Schools Act 2026 400 In Schedule 1 to the Children’s Wellbeing and Schools Act 2026 (relevant authorities)— (a) omit paragraph 9; (b) in paragraph 12, omit ‘section 25 of’.”—(Karin Smyth.) This is a consequential amendment to Schedule 1 to the Children’s Wellbeing and Schools Act 2026, which would remove a reference to NHS England and update a reference to NHS trusts to take account of the new conversion procedure created by clause 35 of the Bill. Schedule 11, as amended, agreed to. New Clause 20 Arrangements between NHS bodies and local authorities “(1) Section 75 of the National Health Service Act 2006 (arrangements between NHS bodies and local authorities) is amended as follows. (2) In subsection (6), for the words from ‘consultation’ to the end substitute ‘the making of arrangements by virtue of this section’. (3) Omit subsections (7A) to (7L). (4) In subsection (8), at the appropriate place insert— ‘“local authority” includes— (a) a combined authority, (b) a combined county authority, and (c) the Greater London Authority;’.”—(Karin Smyth.) This enables combined authorities, combined county authorities and the Greater London Authority to enter into arrangements with NHS bodies under section 75 of the NHS Act 2006 in relation to any of their functions, replacing the current different and more limited provision about combined authorities and combined county authorities. Brought up, read the First and Second time, and added to the Bill. New Clause 21 Dispensing medical practitioners etc “(1) The National Health Service Act 2006 is amended as follows. (2) In section 132 (persons authorised to provide pharmaceutical services)— (a) for subsection (1) substitute— ‘(1) Except as may be provided for by or under regulations, no arrangements may be made by an integrated care board with a person providing primary medical services under Part 4 to provide pharmaceutical services.’; (b) in subsection (3), for ‘medical practitioners’ substitute ‘persons providing primary medical services under Part 4’; (c) in subsection (4)— (i) for paragraph (a) substitute— ‘(a) as to grounds on which an integrated care board may, or must, refuse to grant an application for inclusion in a list referred to in subsection (3),’; (ii) in paragraph (aa) omit ‘of medical practitioners’; (iii) in paragraph (b), for ‘NHS England by a medical practitioner’ substitute ‘an integrated care board by a person’; (iv) omit paragraph (c). (3) In section 134 (pilot schemes), in subsection (8) omit ‘by a medical practitioner or dental practitioner to a patient of his’. (4) In Schedule 12 (LPS schemes), in paragraph 1(8) omit ‘by a medical practitioner or dental practitioner to a patient of his’.”—(Karin Smyth.) This updates the legislation about the provision of pharmaceutical services by medical practitioners to conform with current law and practice whereby commissioning arrangements are generally made with the practice rather than individual doctors. It also removes a reference to dental practitioners that is not needed. Brought up, read the First and Second time, and added to the Bill. New Clause 22 Inadequate provision of pharmaceutical services “(1) Section 133 of the National Health Service Act 2006 (inadequate provision of pharmaceutical services) is amended as follows. (2) For subsection (1) substitute— ‘(1) Subsection (2) applies if the Secretary of State is satisfied that a situation or event has caused or is likely to cause a disruption resulting in the inadequate provision of pharmaceutical services in England or in an area within England.’ (3) In subsection (2)— (a) after ‘Secretary of State’ insert ‘may by direction’; (b) for paragraph (a) (but not the ‘and’ at the end) substitute— ‘(a) require an integrated care board to make other arrangements,’; (c) in paragraph (b) omit ‘may’. (4) After subsection (2) insert— ‘(3) A direction under subsection (2) must specify the period for which it has effect. (4) The period must not be more than 6 months. (5) But the Secretary of State may by further direction extend the period for which a direction under subsection (2) has effect by up to 6 months at a time. (6) The Secretary of State must publish any directions under this section.’”—(Karin Smyth.) The amendments made by this clause (among other things) relax the legal test for making alternative provision to address the inadequate provision of pharmaceutical services owing to a disruption of services. Brought up, read the First and Second time, and added to the Bill. New Clause 23 Pharmaceutical services: appeals etc “Schedule (Pharmaceutical services: appeals etc) makes provision about the destination of appeals, and jurisdiction to determine certain matters, currently governed by Part 7 of the National Health Service Act 2006 (pharmaceutical services and local pharmaceutical services).”—(Karin Smyth.) The clause introduces a Schedule which amends provisions about certain appeals etc to the First-tier Tribunal. Those appeals will be transferred to an NHS body determined by regulations. It is expected that initially this will be NHS Resolution. Brought up, read the First and Second time, and added to the Bill. New Clause 91 Regulations: reference to agreements and standards “(1) The Medicines and Medical Devices Act 2021 is amended as follows. (2) In section 2 (power to make regulations about human medicines), after subsection (4) insert— ‘(4A) Regulations under subsection (1) making provision in reliance on section 3, 4, 5 or 7 may refer to international agreements or standards relating to human medicines, including agreements or standards as they have effect from time to time.’ (3) In section 16 (manufacture, marketing and supply), after subsection (2) insert— ‘(3) Provision made in reliance on subsection (1)(a) may refer to United Kingdom standards that— (a) relate to the marketing, putting into service or other supply of medical devices, and (b) are specified in a list published by the Secretary of State from time to time. (4) Regulations made under section 15(1) that contain provision made in reliance on subsection (1)(a) about relevant requirements (or exceptions from them) may include provision in relation to a medical device where— (a) the device complies with regulatory requirements applicable somewhere outside the United Kingdom which is specified in regulations, and (b) a description of the device and the regulatory requirements applicable to it are contained in a list published by the Secretary of State from time to time. (5) In this section “United Kingdom standard” means a standard that is— (a) set by the British Standards Institution, or (b) primarily developed for use in the United Kingdom, or part of the United Kingdom.’”—(Karin Smyth.) This new clause would amend the Medicines and Medical Devices Act 2021 to (a) enable regulations to refer to both international agreements and standards and standards developed in the United Kingdom and (b) enable the Secretary of State to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom. Brought up, and read the First time.