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1. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (First sitting)

   Q I am a member of the all-party parliamentary group on patient safety, and one of the things we have heard is that the idea behind HSSIB and the air accidents investigation branch is, in the long run, to reduce the need for public inquiries to save money. Can you elaborate on that a little bit? Sir Jeremy Hunt: Ideally, when something goes wrong, what you want is for there to be an investigation and for lessons to be learned, so that grieving families can say, “Well, at least we are confident that this wouldn’t happen again.” What happens in the health world is that families still think the only way they can get real change is through a public inquiry, so there is endless demand for more inquiries, rather than for things to actually change. If HSSIB was allowed to flourish, and there was confidence that its recommendations really would be acted on quickly, I think that would reduce the demand for public inquiries. They are very expensive, and the fact that they often take five, six or even seven years also means that there is enormous delay before anything changes.

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2. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (First sitting)

   Q As a former Secretary of State for Health, what are your reflections on the abolition of Healthwatch and the absorption of its functions into the Department of Health, ICBs and local authorities? Sir Jeremy Hunt: It is not dissimilar to my earlier reflections. It is really important that patients have a voice, but it is even more important that their voice is heard not just through a bureaucratic process that listens to them, and gives them a sense of being listened to, but then nothing happens. The problem with the Healthwatch structure we have is that it is very good at the listening bit, but I do not think people have confidence that things actually change.

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3. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q I am a member of the all-party parliamentary group on patient safety and I am also a vice-president of the Local Government Association. Can I ask about Healthwatch? We heard this morning that ICBs will be taking on a chunk of the current operations of local healthwatches, but that they will not have any additional budget to enable them to do that. In fact, we know that their budgets have been significantly reduced. Could you elaborate on how you think that will work, and will it be as effective as the current system? Sir Ciarán Devane: The ICBs have a capitation fee of £19.40, which they have to do everything out of. This is an additional duty placed on them. They will have to work out how to do it if there is no extra money coming, but it will be pressured. I hear the argument that local healthwatches were variable. This function has been slightly outside and independent, playing back into decisions; we have to ensure that the level of independence remains somehow in how this is constructed, but that the variability is not just transferred from local healthwatches to how it is done within or across ICBs. Again, the implementation will need to be done well. That leads into the question about local authorities and the connection with them, making sure the democratic voice is brought in and equally the local voice. The legislation does not stop an ICB doing this well. Therefore, without the legislation, part of what we can be doing collectively is trying to make sure that what was good about healthwatches is preserved and is understood by ICBs. There are only 25 of them, so it should be a manageable task for the rest of us. The effectiveness comes back to whether you believe this is a good thing. One of the things we have to do is secure that the benefits of having the patient voice in there, along with the clinical voice and the voice of the manager, at the same time, so that it is not a case of saying, “Oh, now we’ll go and consult the patients on the font size of the report,” but is authentic. That puts a lot of work on to the ICBs and on to those of us who believe passionately in engaging with the patient voice, but there is a risk because of that pressure. Done well, it will enable strategic commissioning and ensure the quality remains, but they are starting, if maybe not from scratch, from a new place.

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4. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q My second question is similar. In reality and in practice, how do you envisage ICBs will be locally accountable once these legislative changes have taken place? Sir Ciarán Devane: According to the ICBs we are talking to, which is all of them, they are saying that they believe in local authority engagement. We will be saying, “You may not be told you have to, but we would encourage you to do it.” I am sure that should be coming from the Department as well. The witness to my right is an example of that; we know that when the NHS has really good local connections, you can get things done in the interests of your patients much more easily. The belief is there, but we need to make sure that the legislation is not seen as a signal that this is unimportant. That is a risk. As a representative organisation, we have to say to people, “We hear you saying that you really believe in this. Therefore, you need to demonstrate, not least to the Secretary of State, that you are following it through.” I have a small additional point about mayors in unitary authorities being able to appoint somebody who is both the chair of the ICB and the local health commissioner. That should help. Those individuals will have to work out how to serve two masters, but that is okay—other people learn how to do that, too. James Blythe: I would focus on a slightly different part of the Bill in terms of how this needs to work. There are 25 ICBs; that is quite a large footprint. From my experience of delivering meaningful collaboration and joint working between health and local government, I think it tends to happen at a more local level than that. The neighbourhood health plan in the Bill becomes extremely important. As a system, we should be very ambitious for those neighbourhood health plans. They should go a lot further than just describing what should happen in terms of improving health outcomes at a local level. We should set an aspiration as a system that there should be a responsibility on health bodies and local government bodies to describe how changes will be made. The role of ICBs is to enable groups of providers and other organisations in local areas—most ICBs will have several places—to come together and not just work out what a local population needs, but actually do it. That will mainly be about relationships on the ground between an acute hospital team, a community services team, a mental health team and a social work team. The role of ICBs is very much to give the contractual tools and mechanisms to local NHS organisations to work effectively with their local authorities so that there are really good neighbourhood health plans. Most importantly, they should not just write them but actually see them through.

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5. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q Sarah, the Patients Association has said that it is concerned about this reorganisation distracting from patient priorities. Could you elaborate on where those concerns come from and what should be done to mitigate that? Sarah Tilsed: I said a lot about that earlier, in response to a previous question, so I am not sure how much more I have to add. I think my main point is that we must not divert attention away from the urgent priorities that patients are facing at the moment, ensuring there is a truly independent patient voice and trust—there is a lack of trust among patients, as I keep saying. How are we going to ensure that the reporting system is there for this? Ultimately, patients need reform to lead to better care, not simply to different structures, which I fear is what often happens. Sir Robert Francis said, following the Mid Staffs situation, that patients must come first. Throughout the passage of the Bill, the Patients Association question will remain simple, and we will ask it time and again: will these changes actually help patients to receive better care, and how will we know if they do? That is the first principle to come back to. When everything is happening—all this restructure—how are patients going to be affected and involved in it?

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6. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q My second question is about Healthwatch. The Committee heard this morning about the variability of Healthwatch’s effectiveness at a local level. What could be done to ensure that the best and most effective Healthwatch practice is rolled out across the whole of England? Professor Croisdale-Appleby: Thank you for that question. One of the reasons there is a difference or variation among the 153 is that the amount of funding is very different. Some of them get 10 times the funding of others, which makes a difference to the scope of what they can do. What it does not allow—and I think Healthwatch England has an important contributory role in this—is a change in the quality of the way in which the research is done. One of the things that I have encouraged very strongly—although it happened before I joined Healthwatch—is the use of qualitative as well as quantitative data. The system is awash with quantitative data, but that does not necessarily cut through to the way that people are, the way they think, the lexicon they use, the concepts they use in communication etc. One of the great strides that Healthwatch England and our 153-member network have made is the intelligent use of qualitative data. That is an art in itself—I would like to think that is a science, but it is certainly an art. It would be easy to remedy that, in the sense that if the funding were more equitable, some of that variation would disappear, but the variation is not in the quality, the effectiveness of the listening or the ability to look thoroughly at the impact, and it does not affect the fact that the organisations concerned are held responsible for what happens to the recommendations in terms of implementation. That is uniform across the system—it is just the amount of it that will vary naturally, because of the differential funding.

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7. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q I am a vice-president of the LGA, and I am also on the all-party parliamentary patient safety group, just to declare that interest up front. I will use the example of my own local authority, Shropshire, which is a unitary authority. It is extremely financially challenged and operates with an ICB in a similar situation. The hand-off that Sally described between continuing healthcare and provision of social care is really problematic because neither organisation really wants to pay for the care for the people who need it because they do not have the funds. It is a really tense relationship between the two. I am really concerned that that will become even more problematic because they cannot work together, given that we are not a combined mayoral authority, that we will not have a mayor sitting on our ICB and that our ICB merged footprint does not fit with our local authority geography. How can the health and wellbeing boards work between the two organisations to deliver good social care?

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8. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   I am directing it at all three, if that is okay.

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9. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

   Health Bill (Second sitting)

   Q Do you think that the health and wellbeing boards, as envisaged by the Bill, will be the right structure to deliver those relationships, and how do you ensure that they have the right skills? Councillor Wright: I chair a health and wellbeing board, and everyone comes to those; there are really good conversations and really good reviews of what is happening. I think they are in a really good position. What I worry about is how much influence they will have over NHS wider strategy. I was at a King’s Fund day, and someone said something that I thought was so true: the Health Bill and the NHS 10-year plan is the NHS 10-year plan. The NHS will be judged on how it achieves what it is meant to achieve. Although, as local authorities, we want to help with prevention and those wider determinants of health, ultimately the responsibility sits with the NHS. It is about trying to work out how we have better conversations with the NHS, to say, “We have done neighbourhood health for years; this is what we do as local authorities. We look at all these things and we use public health and our adult social care system to create healthy environments. We need you to be on board with us.” I therefore think there is something about the power dynamics regarding health and wellbeing boards and how we address them. But overall, I feel that they are the best way of ensuring community health. The other thing is about geographies. Health and wellbeing boards might not match neighbourhood health geographies, so there are also some challenges in working out how that will work.

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10. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q We have talked a lot about the single patient record, but I want to touch on whether the Bill does enough for people who have historically not been listened to, as we have heard has been the case for carers and women who have suffered in the maternity system. Does the Bill deal with the problem of people not being listened to? What opportunities are there to improve the Bill in a way that improves the situation? Paul Farmer: Listening to patients is an incredibly important part of any health system. It is necessary to make sure that the right mechanisms are in place at both the individual and the systems level. The aspects of the Bill that cover patient experience need careful consideration. Many people were fans of what Healthwatch delivered, and others were not, but it had a clearly established system and mechanism in place to ensure that patient voices were heard. It is important that clear systems are established to ensure that that patient experience is heard. I have operated around the health system for a number of years, seeing a number of incarnations of patient voice organisations and representation; you really have to think about it from the individual and the whole-system level—from top to bottom. It is important that the Committee looks at the provisions in the Bill in that context to make sure that where there are good supports, they not only are preserved but can be built on. For example, how do you make sure that patient voice is heard at ICB level, in providers and, in particular, in the new world of neighbourhood health? Kath Abrahams: Helen, it is a great question. Clearly, the Bill itself, and certainly the single patient record, are never going to replace wonderful, kind and compassionate care where people feel they are listened to. As I have already said, but I will say again, a combination of people not being listened to at all, despite knowing their own health better than anyone else, or having to retell their stories has very challenging consequences. Both leave somebody feeling that nobody really cares or understands them. I spoke to a supporter of Tommy’s this morning who has had five miscarriages. She was saying it appears to be quite a small thing, but every time she went to see a clinician, they said, “Oh, you’ve had four losses” or “You’ve had three losses.” It was about them not understanding, and her having to correct her records and getting letters through. It is about that sense of not being listened to. As we develop the Bill, women and birthing people, from a maternity perspective, should have the opportunity to contribute to the way something like the single patient record is shaped. You could have a digitally accurate system that did nothing to reassure women or help them feel looked after or listened to, or you could have a beautiful system where the information was recorded in such a way that it really helped. Alongside that, clinicians need to continue to receive the right sort of training. They need to have enough time. As Paul said, you need those patient voices involved in overseeing how things are going, and able to contribute and help. The Bill itself, as a mechanism, will not do enough. This is about designing it carefully with patients in mind and, in the case of maternity services, involving women right from the start. Emily Holzhausen: There are provisions in the Bill that transfer responsibilities from NHS England to the Secretary of State in relation to involving patients, and it is very explicit that this also involves carers. It is very important that explicit Healthwatch duties to involve carers have been transferred into the Bill in relation to integrated care boards. That matters because their portfolio of commissioning different services is increasing, as is that of local authorities. Those are strategic duties. The reason why that is important, to be very specific about carers, is that they provide £152 billion-worth of care. They outnumber staff three to one. They are experts in care over time and they want to be involved. Of course, what colleagues have said about good practice is critical to look at. The changes to Healthwatch—others have raised this—do not consider the person’s journey across different services, health and care. There is an independent voice that we do not have, and will not have, in quite the same way. A very small proportion of carers felt that, if they raised a complaint, it would be acted on. That kind of independent voice is actually very important. As Kath said, those duties are really important, but we need top-to-toe listening to patients. We also need to be explicit about listening to carers, not just on behalf of the patient, but by asking, “What is your experience as a carer of managing this care?” because that is very different. To be honest, I do not think we have the right data flows behind that to collect and understand people’s journeys and improve things. I hope that that is also something that will be looked at.

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11. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I think everyone is agreed about the transformative potential of the single patient record, and we have heard various concerns around privacy and the types of use. I am interested in how all these different systems can speak to each other, because, in my experience as an accountant, you can have interoperability, but if the data that you are interoperating with is not consistently curated, you have a problem, because you have something that looks the same for everybody, but that actually means something very different to each person who inputs that data. Do you have any advice for us on the development of that single patient record and how we make sure that the data is clean and consistent between trusts and different systems, so that the single patient record is actually meaningful? I will ask Dr Cocker first, if he is the technical expert. Dr Cocker: I would not go that far—my involvement in this whole project is clinical, rather than having any sort of particular technical expertise. I think that is a pertinent issue, however, because, as has been discussed previously, if an error enters the SPR—say, a code is incorrectly followed through into the system—that error can then perpetuate. That is the risk of a single record: a documentation error can ripple out, rather than being contained within the system it originated in. Does safeguarding that involve putting requirements on the providers of systems to mean that data can be exported in, maybe not a standardised format, but a set of formats that the SPR recognises? It is a technical question that I do not know the answer to, or the possible solutions to, but that would be one of my suggestions. Rather than having hundreds of different systems that all require slightly different solutions in order to be fed into the SPR accurately, there could be some sort of framework setting out requirements on the providers of the software products used by all the different organisations that will feed into the SPR. Dr Imam: Like Dr Cocker, I am not technical but, from previous pieces of work that I have been involved with, some of it is to do with the data architecture and making sure that you can agree on the fields being used across the various systems. On frailty specifically, we have had the question of, “If we have multiple source systems that have the same field, which one should we be showing within the single patient record?” Our thinking at the moment is that we would show various entries, with who they have been done by and at what time, so that the clinician could decide how to interpret that data.

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12. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q My other question is about digital exclusion. This is particularly for Dr Imam, because we associate older people with being digitally excluded, although I know it is not exclusively older people who are digitally excluded: how would you envisage the digital record interacting with something more analogue for people who cannot use the NHS app for whatever reason? Dr Imam: That is a really important question; it is something that needs to be thought about very carefully when it comes to the implementation. From my previous NHS England experience, where we have had digital innovations implemented in the older age group, or among those who are perhaps traditionally digitally excluded, that has included partnerships to enable people to have the option of someone coming around, and there has been a thought process regarding people who perhaps cannot engage with technology as easily. That could involve people from the voluntary, community and social enterprise sector—for example, we had Age UK in the previous panel. There are lots of good examples of that type of work to ensure that people are not disadvantaged. Dr Byrne: There is an opportunity here in the context of digital exclusion. In a digital-first NHS, it is really helpful to think continually about what the analogue version of the system is in the event of further cyber incidents and outages of the system. We need to continually build and maintain a resilient system for the times when digital-first is not available. It is an important opportunity to do so if we think about that question of exclusion.

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13. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I will ask about the additional responsibilities that the Bill confers on ICBs. There are additional commissioning responsibilities and an additional requirement to look after what was Healthwatch—the patient voice element. As you have described, you have lost a large number of staff, you have a bigger geographic footprint and you have also lost quite a lot of budget. What do you stop doing, and what is being transferred out to other provider organisations? If the role of such organisations is changing to include some things that the ICB was doing, does that need to be clarified in the legislation? Jon Restell: It certainly needs to be clarified. Whether it needs to be clarified in legislation, I do not know. Leaving aside the fact it took a very long time to get permission to move forward with their consultations, ICBs were thinking about what they needed to do around May or June last year. They will have made a lot of decisions and a lot of staff will have gone already based on the then understanding of what an ICB was supposed to be doing, based on the ICB blueprint that was published by NHS England, so I think that resource has gone. The people who may be connected with the functions that you are talking to have also gone in many cases. The question for me is: if the ICBs are to get more things to do, what is the implication for their running costs? As you know, they are currently capped at about £19 per head. If they get more functions, will they get more resources to do that? Will there need to be other ways of delivering those functions? I do not think that a lot of them can stop doing statutory functions, but that means all the good stuff that we want to see done in health systems—the innovation and the discretionary stuff, much of which is already on hold—will probably be the stuff that goes while they deliver their statutory obligations. On the providers side, we need urgent clarity about what is going to go to the providers’ responsibility because they are taking out a lot of costs. I do not think that all, or many, providers know that these plans are afoot for them. That will create quite a shock. Again, they are choosing people to go now based on their current understanding of what is needed.

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14. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q If I may ask a related question, one element of the Bill is the reorganisation of who sits on the ICB. We have seen the removal of local authority representatives and their replacement by a mayor or his or her appointee. What concern does that cause to your members—or do they think that is the right way to go? Jon Restell: A lot of the concern is to do with the political make-up of mayoralties in the future and what that might mean; if mayors have an ever-growing responsibility and say in the who, what and where of health services, that is probably different from the more representative, advisory function that they have had. That really needs to be thrashed out: is that the new democratic accountability for health services, or does it remain, as now, with the Secretary of State, accountable to Parliament, making provision for healthcare? It feels a little unclear how much decision-making power those new local government voices will have on ICBs. Have people raised that as a concern? Of course they have; it is uncharted.

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15. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I am a vice-president of the Local Government Association. With changes to the better care fund pooling and the link-up with local authorities, are there concerns at ICB level that the partnership with social care will start to become more difficult? Jon Restell: I cannot comment specifically on the BCF, but a general theme coming out of what our members are telling us in surveys, and in the regular surgeries and meetings that we have with them, is the sense that policy at the moment is trying to get you thinking in terms of your own organisation again, and thinking less about system-wide transformation, innovation or co-ordination. ICBs are getting bigger and providers are getting bigger. It is some of the system stuff, where I think a lot of our members would say the innovation will come in the way different organisations try to solve problems around patients and populations, that they feel is at risk, by the way—not just from the Bill putting things together, but from the stripping out of resource to do anything different.

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16. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q You just used the phrase, “instrumental damage to the NHS”. Can you elaborate a bit on that, and perhaps explain how the NHS might be able to function better if there were a mechanism within the Bill to sort out social care? Sir Andrew Dilnot: I think there are two main ways. The first, and perhaps the one that has received most attention, is that there are people who have been hospitalised, perhaps following a fall or infection, who have some mobility challenges and need some care, but who cannot leave hospital because a social care package is not available for them in the community. That is extremely damaging for the NHS, because if we have somebody in a bed that they do not need to be in because they have nowhere else to go, not only are we spending money having them there but we are then not able to use the bed for other activities. If you have somebody with a delayed transfer of care that means they are stuck in hospital, when they do not need to be, for 20 days, which is not uncommon, very large numbers of elective procedures cannot take place because that bed is being used. That is a dead-weight loss from the system. There is another thing that I think is at least as important, which is that, because of the lack of good social care, we have people falling, injuring themselves and needing to be hospitalised. We have people sustaining more urinary tract infections than they perhaps would if they had good social care. That is adding an additional burden, which the NHS deals with as well as it can, but all of this just seems unnecessary. Social care appears to be so invisible to us all. It is easy to blame politicians, and of course it is politicians like you who ultimately have to vote for these things, but the electorate—the whole of our society—have to look at ourselves and ask, “Why can’t we make this challenge, which is so significant, better?” Any of you who have experienced it in your own family know how brutal and difficult it can be. If I can be allowed one more general point, we should reflect that this is the result of the great triumph of the last 150 years. At the beginning of the last century, across the world, average life expectancy at birth was 32, and now it is 73. In this country, average life expectancy at birth in 1900 was 46, and now it is 81. We have added 35 years to the expectation of life from birth, which is an astonishing transformation. Some consequences come with that, one of which is that there is much more social care to be done, but we should be celebrating this, delighting in it and doing it well, instead of hiding it away and ignoring it for so long that it is doing real damage to the NHS, let alone to the lives of people who need social care.

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17. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I will put words in your mouth, and you can disagree with me. Do you think the Bill should tackle the point about having a properly funded care service so that the transition from hospital to the community can actually take place? As you have just said, if people are not cared for properly, they end up back in hospital, and everyone here agrees that is what we are trying to avoid. Sir Andrew Dilnot: Yes, it is very odd. It is worth doing the odd thought experiment: imagine that the bit of healthcare that was underfunded and available only subject to a means test, and not free, was for heart disease. We cannot imagine it. The fact that it is dementia and severe arthritis means we have drawn an arbitrary line, and while that line still exists and there is still inadequate funding, even in a means-tested system, we are hamstringing the NHS. Now, that is not the most important problem, which is that we are failing to give people flourishing lives and allow them to live to the full, but it is now so bad that it is actually making it hard for the NHS to work.

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18. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I think I would agree with you, Minister, that no one thinks that abolishing NHS England is, in itself, a bad idea, given the duplication and cost. People do not think that a single patient record is a bad idea; I think that they assume that it already exists, and it could be transformative. There are therefore some really good points of agreement on the Bill. It would, however, be helpful to reflect on where there is not agreement: on abolishing Healthwatch and HSSIB. You make the very good point that they have not been successful in their current incarnation, but it is important to consider whether that is because they do not have teeth, or because the organisations that they are trying to change are defensive. We heard earlier about the culture of fear, and I think that we have probably all had people in our surgeries who can describe being frightened to speak up about their own personal care because they feel that they might be victimised for it. I know of clinicians who are frightened to speak up about their own experience in the organisation in which they work, because they feel that they will be punished for it. In the light of that defensive culture that we know exists in the NHS, and has been highlighted time and again—Mid Staffs; the Shrewsbury and Telford maternity scandal—is the answer not to put the patient voice in the organisations that have a culture problem, but to give those other organisations the teeth they need, or confer a duty on the ICBs or providers to act on recommendations that are given to them, because I think that might be a more helpful way of dealing with this problem? Karin Smyth: I think that gets to the crux of some of this. We will discuss it a lot in Committee, and I am obviously very open to keep discussing it. Thank you for your support on the main provisions. I do not take that for granted because, again, they are still controversial. However, as I think I said earlier, you are right, although it is not true everywhere. I am not blaming individuals, because I think that people have been trying to do a difficult job, particularly in getting us through the pandemic and beyond. But they are defensive. That is why Members of Parliament and others do not get responses to their phone calls or their emails. That is a culture that we have to change, and we need to support people to change. One of the things that we will do is to bring in regulations—that is a manifesto commitment from the Government—but another commitment that we have made outwith the Bill is to develop a leadership college to support in particular clinical and non-clinical managers, who have a very difficult job, in having the right skills for the new world, which patients and the public rightly expect to be more open and more transparent. We have to change this defensive culture. However, even since Francis, the adding of bodies and the adding of recommendations, and with the bad experience that you have done so much around, something different has to happen. Again, what we heard from Jeremy Hunt was that we needed to put more prescription into the system and yet more requirements to do something without actually making that someone’s central function and job. Now, it is a source of disagreement. As I have said, I think that there is a philosophical disagreement about the best way forward. It is not an antagonistic disagreement; there are fundamentally different views about what to do. We will continue to have discussions, because I think that ultimately we all want the same thing: a more open, transparent and supportive culture. By the way, nobody wants to work in a defensive culture, so I think people want that outcome. It is up to us as politicians to support difficult conversations and trade-offs that happen locally. My view has always been that politicians will support difficult conversations and trade-offs—we heard a little bit about reconfigurations earlier—if the system provides good clinical rationale, good data and good evidence, but those bits of it do not always line up. That is what I would like to get to. I absolutely understand and hear what you say—we will hear more about it and discuss it more, and I have read all the amendments about the best way forward. I think that we all want to get to the same place, but what is the best way to do that, given that we all know that this is really not working and cannot continue?

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19. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    Q I have a technical question about foundation trusts. The 10-year plan says that foundation trusts could be given population health responsibility for commissioning and budgets. I do not understand how that fits in with the Bill. Could you clarify whether that is not envisaged for now or if it is lurking somewhere in the Bill that I have not spotted? Karin Smyth: I will need to come back to you on the detail of that. In much of the Bill, we are trying not to over-prescribe. However, we need to get foundation trust licensing right. There are some things that are needed in the Bill, which is what we have put in as far possible, and some things that are not. Can I come back to you on that specific point if that does not answer your question?

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20. 16 Jun 2026·Parliament·Lib Dem·Helen Morgan

    Health Bill (Second sitting)

    indicated assent.

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21. 16 Jun 2026·Parliament·Lib Dem·Helen Maguire

    Community Hospitals

    It is a pleasure to serve under your chairship, Sir Jeremy. I thank my hon. Friend the Member for South Cotswolds (Dr Savage) for securing this important debate on community hospitals. Community hospitals have been a core part of our healthcare system for more than 150 years. They are rooted in a strong tradition of providing care and a range of clinical services to support their local populations. There are over 500 community hospitals throughout the UK, and they vary considerably in the services they deliver as their fundamental focus is to adapt to ensure that they serve the needs of their local area. Community hospitals serve as multidisciplinary sites for immediate care across both health and social care, bridging the gap between primary and secondary care services. This adaptation and integration of services in particular makes community hospitals so valuable in bringing vital health services into the community and truly serving the specific needs of the community they represent, whether they have a significant older population or are situated in an area of high deprivation. The value of community hospitals cannot be overstated, as we have heard today. They are ideally placed to support effective prevention and the management of long-term conditions. They have the ability to be flexible, change and adapt with their population. By reimagining what we can do with community hospitals, based around the needs of an ageing population and rising complexity, we can make a significant difference to patients. I have seen the benefits of community hospitals at first hand in my constituency of Epsom and Ewell. Leatherhead community hospital, which is highly valued by the local community, demonstrates the importance of maintaining strong accessibility, continuity of care and patient flows across community health infrastructure. Leatherhead community hospital provides more than 33 specific consultation and out-patient services, including a stoma clinic, physiotherapy rehab, and speech and language therapy, for the diverse population it serves. We must support community hospitals to ensure they can continue to provide such services. Community hospitals also play a core role in reducing the pressures on larger acute hospitals. Their role will only continue to grow in importance as demand on NHS services continues to rise. Community hospitals support earlier discharge and step-down care to patients who are medically fit to leave acute hospitals, but still need further support to regain their independence prior to being fully discharged. The Health Foundation estimates that, in England, about 125,000 people enter intermediate care services each month. The cost of providing this care continues to rise, increasing the pressure on these underfunded services. The average local authority spend on a single episode of care in 2022-23 was 27% higher in real terms than in 2019-20. Community hospitals provide intermediate care beds, so they free up hospital beds, reducing the high demand on A&E departments. That intermediate support is particularly important in rural and coastal areas where, as we have heard today, access to acute hospitals is often limited. In 2021, the chief medical officer’s annual report on health in coastal communities provided official recognition of the range of healthcare needs across different rural communities. Those living furthest from healthcare services in rural and coastal areas are most at risk of experiencing inequalities, particularly when there are poor and unaffordable transport connections—not to mention the patients who, due to old age or disability, are unable to drive long distances to access essential healthcare. It takes twice as long for people in rural areas to reach their nearest GP by public transport as it takes people in urban areas; it also takes about a third longer for those who drive, according to the Rural Services Network. Those findings were affirmed by Lord Darzi’s report on the NHS, which found that across much of rural England—including nearly the whole south-west as well as much of the east of the country—there are fewer than 46 dentists per 100,000 people. A Liberal Democrat freedom of information request found that waiting times for life-threatening calls are 45% longer in rural areas than in urban areas. Community hospitals, like rural GPs, pharmacies and other healthcare services, have frequently been an afterthought. That situation is unacceptable: we must take action to change it, particularly given that the Government say they want to move services into the community. Access to vital community healthcare cannot be dictated by an unjust postcode lottery. Community hospitals receive less funding and less attention than larger acute hospitals, resulting in workforce shortages and rundown estates. There has also been an escalating process of service reductions at many community hospitals. Often, these changes are introduced under the guise of being trials, but they almost always become permanent. Pragmatic changes to services because of shifting demand are sometimes necessary, but too often changes are made without proper consultation or a proper explanation to the communities affected. The Liberal Democrats are clear that we wholeheartedly support the ambition to shift more care into the community, but we must get community hospitals to a place where they can complement and play a vital role alongside neighbourhood health centres. Rural communities know all too well the pressure that the healthcare system in their areas is under, and the important role that community hospitals play. Consequently, we have been calling for a rescue plan for rural health services, in which rural community hospitals would be an essential pillar. As part of the plan, we have called for a strategic small surgeries fund to sustain services in rural and remote areas, as well as a strategy to close the gap in access to primary healthcare between urban and rural areas. We are also calling for an emergency fund to reverse closures of community ambulance stations and to cancel planned closures of services where they are needed, which would particularly benefit rural communities. We would put an end to the postcode lottery of care provision, which disproportionately impacts rural communities, through a national care agency. We need a new national drive for first responders in rural communities. We need to protect air ambulances, integrating them into the emergency care system, and to ensure that they receive adequate NHS funding in addition to charitable donations. Will the Minister heed these calls and take the necessary steps to ensure that community hospitals that serve rural communities receive the support they deserve? The bottom line is that community hospitals are a service to us all. They are vital in the provision of care closer to home; they bring multidisciplinary services closer to the community; they bridge the gap between hospitals and GPs; they relieve strain on hospital beds and A&E departments; they support faster discharge and rehabilitation, and so help patients to regain their independence; and they improve healthcare access for elderly and vulnerable patients by reducing travel burdens for both themselves and their families. I urge the Minister to reflect on the important calls that I, my hon. Friends and others across the House have made in this debate, to ensure that we are all doing all we can to better support community hospitals.

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22. 16 Jun 2026·Parliament·Lib Dem·Helen Maguire

    Community Hospitals

    I want to expand on that point because, as we have heard from Members, there are many elderly people in rural communities who may or may not have access to digital services. Will the Minister provide some assurances to me and my hon. Friends that elderly people will not be excluded because they cannot access services digitally?

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23. 16 Jun 2026·Parliament·Lib Dem·Helen Maguire

    Thames Water

    Thames Water is in crisis, so I thank the Secretary of State for not approving the deal. It is sinking under £20 billion of debt. It is like a leaky ship that cannot stay afloat. Last year, my constituents were, on average, paying an additional £203 a year. They simply cannot continue to pay the price for this failure. When will she stop pouring money into this leaky ship, put Thames Water into special administration and put everyone out of their misery?

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24. 16 Jun 2026·Parliament·Lib Dem·Helen Maguire

    Cyber Security and Resilience (Network and Information Systems) Bill

    In my view, this Bill does not explicitly reference misinformation or disinformation threats. I have just met with the Council for Countering Online Disinformation, and in that meeting I learned that X’s algorithm amplified misinformation and disinformation online about the riots that took place in Epsom. Does the hon. Member agree that it is really important that we add strong safeguards against misinformation and disinformation into the Bill?

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25. 16 Jun 2026·Parliament·Lib Dem·Freddie van Mierlo

    Thames Water

    Ten months ago, the Government appointed FTI Consulting to advise them on taking Thames Water into special administration. Can the Secretary of State update the House on the outputs of that work and how much it has cost to date?

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26. 16 Jun 2026·Parliament·Lib Dem·Edward Morello

    Topical Questions

    T4. On 28 May, Prime Minister Netanyahu ordered the Israeli military to seize control of 70% of the Gaza strip, in breach of the ceasefire agreement. Some 90% of the homes have now been destroyed, and an estimated $53 billion is required to rebuild the strip. Meanwhile, settlement expansion in the west bank has increased by 80%, with Israeli settlers now comprising one in six of the population. What is the Foreign, Commonwealth and Development Office doing with European allies to help the Palestinian people?

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27. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I beg to move, That this House has considered community hospitals. It is a pleasure to serve under your chairship, Sir Jeremy, and I am grateful to have secured this debate. I want to begin by thanking Jo Posnette and Dr Helen Tucker from the Community Hospitals Association, who have been an enormous help in preparing for the debate. I welcome Jo, who is in the Gallery. Last year, according to the Royal College of Emergency Medicine, around 15,860 patients died in NHS A&E departments in England while waiting for care that could have saved them. That is roughly 1,300 people every month—nearly 10 times the figure recorded in 2015. Every week, more than 300 people died a preventable death simply because they waited too long. Those numbers are shocking, but behind every number there is a real-life tragedy. Let us remember that human aspect throughout the debate. I am sure I do not need to point out to colleagues that in rural areas the situation is often even more challenging. The ambulance takes longer to reach people, the journey to A&E is longer and, when services at a community hospital have been reduced to a limited number, as is currently happening in my constituency, there might be no early safety net to catch the patient before a crisis becomes a catastrophe.

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28. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    My hon. Friend makes a good point. Not everybody can time their minor injuries to fall conveniently within the unit’s opening hours, so I absolutely sympathise with the challenge facing her local hospital.

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29. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I thank the hon. Gentleman for his perceptive intervention. Community hospitals often do feel more like a home from home. They are more accessible for a patient’s friends and family to visit, and they deliver better outcomes for patients and clinicians alike. In the south-west, ambulance handovers at acute hospitals took more than 30 minutes in more than half of cases in January 2025—nearly 30% above the England average. A few months ago, I had the privilege to ride in an ambulance for a day. In what ended up being a 13-hour shift we attended only three call-outs. Maybe it was a quiet day—I am definitely not saying I wish there had been more grief out there—but we spent much of the day on the road and/or waiting outside hospitals, which did not seem the best use of a highly qualified ambulance crew and an expensive resource. It will not be news to anybody in this room that our NHS is under pressure, yet, against the odds, community hospitals continue to perform. The Care Quality Commission reports that between 75% and 92% of community hospitals are rated good or outstanding, which is remarkable given that the number of district nurses working in them fell by around 55% between 2009 and 2024, with underinvestment and the loss of EU staff after Brexit cited as key causes.

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30. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    That is a very good question that I hope the Minister will be able to answer. I pay tribute to the absolute heroism of the people who staff our community hospitals; they are delivering an incredible return on investment.

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31. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I absolutely agree that a lot of the frustration felt on the frontline is due to lack of clarity of communication. Community hospitals are institutions, and I pay tribute to the people who work at them, who do more with less, year after year. They deserve better than for services to be quietly wound down. I invite Members to imagine for a moment that they are 80 years old—it is less of a feat of imagination for some of us than for others—and living in a village outside Cirencester. Maybe they can no longer drive due to poor eyesight. They wake up one morning with chest pain. There is a hospital in town, but the services have dwindled one by one: no A&E, acute ward or surgery, and the theatre may be currently paused. What is actually needed—prompt assessment, a bed close to home and blood tests that do not require a 25-mile journey to Cheltenham on rural roads—may not be available. That is the reality for many people across my constituency right now, and it is getting worse. Community hospitals have been an honoured part of our healthcare system for over 150 years. Research published in the Journal of Community Nursing in 2024 describes them as bridging “the gap between primary and secondary care.” They are person-centred, nurse-led and multidisciplinary settings that help people to recover, maintain independence and enjoy visits from friends and family. They are not a quaint historical relic; they are precisely what the NHS says it wants more of. The Cirencester community hospital was exactly that kind of place. Since the day surgery unit was suspended last year, I have heard so many moving stories from constituents, their fond memories of being in hospital, and how much that hospital, right at the heart of their community, meant to them when their children, parents or spouses were sick. But over the years the services there have been eroded one by one: first A&E, then acute wards, paediatrics, maternity and blood services. In 2025, the day surgery unit was paused as part of NHS Gloucestershire’s centres of excellence trial. Each change came with reassurances, but each one left residents further from care. My constituents have become deeply and rightly sceptical that a trial closure will ever be reversed.

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32. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I absolutely agree with the hon. Lady’s point. I have been pressing the NHS to find out the criteria by which they will judge the trial closure, but the criteria have not been forthcoming. I am concerned that there is a circular logic: “Well, you’ve managed without that ward for six months or a year, so you can continue to manage without it.” A constituent described a cardiac arrest at Cirencester, handled with what she called “absolute skill and excellence” by a team of senior staff working together to stabilise the patient before transfer to an acute hospital. She told me that the nursing care on the wards is excellent, and that patients nearing the end of their lives are cared for with compassion and great dignity. That is what we are talking about when we talk about community hospitals, and that is what the trial closure of a ward potentially puts at risk. Another constituent—a former GP who started practicing in Cirencester 40 years ago, in 1986—told me about a child who, after the surgical ward closed, waited 20 hours in Cheltenham for an appendix operation. Previously, that operation could have been done in Cirencester much more quickly. That is a family sitting in a corridor in an unfamiliar hospital at 2 in the morning, feeling anxious and far from home, because the local service they relied on had gone. A month or so ago I launched a petition, in collaboration with a local county councillor, to protect community hospitals across the Cotswolds. Within a couple of weeks, well over 3,000 people had signed it, and last week we handed it in at No. 10. The South Cotswolds population is growing rapidly, largely due to the Government’s housing targets. Thousands of new houses are being built around Cirencester, and there are plans for many more housing developments that will swallow up nearby villages. It does not make mathematical sense for communities to grow while the services that support them shrink. The numbers just do not add up. NHS bodies often describe these changes as reconfigurations—a shift in how care is delivered rather than a reduction in what is available. For a rural resident with no car and negligible public transport, a 25-mile journey to Cheltenham is a significant barrier to care. The Government’s own 10-year plan talks about “neighbourhood health” and care “closer to home”, but Gloucestershire is heading in the direct opposite direction. I would like to hear from the Minister how those two things can be reconciled. A few miles to the north-west of my constituency, post-natal beds at Stroud maternity hospital were suspended in 2022. That year, the Care Quality Commission rated Gloucestershire’s maternity services as inadequate—a rating they retained on reinspection the following year. The hon. Member for Stroud (Dr Opher), who is a GP, has made the valid point that post-natal care saves money downstream because it is the time when mothers and babies bond, when breastfeeding is established and when families who need extra support get it on a timely basis. If we lose that support, the costs will appear elsewhere later on. Will the Minister provide a timeline, with dates, for the full restoration of maternity services in Gloucestershire, including the Aveta ward in Cheltenham, which is currently closed for labour and births? Will she provide details of the specific workforce support the Government are providing to make that happen? In other countries, the decline of community hospitals is not seen as inevitable. Other countries are under the same pressures, but they are making different choices. In Sweden, research found that rural GPs value community hospitals because they provide exactly the things that cannot be replicated in a large acute centre, including proximity, continuity and a holistic understanding of elderly patients and others with multiple conditions. Heart failure and pneumonia rehabilitation can be managed closer to home by staff who know the patient and their family. In Italy, the Government have committed to building or renovating 400 community hospitals using European recovery funds, backed by research from the Emilia-Romagna region showing that they deliver better integration among care sectors, between primary and specialist staff, and between healthcare and the communities it serves. Last October, more than 150 people from 23 countries joined an international webinar co-hosted by the Community Hospitals Association, and the conclusion was consistent: community hospitals anchor care in local communities, support home-based care and help people to live better for longer. The Government’s NHS 10-year plan commits to shifting care from hospital to community. That sounds like a very good idea, but a Nuffield Trust report published in September 2025 makes a point that needs to be heard: this ambition is not new. Successive Governments have promised to move care closer to home, and most have fallen short, almost always because the community infrastructure needed to enable the shift is simply not there, and nor is the investment. Ireland, which has pursued reform for nearly a decade, had the wisdom to invest up front in new facilities, digital systems and community workforce capacity. Unfortunately, the Nuffield Trust found that England’s 10-year plan contains no equivalent ringfenced funding. The expectation appears to be that hospitals cut waiting lists and simultaneously release funds to build community capacity. Again, the maths just does not work. The starting point is already challenging. More than 1.1 million people are currently waiting for community care in England, with the steepest rise among children and young people. A hospital where the theatre has been paused cannot absorb more community care. A maternity unit closed for three years cannot deliver neighbourhood health. A community health system with 1.1 million people already waiting cannot become the landing ground for patients displaced from acute settings unless it is properly resourced to do so. As so often, rural areas pay the highest price when the gap between ambition and delivery opens up. There is no slack in the system and no easily accessible option down the road.

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33. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I absolutely agree with my hon. Friend’s point. We need a more joined-up approach. From conversations that I have had with nurses in my constituency, I know that those on the pointy end can see very clearly where the bottlenecks in the system are. We need to relieve the pressure on those bottlenecks. I will conclude with five asks for the Minister. First, will the Government give a clear commitment to protect and properly resource Cirencester hospital as a local health hub, with the operating theatre restored, not paused indefinitely while the trial closure quietly becomes permanent? Secondly, will the Government give a timeline, with dates, for the full restoration of maternity services in Gloucestershire, including post-natal provision at Stroud? Thirdly, will the Government give an honest account of how the shift from hospital to community will actually be delivered in rural areas? What oversight will there be? What protections are in place? What prevents the same pattern of managed reduction from continuing in the name of the 10-year plan? Fourthly, will the Government commit to work with the Community Hospitals Association towards a national definition and dataset for community hospitals in England, so that our 500 community hospitals can finally be planned for, funded and properly valued? Finally, will the Minister agree to a meeting? I would very much welcome the opportunity to sit down with her, alongside local NHS leaders and the Community Hospitals Association, to discuss the long-term future of Cirencester hospital, its role and resourcing, and its place in the vision of care closer to home, which this Government say they believe in. My constituents are not asking for anything exceptional. They just want to know that, if they get ill, there is somewhere to go that they can get to. The NHS was founded on that promise, and that promise must be kept.

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34. 16 Jun 2026·Parliament·Lib Dem·Dr Roz Savage

    Community Hospitals

    I thank all Members who have contributed to this debate with wonderful and sometimes moving stories about the role that community hospitals have played in the lives of their constituents and who have shared their concerns. I also thank the Minister—I appreciate that this is not her brief—for stepping up today. I echo the words of the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) that community hospitals are “much more than buildings”. There is the expertise of the staff working there, and they are an important hub for healthcare in a community. While I welcome the announcement of 250 neighbourhood health centres, I would like the message to go back to the relevant Minister that we already have community hospitals that are well known and well loved in our constituencies, so I very much hope they will form an integral part of the NHS’s plans for the future. I thank the Minister for passing on my requests to the relevant Minister; I look forward to hearing more about them in due course. I will end with a reminder to all of us that we are talking about human beings at a very vulnerable moment in their life. I was especially moved to hear about the urgency of the husband of my hon. Friend the Member for Frome and East Somerset (Anna Sabine) suffering anaphylactic shock. Local medicine delivery is not just sentimental or about harking back to a bygone era. It is so important to recovery that patients do not feel scared and do not feel far from home, their community, or their family, friends and neighbours, but feel that they are not so far from home and are still in the bosom of their community. Anything we can do to minimise their stress and maximise their sense of connection and comfort can only ever help the speed and quality of their recovery. I thank all colleagues for their contributions today, and I thank you, Sir Jeremy. Question put and agreed to. Resolved, That this House has considered community hospitals.

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35. 16 Jun 2026·Parliament·Lib Dem·Dr Danny Chambers

    Russian Oil Sales

    18. What recent discussions she has had with international partners on the potential merits of increasing sanctions against Russia.

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36. 16 Jun 2026·Parliament·Lib Dem·Dr Danny Chambers

    Russian Oil Sales

    Two years ago, I visited Ukraine, taking medical supplies in refurbished ambulances; we had to stop only twice to fill up with diesel, which made us realise just how close to us the frontline really is. It is deeply troubling that the Government are now reneging on their full support of Ukraine by pursuing an indefinite waiver on imports of Russian oil via third countries. I ask the Foreign Secretary to reverse course on this, and to close any loopholes putting any money into Putin’s war machine.

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37. 16 Jun 2026·Parliament·Lib Dem·Clive Jones

    Topical Questions

    T5. Last month, two people were convicted of spying on Hong Kong dissidents in the UK on behalf of the Hong Kong Government. Alarmingly, one was a UK immigration officer. What is the Minister doing to better protect Hongkongers in Wokingham and across the UK who are concerned about growing Chinese influence threatening their freedom and safety?

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38. 16 Jun 2026·Parliament·Lib Dem·Clive Jones

    Thames Water

    Thank you very much, Mr Speaker. Residents in Wokingham have endured years of sewage dumping by Thames Water and ever-rising bills, while stakeholders have lined their pockets. The current ownership model is unsustainable, so will the Minister consider the Liberal Democrats’ call for water companies to be mutually-owned public benefit corporations, putting customers and the environment first, rather than prioritising the interests of creditors and financial institutions?

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39. 16 Jun 2026·Parliament·Lib Dem·Christine Jardine

    Topical Questions

    Watching coverage of the football in America, it may be difficult to believe that a great number of Scottish football fans were refused ESTAs—the electronic system for travel authorisation—at the last minute, after they had previously been approved, costing them thousands of pounds in cancelled airfares and hotels. Will the Minister tell us whether there have been conversations with the American authorities about how this has happened and how to avoid it, and will she impress on them the economic loss that they will face from all those missed alcohol sales?

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40. 16 Jun 2026·Parliament·Lib Dem·Charlie Maynard

    Thames Water

    It is clear that the creditors’ consortium has material influence over Thames Water, as it is funding the company and bilaterally negotiating with the Government. Material influence means that the consortium meets the defined criteria of being an ultimate controller. Will the Secretary of State finally acknowledge that fact and work with Ofwat to enforce it?

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