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1. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   I have sympathy with the principle behind amendment 58, in the name of the hon. Member for Wells and Mendip Hills. The hon. Member for North Shropshire is right to say that individuals with ME have not always received the best quality care. In many cases, ME is a debilitating and incredibly frustrating condition, and around 10% to 25% of sufferers have severe ME, meaning that they are housebound or bedbound. We know that some patients are sadly not believed by medical professionals. In 2021, NICE said that most medical students have little or no training on the condition. The Government have previously committed to increasing the uptake of ME modules among NHS professionals. What progress has been made on that in the last couple of years? The Government also committed in the ME/CFS action plan to develop and run a public awareness initiative, with implementation expected by May this year. Has the Department developed that initiative yet? If not, what is responsible for the delay? It is not marked as complete on the Government website. The amendment would put guidance for medical professionals into legislation, though, and my concerns about that are twofold. First, it may slow down improvements in the future. If individuals have to legally follow that guidance, how can they innovate and improve treatment without having to come back to Parliament for more primary legislation? That will take time and may mean that people with ME get worse rather than better care in the short term. The requirement would also limit clinical judgment. A patient may have a particular set of symptoms or conditions or be on a particular set of medications that mean that the doctor or clinician looking after them needs to vary from the guidance. NICE intends the guidance to be just that, guidance, not law, but if guidance becomes law, the doctor or clinician will not be able to vary from it. My concern is that the amendment would be overly restrictive. Although it is well-intentioned, and it is a good idea to ensure that guidance is followed where possible, it would be too rigid. I therefore do not support the amendment, while continuing to support the aim of better treatment. Clause 58 amends the Health and Social Care Act 2012 by inserting a new section 237(8A), which states: “Provision made under subsection (8)(b) may include provision about the period within which a recommendation is to be complied with (including provision for the period to be determined by NICE or the Secretary of State).” At the moment, NICE technology appraisals check the value of a product, whether a drug or a technology, then NICE makes a recommendation. It is then supposed to be the case that within 90 days or three months, ICBs ensure that those technologies are available, but we know that in the real world it can take longer—sometimes 12 to 24 months—for some things to become available. That could be because technology needs to be bought or training needs to take place. I understand why there could be variation and why the Government may want to consider varying the period, but it is not clear why they need to do so in legislation, because it is possible now to vary the period on an individual basis. For example, the Government imposed a five-year limit rather than a 90-day limit for the introduction of hybrid closed loop systems for diabetes, because that is a technology that requires proper training and they were never going to be rolled out in such a short period. The other product that notably has a longer time is tirzepatide, which is more commonly known as Mounjaro. I suspect that that is down to cost, but I am not certain. Why do the Government want to change the 90 days? The patient’s right to treatment with a NICE-approved product within 90 days will become a right to getting the product when the Secretary of State says so. That is not really a right at all, because it does not give patients any comfort and may mean that products are received later. The Government have put this power into the Bill, so they clearly intend to use it. Given that they have the power to vary on an individual basis, why do they need the power to vary on a blanket basis? Do they intend to extend the 90-day limit across the board? If so, by how much? There is no ceiling. The Committee received written evidence from Henry Burkitt from Oxygen Strategy, who made the point that there is no ceiling, no maximum time, no duty to consult and no necessity for the Secretary of State or NICE to give reasons why a delay has occurred. The life sciences industry talks about how it wants products to be rolled out. When it is investing and doing research in this country, it wants to see new products rolled out as quickly as possible once they have been approved, and the clause is a sign that roll-out might be delayed. I understand that the Government might want to be able to vary on certain products, but they already can; why do they want to vary on a more general basis? It is presumably to slow down roll-outs, but by how much?

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2. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   These clauses are about patient safety. As has been pointed out this morning, patient safety is the absolute key here: that is well recognised across the House, among the public and across the national health service. Before going any further, I declare an interest as a patient of the NHS, a member of the British Medical Association, a member of the Royal College of Paediatrics and Child Health and a consultant paediatrician. When I was interviewed in 2012 for my current consultant role, I was asked to deliver a presentation about how I could demonstrate to the trust board that the paediatric services in the hospital were safe. The first question I posed—Members will be pleased to know that I will not go through the whole presentation—was: “What is safe?” Are football stadiums safe? Is the London underground safe? Are aeroplanes safe? Broadly, yes, I think we would say they are safe, but they have not been without incident or safety issues. Healthcare is similar. It involves millions of people, clinical judgment, human decision making and huge variability in the way that patients can present with different symptoms for different problems at different times. Is healthcare safe? Yes, it is safe. Again, however, we know from the many reports we have read that there is a long way to go to make it better and we need to prepare for that. We need to make sure that we design out room for error—that we design processes that limit the opportunities for error—use technology to limit the risk of error, and train people in a way that reduces the risk of error. One of the key factors in that work is accepting that where there is human decision making, mistakes can happen, and that we need to identify and learn from those mistakes. One of the main ways of doing that is striking a balance between accountability and blame. If there is insufficient accountability, there can be an unclear escalation process, such that people do not know who to go to when they identify a problem. There can be a careless culture, which can develop in places where there is not enough accountability. However, if there is too much focus on fault and determining whose fault something is, we can get a blame culture. That can lead to a failure for people to come forward and therefore to a failure to learn from mistakes. It can lead to a culture of cover-up, whereby people try to avoid getting either themselves or their colleagues into trouble. That is where HSSIB comes in because, like the air accidents investigation branch and the similar bodies for rail and shipping, it provides a safe space. That safe space is important in ensuring that people can speak up freely without fear, and know that we can get to the bottom of a problem and understand why and how something went wrong, because that is how we fix it. At the time that HSSIB was established, there was consensus about it. The General Medical Council said: “We support the creation of a ‘safe space’ approach to investigation. This is consistent with our guidance to doctors about their responsibilities to learn from mistakes and reflect on their practice, and their duty to take part in systems of quality assurance and quality improvement to promote patient safety.” The British Medical Association told Parliament: “We welcome the establishment of the HSSIB…Doctors must feel able to report errors and reflect on their own mistakes openly, without the fear of these reflections being used against them at a later stage. Only then can true improvements to patient safety be made.” Similarly, NHS Providers told Parliament: “NHS Providers welcomes the creation of the HSSIB as an opportunity to develop a just culture in the NHS and a focus on learning…For the HSSIB to succeed in contributing to improved patient safety, any investigations associated with it must be carried out independently and without conflict of interest, and be perceived as such.” Indeed, the Minister for Secondary Care herself is on the record as having said: “HSSIB is a really important new body…It must absolutely be built on the highest standards of trust when it comes to the wider system and the general public.”––[Official Report, Health and Care Public Bill Committee, 19 October 2021; c. 564-565.] I think that I have demonstrated that the creation of HSSIB was a matter of consensus and it was confirmed that it was the right thing to do. In order to work, HSSIB needed to be independent and without conflict of interest. NHS staff backed it, the providers backed it, the patients backed it and even the Minister backed it. That is what makes the Government’s plans for HSSIB so perplexing. I am not aware of a single royal college or union that supports folding it into the CQC. Essentially, Ministers have said that this is being done because of the Dash review. “The Dash review says so,” they argue, “so that’s what we’re going to do.” I have huge respect for people who say, “I’ve asked for some experts’ advice, and they have given it, and therefore I should follow it.” However, Ministers also commissioned the report by Lord Darzi, which said that “a top-down reorganisation of NHS England and integrated care boards is neither necessary nor desirable”, and yet here we are, doing exactly that. It is perfectly possible for Ministers to take one report as gospel and another as guidance. I would be grateful if the Minister could explain that. The other reason given for this measure is that it will declutter the landscape, yet few people outside Government seem to think that HSSIB is responsible for cluttering the landscape. For example, the Health Foundation wrote in its submission that “the government needs to do more to explain how the abolition of HSSIB and transfer of its functions to CQC will meet its aim of reducing complexity and, most importantly, maintain the essential focus on improving patient safety.”

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3. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear. Dr Benneyworth made it clear to the Committee that “we are still working in a culture of fear”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.] and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that “people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”.—[Official Report, 1 June 2026; Vol. 786, c. 915.]

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4. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   My hon. Friend is absolutely right. That answer was quite shocking, really. The pause before it and the reaction was remarkable. The purpose of HSSIB is to investigate without fear or favour, and to enable people to come forward in a safe way, but if it was folded into the CQC, as the regulator, and the problem was the regulator, how would it investigate itself? How would it make recommendations to itself? What if it thinks the board that it works for is incompetent? Is it going to tell its boss that it is incompetent? How does that work? No one seemed to know the answer. It also seems that Ministers have not thought about how the HSSIB unit will be vulnerable to political pressure. Under the Bill as drafted, the Government are planning to direct the “vast majority”—according to the impact assessment—of the investigations, and the quality board is going to have some influence over the recommendations, again under the direction of the Secretary of State. The Liberal Democrats have tabled amendment 5, which would require the appointment of a committee. That idea is well intentioned, and we recognise the same problems and the same flaws in the Government’s approach, but I do not think it is enough to solve the problem. Even if the law says that the oversight of the investigative units will remain operationally independent, I just do not see how that is possible. I can see that the hon. Member for North Shropshire is trying to help by creating something better than what the Government have produced, but I do not think it is enough. We have also tabled some amendments, including new clause 42, which would ensure that there is some operational independence in the choice of investigation by requiring the Secretary of State to adequately fund and resource patient safety investigations, including some of those initiated by this unit within the CQC. Amendment 55 is a probing amendment. We noticed that much of the legislation has been lifted and shifted from the previous Act, but some things are missing, including national security grounds. We want to understand why that ground has not been included in the Bill. Very occasionally, health events have national security connotations—the Salisbury chemical weapons attack, for example. In such circumstances, restrictions on investigatory capabilities could be necessary. I do not know—I was just interested in why the Government have chosen deliberately to remove that particular clause. Amendment 56 would allow “the Commission to recoup charges in excess of the costs incurred in providing assistance.” The HSSIB programme is world-leading. People look at it from across the globe, and some have asked for training or information on it, for which we have been able not just to recoup costs but actually charge. I do not understand why the Government have removed that provision, because it is an opportunity for them to get extra money without taking it off people in taxes. Do the Government want HSSIB to lose its international standing, or do they want British taxpayers to subsidise training for foreign health services? It is not clear. I would be grateful if the Minister explained that. We need to come back to what the hon. Member for Bury St Edmunds and Stowmarket said at the beginning: what is the purpose? The purpose is patient safety.

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5. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   I thank the hon. Gentleman for that intervention, but I think this comes to part of the problem. When producing a list of faults—of things that are wrong with the service—and saying, “We need to improve the culture; it needs to be better”, we need to ask, “Okay, but how? What will be the deliverable, measurable way of doing that? How will we go about improving things?” For example, let us say that there is a problem with patients with aortic dissection, so how will we prevent that? The benefit of HSSIB is that it produces a plan, the plan is implemented and patients are safer. Part of this is about the delivery plan. As for the other part, the hon. Member talked about monitoring progress, but that is not the job of HSSIB. If a mistake or an event happens, it is investigated by HSSIB—HSSIB produces a set of investigations based on understanding how and why it happened, because of the safe space—and then those recommendations are put forward to the Government. The Government then, ideally, implement those changes. The Minister is there to ensure that those are implemented. It will be her job to ensure, having decided which recommendations are to be implemented, that that is done fully and properly. It is a separate function. The CQC is a regulator, HSSIB is an investigator, and the Minister is there to ensure that things are delivered properly. Going back to patient safety, at the end of my interview, I essentially told the panel, “I cannot tell you that anything is 100% safe”. The assurances that can be provided are that the staff and equipment are available, that training is available for people to do the job, and that processes are in place to identify shortcomings and learn from them, so that they are not repeated. That is key: to find the learning and spread it more widely. As the hon. Gentleman said, implementation is a challenge. It is possible to implement this on an individual basis or to implement a lesson in a unit that has had an error or mistake. Spreading it more widely, so that this is heard in every unit across the country, is more challenging. Fundamentally, I do not think I have heard anything from any of the Ministers, and I do not think it is in the Dash report either, to explain why the Government believe that rolling HSSIB into the CQC with all the problems that it might cause—the risk of it suing itself over whether the safe space is available or not—makes patients any safer.

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6. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   My right hon. Friend will be aware that it is not the only thing that the CQC is being asked to take on. It is also being asked to take on the regulation of event healthcare, which is another new function for the CQC, all at a time when, as he says, it has its own difficulties to manage.

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7. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   On pages 8 and 9 of the Dash review, Dr Dash talks about this. She states: “Recommendations are…focused on inputs, rather than outputs or outcomes, and fail to…balance…risks within organisations and across systems…the existence of so many recommendations causes considerable confusion for staff. They result in more clinical staff moving into supervisory roles to check that other…staff are adhering to the recommendations. The overwhelming majority of recommendations lack data as to the cost of implementation or the expected impact.” She recognised, did she not, that there was a problem with people being asked to check up on one another’s work and check up on their work? But the recommendations do not deal with that, perhaps because the scope, as my right hon. Friend has described, is so narrow.

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8. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Twelfth sitting)

   My hon. Friend is making a very important case about the importance of the perception of independence and the safe space actually being safe. There is a risk that people feel that they will be hounded or—

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9. 7 Jul 2026·Parliament·Dr Caroline Johnson

   Health Bill (Thirteenth sitting)

   My hon. Friend the Member for Isle of Wight East was talking about the importance of the perception of the safe space, in relation to people being able to come forward, and the fears of whistleblowers. Does he agree with me that it is not just this perception that causes potential whistleblowers to worry? If they read the newspapers on a regular basis, or are on social media, they will see examples of people who have suffered mistreatment as the result of having been whistleblowers.

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10. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    Will the Minister give way?

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11. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    My understanding is that, in the past, HSSIB has provided services to not only British health services but overseas health services, which were, in some cases, charged for that service, as it is a world-leading organisation. Why would the Minister not want that to continue?

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12. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    The Minister seems to be saying that her reasoning for moving HSSIB into the CQC is to ensure that actions take place in response to the recommendations. But if HSSIB outwith the CQC makes recommendations that are delivered by the provider organisations, commissioned by the ICBs and overseen by Ministers, and then the CQC checks that as part of the regulation, why does HSSIB need to be within the CQC for that to happen?

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13. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    The Minister has reassured us that, although it has not been lifted and shifted from the original, the amendment is a duplication of another clause. Therefore, we believe the Committee—

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14. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    No, I am not. Schedule 8 Transfer of HSSIB’s Functions to CQC

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15. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    I have just a couple of questions. Clause 62 will update the CQC’s power to conduct special reviews of NHS commissioning to cover ICBs and the Secretary of State’s commissioning functions, and the requirement for ministerial approval before the CQC can investigate will be retained. How will that apply when HSSIB is moved into the CQC? Is it the Minister’s intention that HSSIB will need the Secretary of State’s approval to complete investigations?

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16. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    As the Minister said, clause 63 amends section 90(2) of the Health and Social Care Act 2008 to extend the limit on proceedings relating to the registration of offences under part 1 from three to five years. The impact assessment talks a little about the time it takes to investigate these cases, but as the Minister said, the time to investigate is 12 months from the CQC being given enough evidence to consider whether the case is prosecutable. Why has she chosen not to change that too? Does she think people will have enough time to investigate? She is looking puzzled.

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17. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    The Minister talked about changing the time period in which proceedings can be effected from three to five years, but once the CQC is aware that an investigation could be brought and there is evidence that needs to be looked at, it will still get only 12 months. That has not been changed. I wonder what the rationale is for that. I am not criticising it; I am just asking the question. The other issue is that clause 63 is prospective, so if an offence were committed immediately after the Act was passed, for the first three years things would effectively be as they are now; the change from three years to five would be relevant only after three years. Clause 71(2) on commencement provides that clause 63 will not come into force until two months after the Act is passed. I just wonder in practical terms why, given that it will take three years to come into effect in any case, it will not come into force on the day the Act receives Royal Assent. The impact assessment talks about the CQC prosecuting two or three additional cases a year, and a cost of £4.3 million over 10 years with fines of £2.7 million over 10 years. Will the regulator keep the fines, or will they go back into the Treasury? Can the Minister guarantee that the additional funds that are estimated to be required for the additional cases under this new regulation will be provided so that the CQC can do the investigations that she is giving it the opportunity to do?

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18. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    Clause 64 abolishes Healthwatch England, which I believe is a mistake, and introduces schedule 9 to facilitate that. The impact assessment talks about the roles of local healthwatch and Healthwatch England, with local healthwatch obtaining views, making reports and recommendations, promoting and supporting public institutions, signposting to advice, and giving views to Healthwatch England nationally; and Healthwatch England then providing leadership, guidance and support to local healthwatch, escalation to the CQC, which we have heard a lot about already, and advice to the Secretary of State or NHS England. Members may be familiar with the term “nothing about us without us”—the idea that policies should not be decided and services should not be shaped without the participation of those who will use those services or be affected by the decisions that are made. As a medical practitioner, I believe that is an important principle. Patients must have a voice, because it is they who have the lived experience of their conditions and know their needs better than any civil servant in Whitehall. They know what is working and what needs to change. Let us look at the history of patient voice. In the two decades after the NHS’s inception, the provision of care was really quite paternalistic. Patients did not really have any role in shaping the services that they received. That changed in 1974 with the establishment of community health councils, made up of volunteers. They carried out research, conducted visits to inspect standards and represented communities when changes were proposed. They also helped the public with information about local services, including how to make complaints—very similar processes. The Labour Government abolished community health councils in 2003, although a cursory trip to Hansard reveals that the Government repeatedly stated before the publication of the NHS plan that at that point they envisaged no immediate changes to community health councils, but they did go on to do that. That is reminiscent of what we are discussing today, because abolishing Healthwatch was not in the Labour party manifesto. In 2003, the community health councils became patient and public involvement forums, and five years later they became local involvement networks. The names and structures have changed, but the principle of patients having an independent voice remained. Healthwatch is the latest iteration. To be precise, Healthwatch England was established initially as a committee of the Care Quality Commission in 2013. It operates a hub-and-spoke model with more than 150 local healthwatches spread across local authority areas. Healthwatches play a vital role in exposing problems in the health service. Indeed, even the King’s Speech contained a reference to Healthwatch England. According to Healthwatch England’s May 2025 report, “nearly one in four…adults have noticed inaccuracies or missing details in their medical records”, such as inaccurate personal details and inaccurate records of medicines, diagnoses, treatments and conditions. I note that the Minister herself has relied on Healthwatch when bringing problems facing her constituents to the House. She said: “In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling.”—[Official Report, 10 February 2022; Vol. 708, c. 484WH.] So Healthwatch is valuable. I invite Members to look at the impact that Healthwatch had in 2023-24. More than 925,000 people used their local healthwatch to get advice and information about their health and care. More than 329,000 people shared their experiences to help improve services. Healthwatch England helped to secure changes to Royal Mail so that NHS letters are delivered to patients on time. It also led new NHS guidance so that patients commencing cancer treatment have priority access to NHS dentists. A piece of Healthwatch research indicated that millions of eligible adults may be missing out on social care. Recently, my local branch, Healthwatch Lincolnshire, produced a report on the challenges facing carers nationally. Healthwatch has influenced the future of attention deficit and hyperactivity disorder care, encouraged the uptake of cervical cancer screening and so much more. That is why the public and health experts are alarmed by the Government’s plans. As for HSSIB, the success of Healthwatch is due to its independence, but the Government want to do away with that. Their policy paper commits to replacing Healthwatch with a new patient experience directorate, which will sit inside the Minister’s Department. Instead of having organisations embedded in communities sitting on local health and wellbeing boards, the public will need to interface with the Minister’s Department. How can she guarantee the independence, and the perception of independence, of the new directorate? How can she be sure the public will trust it? I remind Members of what Councillor Dr Wendy Taylor of the Local Government Association said: “The current proposals to disband Healthwatch and allow health and social care services to gather and respond to feedback, rather than being challenged by an independent voice, risks organisations being seen to mark their own homework.” When Healthwatch conducts surveys, it often solicits information that proves problematic for the Government of the day. How can the public have confidence that the new directorate’s process will do the same? What will stop the Secretary of State deciding what questions get asked and what data gets published? From my reading of the Bill, the answer is nothing. The Government have made it clear that, alongside the new directorate, ICBs will take over several patient voice functions. I appreciate that this strays slightly into the subject of the next group of provisions, Ms Lewell, but it is difficult to separate Healthwatch from local healthwatches. The Patients Association has warned: “Splitting local Healthwatch between ICBs and local authorities risks creating a patchwork of accountability with no single body responsible for ensuring patients are heard”. If responsibility to deliver those functions is shared between different parts of the health system, who becomes accountable if it is not funded? Who is accountable if people fall through the cracks? If accountability is divided, it often means that accountability is somewhat diminished. Members also need to ask whether it is financially feasible for ICBs to deliver patient voice. In its evidence, the Health Foundation wrote: “Moving the NHS functions of local HealthWatch organisations into newly enlarged ICB footprints could also result in the loss of a more nuanced local understanding of the public’s priorities and needs, with particular implications for seldom heard or more vulnerable communities.” We know that ICBs are under financial pressure because of decisions by the Labour Government; they have had to slash operating costs by 50%, and many are pencilling in cuts to frontline services. Against that backdrop, how can they afford to deliver patient voice functions? Ms Lewell, your guess is as good as mine. We have not heard about any additional funding from the Government for the purpose of patient voice. Healthwatch England was provided £3.3 million in 2025-26, and local healthwatch £14.1 million. How much of that money will be redirected to the patient experience directorate and the ICBs? I tabled a written question about the benefits to the public purse of abolishing Healthwatch. The Minister’s response was as follows: “The potential savings from abolishing Healthwatch England and Local Healthwatch are dependent future policy decisions regarding the approach taken to collecting user experiences post-abolition.” She set out an intention for “future policy decisions”, but there was, and still is, an absence of a plan. That is something we have heard again and again in relation to health, in Committee and throughout the two years that this Government have been in power: the absence of a plan for how things will be achieved. They have lofty aims, and understandable and sometimes really good goals, but no understanding of how they are going to get there. It is not just the Opposition who are concerned; I will give some examples of Government Members who are, too. The hon. Member for Birmingham Erdington (Paulette Hamilton) said: “One of my biggest concerns about the Bill is the reduction in independent patient representation, including the abolition of Healthwatch structures.”—[Official Report, 1 June 2026; Vol. 786, c. 921.] The hon. Member for York Central (Rachael Maskell) said: “Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners.”—[Official Report, 9 June 2026; Vol. 787, c. 136.] The hon. Member for Blaydon and Consett said: “I understand that the Government’s real intention, through the Bill, is to strengthen the patient voice and the ability to raise issues, but there is real concern that an organisation inside the Department of Health and Social Care will not provide that independence. Will the Minister commit to looking again at how that independence can be built in and…with the ability to pull the levers”?—[Official Report, 1 June 2026; Vol. 786, c. 944.] We have also heard concerns from the Health and Social Care Committee. But the Member that the Minister may be most interested in is the right hon. Member for Makerfield (Andy Burnham). He wrote to the former Secretary of State last year saying: “People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.” Does the Minister agree? If so, why does she want to remove the independence of patient voice? The right hon. Member for Makerfield also said: “The independence of resident and patient voice is a necessity. Without it, we risk losing the trust of the public, the richness of lived experience, and the ability to challenge and improve the system from within, particularly during this time of significant system reform”. My plea to the Minister is this: think again about the importance of the independence of patient voice. People will give their views when they think they can do so independently and safely—a principle that was echoed in the debate this morning. Removing the independence does not seem necessary, and I do not understand why the Minister thinks that it will improve patient care and thereby patient safety. It is clear that Members not only on the Opposition Benches, but right across the Government Benches—in fact, potentially the new Prime Minister from next week or the week after—may think the same. I encourage the Minister to reconsider this step.

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19. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    Will the hon. Gentleman give way?

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20. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    As I understand it, the objectives of the Bill are to replace the local healthwatch with a less independent, internalised gatherer of patient experience feedback. The objectives appear to be featuring feedback more centrally in strategic decision making, getting people into the room and simplifying the patient landscape. There are things that I do not understand about that. If the problem is that those who commission or deliver the services are not listening adequately to the people who gather the patient experience information, why not invite the independent individual who has gathered that information into the room? Why ask someone in the room to gather the information and risk the independence? Why not compel more listening? The Minister talked about who is accountable for action. My understanding is that it is the healthwatches’ job to gather the patient experience and present it to Healthwatch England and the decision makers. It is not their job, as I understand it, to make decisions on how care is delivered or to deliver that care differently. Does the Minister intend that to change? The Minister also talked about strengthening the impact of Healthwatch, but I do not understand how this change will do that. We have heard how its independence allows Healthwatch to go on telly, talk to Members of Parliament, Select Committees, radio stations and others, and publicise its findings. If it is within the Department, will it be able to do so as freely? I suggest that it will not. The other thing that I do not really understand—perhaps the Minister can help us with this—is the organisation. At the moment, it is done in local authority areas. It will now become the job of the local authority and the ICB to commission feedback, but we have already heard how the 50% cuts to ICB budgets have led to ICBs merging into larger conglomerates. Those do not necessarily overlap with the strategic mayoral authorities in the way the Minister eventually wants. What geography does the Minister want the feedback to be gathered over? How does she see that working? Will it require further restructuring? The hon. Member for Lichfield talked about the importance of localism and how different areas of his constituency have different health needs. How does the Minister think that that will work under her new plans? The Minister said that one benefit of the new process is reaching vulnerable individuals, but what is to stop Healthwatch doing that? Ultimately, if we have Healthwatch doing things now that are independent and respected across the House—I am sure your local healthwatch is also excellent, Ms Lewell; Lincolnshire’s certainly is—why not strengthen that voice? Why not say to those who are providing that service, “We’re going to give you more resources,” or “We’re going to ask you to deliver it in a slightly different way,” or “We’re going to ask you to focus on particular populations,” or even, “We’re going to invite you into the room with the ICBs so that they can hear you and listen carefully”? Why not compel those making the decisions and delivering the services to listen to Healthwatch, rather than replacing it? It was not Healthwatch’s job to listen to them, but to gather the information and present it, and that is what it has done. Can the Minister explain how removing its independence is going to help? I simply do not understand it.

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21. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    Is there not a third issue: that the local authority and the ICB will no longer have congruent areas and will therefore look at different populations?

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22. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    New clause 91 would amend the Medicines and Medical Devices Act to enable regulations “to refer to both international agreements and standards and standards developed in the United Kingdom” and enable the Secretary of State “to dispense with requirements placed on devices which meet regulatory requirements applicable outside the United Kingdom.” New clause 92 would amend the definition of “mutual recognition agreement” so that “agreements are defined by a list published by the Secretary of State, rather than a Schedule to the regulations.” New clause 93 “amends the duty to consult in relation to regulations about human medicines and medical devices.” That means that instead of a public consultation, it “gives the option of consulting such persons as the relevant authority considers appropriate”. I would be grateful if the Minister clarified whether that could be nobody, or whether it has to at least be somebody. New clause 94 “changes the parliamentary procedure for certain regulations from the draft affirmative procedure to the negative procedure.” That relates to regulations about medicines and medical devices. I want to ask about scrutiny, because we have had a number of statutory instruments over the last few years that, under the new regulations, would now be put under the negative procedure. When we have looked at them, there have been questions and potential changes. Why does the Minister want a lower level of scrutiny? In general, scrutiny is a good thing. I understand that this could smooth out procedure and make it a bit quicker in some cases, but we had an example where a Minister brought forward fee increases. I then raised the issue of national insurance and that Minister was not aware of whether it was paid at that time. The civil service pay estimate was significantly lower than expected and lower than what was given. Therefore, six months later we were back in Committee with a different Minister asking for more money. There is a scrutiny issue with new clause 94. That also relates to the fees and terms in new clause 95, which was one of the examples I gave.

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23. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    As the hon. Lady said, new clause 1 seems somewhat redundant, because the Government appear to have decided to appoint a maternity commissioner. New clause 13 asks for a report. Before I go any further, I should say that I am a member of the Royal College of Paediatrics and Child Health and have attended the delivery of many babies as a paediatrician at different levels of seniority. I should also say that I am a member of the British Medical Association, that I continue to work as an NHS consultant paediatrician and that I worked at Nottingham University hospitals NHS trust in late 2012, early 2013. I have great sympathy with the reasoning behind what the hon. Member for North Shropshire is proposing. We have all been shocked by the many reports we have read, the circumstances we have heard about, the tragedies that have occurred over many years and the challenges that are faced by maternity care. I am not sure that writing more reports is going to help; I think we need more action rather than words. The hon. Lady mentioned the taskforce. I was disappointed that it took the Government so many months to establish it, that it took so long for it to meet and that it has met only a few times. As we have talked about things such as Healthwatch and the HSSIB, the Minister has shown her enthusiasm to get on with things and ensure that the recommendations made in the varying reports are implemented. I would therefore be interested to understand how that will occur in maternity. My understanding is that the Government are going to produce a plan on how to deliver the recommendations in the recent report, and that is going to be available by Christmas. However, that means that we will then be in a situation where the Government came into power in mid-2024 and then spent a year writing a plan—the 10-year “Fit for the Future” plan. Around the time that they published that, they decided that they needed an urgent maternity report; that was going to take a few months, but it ended up taking another year in of itself. Now we are going to take another six or seven months writing another plan on how to implement the plan we have written, based on the plan we wrote before, based on the plan we did not have at the general election. I am interested to understand how the Government are going to convert the good intentions I am sure they have into action. In particular, their manifesto promised that thousands more additional midwives would be trained. I would be interested to know what progress they have made on that.

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24. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    We talked about clause 1—on the abolition of NHS England—at the beginning of the Bill. The Minister was keen at that time to take unelected individuals out of the picture and create accountability by returning things to democratic control through the abolition of NHS England and putting them back in the Secretary of State’s hands. However, this proposal essentially does the reverse with maternity care, taking it out of the hands of Ministers and the Secretary of State and putting it into the hands of a commissioner. Could the Minister explain that?

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25. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    I rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however. New clause 3 says: “Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.” That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be cumbersome and completely unnecessary to include all of those. Even with the tech companies themselves, there is a risk for small contracts for small pieces of tech to create a huge amount of bureaucracy. I am not sure that it would specifically improve data quality or data protection. It is reasonable that the Minister would consider risk assessments, and I hope that she would automatically consider them before contracts that are particularly sensitive or contain patient data, but I am not sure that the new clause works. Moving on to new clauses 4 and 5, the hon. Member talked about Palantir. It may even have been his intention for these new clauses to target one specific American firm, but the actual impact would erect costly barriers to trade. The NHS contracts IT functions to firms based in other countries when the business case is strong. It uses Microsoft, an American company that offers software, cloud services and Outlook for emails; Oracle for standardising and automating financial processes; Sectra, a Swedish company, for transferring medical images and reports; and Dedalus, an Italian company, for migrating services to the cloud. To echo the point made by the hon. Member for Bury St Edmunds and Stowmarket, should the NHS prioritise a British company over an international company if the service has better functionality and a lower cost and is safe? The hon. Member for Winchester spoke about the vibrant life sciences and tech sector in this country, but if we close off our markets to those from overseas, will others not do the same? Would he want those life sciences companies to be unable to export? There is a barrier to free trade here.

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26. 7 Jul 2026·Parliament·Dr Caroline Johnson

    Health Bill (Thirteenth sitting)

    I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe. New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.

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27. 7 Jul 2026·Parliament·Dr Andrew Murrison

    Summer Jobs

    Does my hon. Friend agree that the biggest tragedy is for those kids who go to university, with all the costs that involves and three years of their life, only to find that they are no further forward? Does he agree that the Government would be well advised to focus on skills through further education, rather than obsessing about higher education, which I am afraid is a fraud on young people?

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28. 7 Jul 2026·Parliament·Dr Andrew Murrison

    Early Release of Prisoners

    Left liberals may not like this, but it remains the case that the public expect the criminal justice system to exact retribution on those who have offended against society. If we do not do that, then individuals may wish to take the law into their own hands. We do not do that in a civilised country; we expect the state to do that on behalf of society. Does my hon. Friend agree that if we constantly diminish the sentences we hand down to serious and dangerous offenders, society may begin to lose faith in the Government it expects to do that work on its behalf?

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29. 7 Jul 2026·Parliament·Douglas Lumsden

    Energy Security

    My constituents know that best way to improve energy security and job security is to drill more. The Government may not want to hear this, but my constituents know it, the trades unions know it, and even the Labour MPs on the Energy Security and Net Zero Committee know it. Will the Government approve Jackdaw and Rosebank as a matter of urgency to improve our energy security, to improve our job security and to improve our economy by billions of pounds?

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30. 7 Jul 2026·Parliament·Douglas Lumsden

    Summer Jobs

    Would my hon. Friend agree that if we want abundant energy, we should produce much more of it in this country? It would be much better for our economy, for jobs, and even for the environment if we produced oil and gas in this country, as opposed to relying on imports.

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31. 7 Jul 2026·Parliament·Douglas Lumsden

    Summer Jobs

    We have heard lots of people describe their summer jobs, and I will do so too. When I was a student, I enjoyed a summer job. I was working as a postman in my constituency, delivering letters and leaflets to homes up and down Aberdeen—and what do you know, Madam Deputy Speaker? Thirty-five years later, I am still delivering leaflets and letters across the city of Aberdeen. That job was vital to me, because it gave me the resource that I needed—the money that I could spend through the rest of the year—as it is for so many people. What has changed in the intervening years is that our city now finds itself under attack from not one, but two Governments—the enterprise-crippling national insurance increase from the Labour party and the double whammy of business rate increases and banditry from the First Minister in Holyrood. The First Minister is clearly content in hoarding business rates in Edinburgh to fund his independence obsession and his other failed projects. That is before we even talk about the barons of Aberdeen city council, which is run by an SNP-Lib Dem coalition of malaise. It will be of no surprise to this House that all it wants to do is tax, tax, tax. That is clear because of the massive 7% tourism tax levied by the council on hotel stays. That is the highest in Scotland—more than Glasgow or Edinburgh. As a result, hotels are sitting empty, with the council content to punish vendors and visitors alike.

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32. 7 Jul 2026·Parliament·Douglas Lumsden

    Summer Jobs

    Lessons must definitely be learnt from what has happened in Scotland, because we are seeing a big impact. Why would someone start a business in Aberdeen now? New businesses have to factor in rent, business rates, insurance, energy costs and waste charges, and that is before they even get to national insurance or staff costs. There is a huge cost to doing business, and it is no wonder that our high streets are struggling. My hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti) made an important point about business owners, because often they decide not to take a salary, or to take very little. We have heard about zero-hours contracts, but that does not apply to them, and neither does the minimum wage. Often they are going without in order to pay all their costs. We have organisations that are trying to make a difference. Our Union Street in Aberdeen, for example, does a great job of providing businesses with incentives and provides start-up grants for new businesses, but it is a private organisation. It should be the council, city council and Governments that are doing more to help industry. Summer jobs are critical for the hospitality sector. I think of the beachfront in my constituency, where we are fortunate to have two whole days of summer every year. It is so important that those businesses have the flexibility to employ part-time, seasonal workers. Across the city there are so many great businesses that benefit from seasonal workers. I think about Codona’s, a funfair at the beach, which employs hundreds of people, but it is most busy during the summer period. That is also the case for cafés in places such as Duthie park, bustling when the weather is good. They need that flexibility. Recently we have been fortunate to have a huge expansion at Aberdeen harbour, under the stellar leadership of Bob Sanguinetti. That means that cruise ships can now visit Aberdeen and Aberdeenshire. That is a tremendous asset, but it is seasonal and we need to ensure that our hospitality sector is resourced to cope with the demand. We need to support our hospitality sector, but the SNP and Labour Governments have been woeful at doing that. We have seen job taxes, business rates, bureaucracy and red tape, and all that is hindering our industry, harming our jobs, causing businesses to fail and impacting young people the most. The Government need to think again, allow our hospitality industry to thrive and support our motion today.

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33. 7 Jul 2026·Parliament·Douglas Lumsden

    Summer Jobs

    The Minister speaks about zero-hours contracts almost as if they are the devil’s work. Does he accept that those contracts give people the flexibility they want when they are doing a job? For a lot of people, a zero-hours contract fits in with their lifestyle; they do not want to be committed to working so many hours a week.

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34. 7 Jul 2026·Parliament·David Reed

    Draft West Midlands Combined Authority (Key Route Network) (Amendment) Order 2026

    I understand the points the Minister is making. However, we had a low traffic neighbourhood imposed upon us in Exeter—the hon. Member for Exeter is here, and will know that within that city, traffic was pushed out on to the higher-traffic roads and it caused more congestion. If LTNs are being suggested in different places around the country, can she see that point?

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35. 7 Jul 2026·Parliament·David Reed

    Summer Jobs

    That is the reality!

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36. 7 Jul 2026·Parliament·David Reed

    Summer Jobs

    Most hon. Members would agree that I have a beautiful constituency. That fact is no secret. Many people visit our corner of Devon, and catering for that tourism means that seasonal work is vital to our local economy. Last year, I visited Devon Cliffs and Ladram Bay, which are two of the largest and most popular holiday parks in the area. Such sites support hundreds of jobs, and their impact reaches beyond the parks themselves, sustaining local suppliers, tradespeople, retailers and service businesses across the constituency. They give young people their first opportunity to step into the world of work. It is an opportunity to contribute, to earn their own keep, to learn customer service, to work in a team and to lead one, and to develop confidence grounded in real experience. We can all agree that those are skills and experiences that form the foundations of a good society, but the accumulation of taxes levied on those businesses has forced them into an impossible position: they must either absorb those costs by cutting jobs or pass them on to the consumer. Tourism is a price-sensitive market. Families choosing a holiday will simply go elsewhere if prices rise. Either way, the result is the same—fewer jobs—and it is the young seasonal workers who are first out the door. That is how this Government’s tax policies have deepened the youth unemployment crisis. Tackling the growing number of young people not in education, employment or training must therefore be a priority for the Government. Youth unemployment has reached the highest level in a decade outside of the pandemic, and too many young people are leaving education without a pathway into work. Alan Milburn’s report found that 84% of young people genuinely want a job. They want to be in education or training, yet this Government’s policies are making that harder to achieve. We all know that the longer someone remains out of work, the harder it becomes to find lasting employment. That point has been raised by multiple Members today. Prolonged unemployment damages confidence, limits prospects and increases the risk of long-term reliance on state support. At the very moment we need the sector to be creating opportunities for young people, businesses within it face mounting pressures: rising wage bills, higher national insurance contributions and business rates, and the burden of excessive red tape. Those are all compounded by unsustainably high energy costs, as my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) mentioned. On top of that, accommodation businesses already face a 20% VAT rate on stays. That is double the rate charged in France, Italy, Spain and Portugal, and the 2024 autumn Budget imposed a £3.4 billion tax on the hospitality sector. The consequences have been serious, and we have all seen them in our constituencies. More than 100,000 jobs have been lost in the hospitality sector since that Budget. Against that backdrop, the proposed holiday tax would add yet another burden. I recently met representatives from the Professional Association of Self-Caterers, who warned that businesses would have no good options. They can absorb that levy and cut back further or pass the cost on in the price that hard-working families pay for an affordable holiday. Rather than giving this vital sector the confidence and breathing space it needs to invest and create jobs, the Government are proposing yet another charge, and it will be left to the discretion of mayors to decide whether to implement it in their area. That will create stark disparities, with areas that choose not to impose the tax gaining an advantage over those that do. Tourism contributes £147 billion to the United Kingdom economy and supports jobs and growth in every corner of our country. It should be encouraged to grow, not be weighed down by ever-increasing costs. It is not just holiday parks and hospitality businesses feeling the strain. The newly passed Employment Rights Act 2025, combined with the sharp rise in the national living wage for 18 to 20-year-olds—the very people who rely on Saturday jobs, summer jobs and Christmas jobs—are compounding the problem. The new zero-hours contract rules actively deter employers from taking on 16 to 24-year-olds for fear of being locked into offering permanent hours. We have heard similar stories from Members in the House today. Businesses need the flexibility to take on extra staff over the summer or at Christmas, and the 2025 Act takes that flexibility away. The legislation creates not job security, but job insecurity. The young people of Exmouth and Exeter East do not want handouts; they want a first job, a first wage and a first step. Businesses in my constituency stand ready to give them that chance, but they cannot do so while this Government tax, regulate and burden them at every turn. I urge the Minister to scrap the proposed holiday tax, ease the pressure on hospitality and restore the flexibility that seasonal employers need. We should give our young people back the ladder of opportunity before this Government kick it away entirely.

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37. 7 Jul 2026·Parliament·David Reed

    Summer Jobs

    The Minister is coming out with these great plans. Can he confirm that the right hon. Member for Makerfield (Andy Burnham) agrees with them, and will implement them when he becomes Prime Minister?

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38. 7 Jul 2026·Parliament·David Mundell

    UK Aid Policy: Global Funding Trends

    I beg to move, That this House has considered UK aid policy in the context of global funding trends. It is a pleasure to serve under your chairmanship, Mr Efford. I refer to my entry in the Register of Members’ Financial Interests. I also thank the Backbench Business Committee for granting this vital and timely debate. We are effectively about to have a change of Government, which will mean an opportunity for a reset. Usually we come to these debates avid to hear what the Minister has to say, but today we might not reflect on the past so much as look to the future. Of course, I commend the Minister for his efforts. I will not commend him too much, because that might not help him in the weeks ahead as the Government are reformed, but I acknowledge his personal commitment to these issues. As the Prime Minister moves on, the cuts in official development assistance and the way in which they have been carried out, with nothing seemingly learned from the lessons of the merger of the Department for International Development and the Foreign and Commonwealth Office, surely cannot be part of his legacy that he will wish to promote. Notably, this Government are presiding over cuts to our overseas aid budget that are deeper and faster than those being implemented in the United States under the Trump Administration. The Foreign, Commonwealth and Development Office’s resource DEL budget has reduced by nearly 20%, over £1.5 billion, with bilateral programmes accounting for almost half of that and no detail yet available. Indeed, stakeholders are still waiting for the FCDO to publish its bilateral allocations for ODA, which are reportedly being held back until just before the summer recess. I do not demur from the arguments about hard choices when there are limited resources or, specifically, the need to increase defence spending, but part of that is also about acknowledging that these decisions have consequences, often for the poorest and most vulnerable communities on the planet.

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39. 7 Jul 2026·Parliament·David Mundell

    UK Aid Policy: Global Funding Trends

    I absolutely do. I will come on to the most effective way in which limited resources can be used, and that is clearly one of them. We need to have honesty in this debate and acknowledge that reductions and changes in funding have consequences. We must have that honest dialogue and move away from the sort of speak that has become commonplace, such as “mainstreaming”. Everything now is to be mainstreamed. In my view that means no resources will actually be devoted to it; it will simply be part of some wider general budget. That has specifically been the case in relation to women and girls, which is something we must push back against.

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40. 7 Jul 2026·Parliament·David Mundell

    UK Aid Policy: Global Funding Trends

    I absolutely agree with the hon. Gentleman, and I commend him for his work on the International Development Committee. I will come on to the Committee’s report on the future of development, which highlighted that very issue. The Committee sought to help this Government take forward their stated objectives. I hope the incoming Government will grasp the report’s recommendations and move forward in the way the hon. Gentleman outlines. Although citizens across the world might have been distracted by the Democratic Republic of the Congo almost knocking England out of the world cup, sadly for that team, the situation at home still verges on the catastrophic. It is an example of where unthought-out and unstructured cuts and changes have a devastating impact. We see the spread of Ebola in parts of the DRC, particularly where US funding and structures have been withdrawn. There is no meaningful alternative government structure to provide a health service. That is an absolute example of where funding cuts have a real impact that could spread to the United Kingdom. There was a recent suspected Ebola case in Glasgow, which fortunately did not come to fruition. We need to push back on the idea that Ebola in a remote part of central Africa has nothing to do with us. We must not be starry-eyed about what happened previously. I was struck by recommendation 7 in the Committee’s report and, in a much more favourable climate for international development, by an article in The Guardian—I am sure my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) will not tell the Leader of the Opposition that I read an article in The Guardian—saying that, in the context of the previous Ebola outbreak, which was successfully tackled, the international response that Sierra Leoneans saw on the ground comprised outsiders setting up compounds, employing local people sometimes to be cooks or drivers, then driving around in white Land Cruisers and not engaging or leaving any positive legacy. My recent experience of travelling to Malawi is that, while the agencies and others had done a really good job, unfortunately the Malawian Government had not, because they are now totally reliant on those agencies to provide services. My right hon. Friend the Member for Sutton Coldfield (Sir Andrew Mitchell) may recall that, when I was Secretary of State for Scotland and we promoted the Scotland-Malawi partnership, I had to decline to meet the then President of Malawi in his suite at the Dorchester hotel because I felt that was a wholly inappropriate way to discuss how we could give them more aid. As I said, we cannot be starry-eyed on what happened before. There needs to be change and a focus on how we can most effectively deliver aid and support, but we must have a coherent, long-term plan that accepts budget realities and aligns with the UK’s wider interests. If the right hon. Member for Makerfield (Andy Burnham) is in search of sound advice, I would point him, as the hon. Member for Rushcliffe (James Naish) mentioned, to the recommendations and huge body of evidence in the International Development Committee’s recent report, “UK Aid and Development Assistance in a Fracturing World”. The report called for greater clarity on the Government’s theory of change in relation to poverty alleviation, and it suggested how to prioritise programmes and schemes to achieve the Government’s stated policies. It also set out a comprehensive vision, which I hope the new Prime Minister might be willing to adopt. If he were to ask my opinion, which I do not anticipate as I do not have a vote in the Labour leadership contest, although maybe I could—in days past, I think people could pay £3 to get one, so maybe there is still time. But if he were to ask my opinion, I would suggest that investment should shift towards programmes that are undeniably value for money. That is where we can make the most profound difference for each £1 spent, doubling down on effective interventions with the greatest multiplier effect.

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