5,731 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them

1. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Sixth sitting)

   That is a helpful clarification, but it raises a number of other questions. I entirely agree with the hon. Lady that named GPs are most appropriate; all the clinical evidence suggests that even for people with non-complex needs, having a named GP whom they can see regularly improves patient outcomes. I therefore support her on that, but does she believe that we currently have sufficient GPs for that to go ahead? Even the six-month lag in her new clause would not be enough time to recruit thousands more GPs. If she does not believe that there are enough GPs at the moment, when does she envisage that they would be in post? How much would that cost? Where would she get the money to fund those extra GPs? Rather than just expressing what I would call “motherhood and apple pie” statements about things that we all want, we in this House have a duty to be honest with our constituents about how we would achieve them—and, if we have to achieve them within six months, what funding and impetus will have to be put in place.

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2. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Sixth sitting)

   I think that clarifies that there is no real concrete plan for how to fund this new clause. I do not mean in any way to demean what the hon. Lady is trying to achieve, because she is trying to achieve something important, and which we all want, but we have to be honest with our constituents about how we can do that, and some ethereal money to come through some ethereal plan at some point in the future—

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3. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Sixth sitting)

   Let me finish this point. I am not in the mind of the current Prime Minister, and I am certainly not in the mind of the potential next Prime Minister, but even if the hon. Lady is right my understanding is that he—either is probably a he—is unlikely to have changed our relationship with Europe within six months.

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4. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Sixth sitting)

   Thank you, Ms Lewell. You have certainly saved me from myself, if not anybody else. I think I have belaboured the point; I will leave it there. I sympathise with and indeed support the ambition of new clause 2, but I have a real problem with the lack of detail on how it would be achieved. I turn quickly to clause 14. As my hon. Friend the Member for Sleaford and North Hykeham said, it has bits that we welcome, but there are some concerns about how the ICB structures fit over the local government structures, and cutting ICB administrative budgets by 50%, while asking them to take on more power and responsibility for commissioning services and many other things, is a real problem. Likewise, we have welcomed, and I think both sides of the Committee agree, having neighbourhood health—however we want to describe it—and care closer to home, and having commissioning closer to home. It is therefore strange that my best performing ICB, Frimley ICB, has been abolished or merged with a number of other ICBs that have been performing far less well. If the Government want to have the principle of place-based, locally responsive commissioning, they have to have a real focus on, actually look at, what fits with the current structures and to ensure that those ICBs that are performing best are encouraged and kept and that those that are not are dealt with. I have real concerns about, for example, the superstructure of the new Surrey and Sussex ICB. It is huge and, essentially, entirely antithetical to what the Government were trying to achieve by making stuff local—closer to home.

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5. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Sixth sitting)

   It is for the Minister to clarify that point, but I share my hon. Friend’s concern. It is ironic that we seem to be heading back towards the strategic health authorities of an earlier age. Things in the NHS are neither created nor destroyed; they just go round and round and round. I think we may end up being back where we were 15 or 20 years ago, in an ever decreasing cycle of spending money on changes that are perhaps not wanted or needed. I have touched on dental services, so I will not go any further on that. On pharmaceutical services, I agree entirely with what my hon. Friend said about dispensing GPs. That is a big issue. And I have touched on the Liberal Democrat new clauses. In conclusion, although Conservative Members support a number of the ambitions in relation to the group that we are debating, the questions that my colleagues and I have raised require more clarification from the Minister.

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6. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Seventh sitting)

   It is a pleasure to serve under your chairmanship, Dr Huq. I will speak briefly about clause 15 and amendment 28, tabled in the name of the hon. Member for Oxford West and Abingdon, the Chair of the Health and Social Care Committee, of which I am a member. The amendment is clearly positively intended. We all want the co-production of services, and we have discussed it quite a lot on the Health and Social Care Committee. A number of amendments were tabled in the name of the hon. Member for Oxford West and Abingdon but were agreed on by the Select Committee. I think it is fair to say that there are a number of areas that the Committee could not agree on and that are obviously not in front of it, given its political make-up, but we all agreed on the ones she has tabled. That being said, cross-party agreement often necessitates fairly non-partisan and perhaps non-specific wording, so while I agree with the intention behind the amendment, and while it is clearly important to have co-production when designing services, I am not entirely comfortable with the way the amendment has been drafted. This goes back to comments I made on the Liberal Democrat new clause 2 about how the requirement would operate in practice or how such an approach would be applied consistently across different commissioning functions. Although I am very keen on the principle, I am concerned about the intention.

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7. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Seventh sitting)

   My right hon. Friend is making an absolutely correct point, which I made when we were talking about the Secretary of State’s ability to remove, by sacking or otherwise, the chief executives of ICBs. There is a tension between us as Members of Parliament trying to lobby the Secretary of State for changes in our constituencies when he currently has no power to actually make those changes. The clause will potentially give him the power to make those changes, but being able to sack a chief executive is probably a step too far. How does my right hon. Friend see the powers in the clause, which are probably correct, balancing with the local decision-making process and clinical expertise? There will clearly be a tension between the two.

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8. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Seventh sitting)

   Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect. We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences. Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about resources. While I think that we all agree in this Committee that the NHS should be free at the point of use, one of the downsides of that is that patients rarely think about what the cost of their care contributes. I personally think that if people understood how much crutches or medicines cost, they would use them much more usefully. Plenty of times I have spoken to pharmacists in my constituency who tell me that once a patient has unfortunately died, their family then comes to the pharmacy with a sackload of drugs that have never been used. I think that if people understood the cost of those things, they would use them more effectively and with more caution. This is not an isolated issue but indicative of a wider problem across the system. If we were to introduce firm timelines for provision, we would need to ensure that there is a robust process for recovery, reuse and proper management of that equipment. Therefore, while I am not supportive of amendment 35 or new clause 35, I ask the Government to consider how those proposals could be strengthened by embedding clear expectations about the return and reuse of that equipment so that public funds are used as effectively as possible. I will now turn to the two amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham. Amendment 51 is important because, while I understand the Government’s intention in clause 16, as my hon. Friend has mentioned, her amendment will prevent any artificial delays in treatment by ensuring patients are seen as soon as clinically appropriate, rather than being required to wait a minimum period. It simply protects the principle that care should be based on medical need—which I think we would all agree on—rather than some administrative target. It helps avoid situations where waiting times are managed on paper rather than reduced in reality. That ultimately safeguards patient outcomes and timely access to care. Moving on to amendment 52, I add my strong support to this amendment, because it goes to the heart of trust, transparency and patient safety in the health system. I have been speaking to constituents and individuals from across the country who have contacted me after a video I posted on my social media that contributed to the exposure of the removal of 351,000 patients from waiting lists in March of this year. The stories I have heard are deeply troubling. Those include patients who have waited years for potentially life-changing treatment only to receive notification late—or in some cases not at all—that they have been removed from the list. For many it came as a shock, while for some it came after months or years of uncertainty. This is not some trivial administrative matter. I would sum up the Minister, when responding to questions on this point, as: “Nothing to see here, this is what always happens.” There has been such a significant jump over a period of two months that there has to be something going on here. The experiences of patients who have spoken to me about this suggest that that is happening. For those patients it is the difference between treatment and deterioration, between hope and abandonment. It is also undoubtedly affecting more vulnerable and less technologically savvy pockets of society, such as the elderly.

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9. 25 Jun 2026·Parliament·Gregory Stafford

   Health Bill (Seventh sitting)

   My hon. Friend makes two important points. First, of course there has to be a validation process. There has been for a long time, and I do not think that anyone is objecting to that. However, it is a question of how it is being articulated and the people it is focused on. It is being focused on vulnerable people. I have anecdotal evidence from conversations with a significant number of people since I posted that social media video that they feel pressured into coming off the lists. It does not help that trusts have financial incentives to take people off lists. Earlier this month, the Health Service Journal said that three trusts are earning more than £1 million in having people taken off lists. There is no problem with giving trusts a financial reward to do due diligence and validate the lists, but there is potentially a perverse incentive for trusts to try to knock people off them.

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10. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list—I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason. While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.

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11. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    My hon. Friend is absolutely right. The danger in this process—especially the multiple instances of chasing within a period of weeks, which sometimes happens—is that pressure is put on patients. Again, I know anecdotally from patients who have been speaking to me that those who are most compliant—if I can put it like that—and do not want to make a fuss are generally older and vulnerable people, who feel that they are perhaps causing an inconvenience to the system. They see people with, in their view, more serious conditions or a greater need. We need to be very careful about creating perverse incentives, financial or otherwise, to try to take some of those people off the list. As I say, the significant jump that we have seen deserves more scrutiny and inquiry, and that is why I am very supportive of my hon. Friend’s amendment. We need to understand whether patients are being removed because they no longer require treatment, as the hon. Member for Bury St Edmunds and Stowmarket said—which is, of course, entirely appropriate—or just to improve targets, present an improved picture of waiting lists, and unlock the financial benefits tied to performance metrics. There is a troubling echo here. We saw similar practices in the 2000s when patients were removed or reclassified in ways that reduced waiting list numbers without genuinely improving access to care; it damaged confidence in the system then and it risks doing so now. What concerns me most is that we may be repeating that pattern. If the Government find they cannot meet their waiting list targets, there is a real danger that the pressure to do so will translate into decisions that, intentionally or not, compromise patient safety and fairness.

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12. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    There have been a number of reports of situations where people have not received care and have died because of that, so I do not see the hon. Member’s point. I think that, with amendment 52, my hon. Friend the Member for Sleaford and North Hykeham is trying to ensure that when the statistics are published, we can scrutinise the reasons behind them. The hon. Member for Ashford may be entirely right; let us imagine that is the case, and there is no gamifying or pressure going on. Why not allow the public to see that? Why not put to bed the HSJ stories that say there is something fishy going on? He should welcome that level of transparency and scrutiny to back up his argument if he is correct.

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13. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However—I am being gentle now—that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar. I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved. If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good measures in clause 16. However, as my hon. Friend the Member for Sleaford and North Hykeham said, there are concerns, so I hope the Minister will be able to pick those up in her comments when she winds up.

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14. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with or includes the whole or any part of the ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates. The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities. Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care. For as long as I can remember, Governments of all colours have talked about bringing health and social care together. Some have been more successful at that than others, but there should be agreement across the House that much more needs to be done. With this clause, the Government seem to be taking at least one step back—I would say numerous steps—from trying to bring health and social care together. Like my hon. Friend the Member for Sleaford and North Hykeham, I watched the Health and Social Care Committee’s discussions with the Minister for Care yesterday, and I too cannot fathom why the Government are doing it. I hope that it is an oversight and that, once the Minister goes away and reflects on it, she will look to table some amendments further down the line—I am sure that she will vote against ours today—so that we can bring these matters back. I am especially concerned about the removal of local authority representation. We are effectively asking local authorities to continue to deliver vital services while removing their voice in the room where strategic decisions about health and social care are made. That raises a fundamental question about how the integration is intended to work in practice. There is also a broader concern about the direction of travel. We are moving away from place-based representation towards a model that places greater emphasis on these mayoral structures, yet the legislation is not prescriptive about who the mayors appoint, and colleagues within and without this Committee have already raised concerns that there is a gap in the understanding at the centre about how local authorities operate in practice. That brings me to the point raised by my hon. Friend the Member for Sleaford and North Hykeham and the hon. Member for Winchester. I apologise; the Minister said that she did not want a geographic tour of our constituencies, but I am afraid that she will get one now. Part of my constituency sits in Hampshire in the Hampshire and Isle of Wight ICB, and as the hon. Member for Winchester said, we may or may not have mayoral elections in a year’s time. Hampshire county council has launched a judicial review against the proposed local government reorganisation; if that is successful, or even if it delays the process, this Bill will come into effect without our having a mayor, and there will be no representation for anybody on this board. We need clarity from the Minister on who will represent the people on the board if there is no mayoral authority. I would say that local authorities—Hampshire county council in this case—should remain on that board, at least until there is a mayoral authority.

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15. 25 Jun 2026·Parliament·Gregory Stafford

    Health Bill (Seventh sitting)

    My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point. That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board. That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham. Reducing the representation to a single mayoral representative is a problem. Reinstating and consolidating the full range of required members and thereby giving the breadth of representation within ICBs that we have all talked about, is essential. It would strengthen the legislative framework, ensuring decision making remains multidisciplinary and balanced and that it incorporates both the clinical expertise, which we are going to lose, and the local authority political input, rather than having a one-sized, over-politicised mayor in charge. By maintaining that membership, the amendments would help safeguard overdominance by a single actor, support a much more informed and locally responsive decision-making process and, crucially, reinforce the collaborative foundation between health and social care that I thought was a given among all parties in this House. I urge the Minister to reconsider what she is proposing in this clause. She should, at least, give us some clarity on what will happen in the interim period or, at best, go back to the drawing board and ensure proper representation of the people who are actually delivering health and social care in our constituencies.

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16. 25 Jun 2026·Parliament·Gregory Stafford

    Civil Service Pension Scheme

    1. What recent discussions he has had with Capita on the performance of civil service pension scheme administration.

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17. 25 Jun 2026·Parliament·Gregory Stafford

    Civil Service Pension Scheme

    As the Minister will know, behind every statistic and delayed case is a pensioner who is not receiving their pension after years of public service. I have constituents whose cases have been outstanding for months, including one from Farnham whose case took nine months to resolve. The end-of-June deadline is now effectively upon us. Does the Minister genuinely believe that Capita will make that deadline? If not, what sanctions or remedial action will she pursue to resolve the issue?

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18. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Sixth sitting)

    I am very grateful to the hon. Lady for giving way; she is typically generous with her time. Can I just seek a little clarification in terms of the right to a GP appointment in new clause 2? Is her intention that that is an appointment with the practice—be that any clinically qualified individual within it—or an appointment with a GP, not with a practice nurse? Would, for example, a telephone appointment constitute an “appointment”, rather than specifically an in-person appointment? I just want to understand a little more about what is expected here.

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19. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Sixth sitting)

    It is a pleasure to serve under your chairmanship, Ms Lewell. My hon. Friends have addressed at some length the Government new clauses and amendments, so the Minister may get a slightly easy ride from me this time, but I want to pick up on new clause 2 and some of the points that my hon. Friend the Member for Farnham and Bordon raised. The hon. Member for North Shropshire knows that I have huge respect for her. I have worked with her, across the health and social care space in this House, on a number of issues, so I can entirely appreciate where she is coming from on this. She raises an issue that is very important to all our constituents, which is access to primary care when people need it. For example, in Melton Mowbray in my constituency, there have been real concerns in recent months about very long waiting times to access primary care services. That has on occasion caused considerable distress for some patients, who have become more and more concerned. I have to say that the practice has sought to do a lot to address that. It has brought on board a new annexe and additional services and been recruiting more GPs, but the challenges remain and the concerns are very real and would, I suspect, be shared by all our constituents. One of the key things in how the practice has been seeking to address the issue and how other practices locally, both rural ones and ones in some of the towns in my patch, have sought to address it has been a degree of flexibility and of clinical triage as to what is the most appropriate access point to primary care services for the individual, based on their symptoms and needs. For me, despite the work being done in Melton Mowbray at the moment to improve waiting times, it remains a very significant concern that despite the integrated care board having a few years ago acknowledged publicly the need for additional GP provision in the town, whether a second GP practice or a new satellite service, it said a few months ago—despite the fact that in the intervening period there has been considerable housing development in the town—that it considers that there is no need at the present time for additional GP provision, and so it does not appear to have a plan to expand that provision. That is obviously concerning. All of us in this House will from time to time have these issues in our constituencies and, I suspect, sometimes get frustrated by the fact that ultimately we can press our ICBs and ask questions of the Minister—who, I have to say, always responds in a courteous and measured fashion—but ultimately the decision maker is the integrated care board’s board and it will do what it wishes to do when it comes to commissioning those services. There is a disconnect there. My challenge with regard to new clause 2, despite my being in agreement with the need to improve access to services, is that there is a lack of clarity about how that will be done and there is the fear that it may raise expectations that are not necessarily deliverable on in the current context. The Liberal Democrat five-year plan for GPs is in their 2024 manifesto, and the hon. Member for North Shropshire alluded to the commitment to 8,000 additional GPs. It is not my usual habit, but I have read the Liberal Democrat website, which sets out the background. I appreciate that this is from 2024 and the hon. Lady may have moved things forward a little bit since then, but it states that the five-year plan “gives patients the legal right to see a GP within a week or 24 hours if needed urgently”. The hon. Lady may wish to respond on that.

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20. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Sixth sitting)

    I am grateful for that, and the hon. Lady has that on the record. As we all know with political campaigning, the headline on the front page of the website may sometimes, although not always, contain the “conditions apply” caveat in the small print. The hon. Lady has read her explanation into the record of the House, and I, as always, take her at her word and accept that explanation. My concern is how this measure would be paid for—8,000 GPs, of which half were to be new recruits and half were either through retention or by encouraging returners to the profession, with a costing of about £1 billion. That works out at about £125,000 a head, so it is not outside the realms of possibility. That was not going to be paid for through closer ties with the European Union; if I recall correctly, I think it was tagged against hikes in capital gains tax with three new bandings, rather than EU links.

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21. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Sixth sitting)

    I am grateful for that clarification. I am conscious that we have to finish at 1 pm, so I will bring my remarks to a conclusion. We can all see the intent behind new clause 2; we can all feel that intent in correspondence we get from constituents. Having taken legislation through the House, my concern is that often the challenge is in the drafting of such clauses: while the objective may be honourable, the opacity of them, or the lack of some detail, can risk creating an expectation while not actually setting out how that can realistically be met. My worry here is about the practicalities, in an era where expectations are being set and dashed and that is causing challenges for our democracy.

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22. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Sixth sitting)

    The hon. Gentleman makes his point in a typically reasonable way. Of course, he is right to talk about the need to shift, where we can, from acute settings to either community settings or, ideally, a preventive setting or focus. The Minister may well disagree with me, but I think that is a desire or thread that, however well implemented or otherwise, runs consistently through Governments. It ran through the Blair-Brown Government, the previous Liberal Democrat and Conservative coalition, the Conservative Government and into what the previous Secretary of State announced and what the Minister today is seeking to achieve. I do not think that anyone would disagree with that. We will always need those acute settings for particular treatments and cases, as well as for those very specialist pieces of work or for people with significant illnesses. There has always been a desire to push the care into the local community. GPS are a central part of that, as are—to address the points raised by my hon. Friends earlier—our community pharmacists and other pharmacists. Pharmacies remain an improving but underused resource as part of that preventive picture. I do not disagree with the hon. Member for Winchester in that, but one can agree with the objective, but nonetheless gently push a little on the detail. As we know, the devil is in the detail, and people will want to see a deliverable plan. That is one of the challenges that I have had in Melton Mowbray, where the ICB says it will do one thing and then says, “Actually, no, we can’t do that anymore.” Expectations go up and down and people are understandably frustrated. When we put such proposals forward we need to be robust in how we are going to achieve them and in their practicalities. The Minister may wish to make further observations.

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23. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    I will not detain the Committee for long, and I will speak primarily to clause 15. I am broadly supportive of what the Minister seeks to achieve, as I understand it, with the clause. It is absolutely right that service users and communities are engaged by their integrated care boards—those commissioning services—in the design of services as well in individual care. As I alluded to before we adjourned for lunch, however diligent an ICB may be in doing formal consultations or conducting surveys, it is all too easy for that to appear to the actual users of the service as a box-ticking exercise, with the board none the less determined to follow through with the strategic plan that it conceived and consulted on in the first place. We have seen that challenge on a number of occasions in my Melton and Syston constituency, with the recent closure of St Mary’s birth centre in Melton Mowbray. There was a consultation and engagement with the public, but we always feared that, ultimately, a decision to close was what the ICB wanted and, lo and behold, that is what happened. Similarly, the ICB decided to pull away from accepting the need for a second GP practice or enhanced GP services in Melton Mowbray. There was a consultation and discussion, but ultimately the conclusion that we feared at the outset of the process was indeed what was reached at the end of it. The clause will not necessarily address all that, but it is a step forward in putting pressure on an ICB, or on those commissioning services, whoever they may be, to engage with local communities in a meaningful way.

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24. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    My hon. Friend comes to this with significant knowledge from his work on the Health and Social Care Committee. He is absolutely right, but that is a tension and a balance that I fear runs as a thread throughout this legislation, between local decision making and tailoring and the genuine need for a Secretary of State to have effective powers. We lobby Secretaries of State; on occasion I have lobbied the Minister, and she has always been very responsive—she does not always agree with me, but she has always been very responsive to me. As Members of Parliament, we do that on behalf of our communities. My argument is that ICBs need to be more responsive, even when they do consult, to make it clear that the decision is not predetermined by the board and that they are going through the process. In the context of this clause, that also needs to be true of the Secretary of State: it needs to be not simply a formulaic approach but a genuine engagement and consultation. My question for the Minister, in that context, is about how we make sure of what she is seeking to do in the clause. The Secretary of State or those undertaking commissioning on their behalf must pay heed to something, but how do we make sure that that consultation, engagement and feedback genuinely have some teeth in what emerges in the final decision?

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25. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable. I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.

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26. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    The Minister has saved me from having to give a speech on this clause, so I will ask her a couple of questions instead. Does the Secretary of State intend to publish the list of criteria against which he will require assessment to take place, so that it is transparent what is being considered? Notwithstanding the Minister’s point about the 2022 legislation, the Secretary of State will define the list, so will he publish those criteria? Within what period following the end of the financial year will the Secretary of State commit that the results will be published?

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27. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    I agree entirely with my hon. Friend the Member for Farnham and Bordon. At risk to my political career, such as it is, I also agree entirely with the hon. Member for Winchester, who made a very good point in drawing the Committee’s attention to something that should not need to be said, which is that the provision of healthcare and social care go hand in hand, and if either part of that equation does not function, the other part will not. He highlighted a good example, and I visited Winchester hospital when I was a Minister. If we do not have a functioning social care system, or a social care system that is closely integrated in and working closely with the NHS, we see the knock-on effects pretty swiftly in terms of the large numbers of people medically fit for discharge who are unable to be discharged, which then impacts on the flow through an acute hospital setting. That is one of the big factors we see in A&E backing up, because people cannot be discharged, people cannot get into beds because the beds are full and then the ambulances are queuing up outside. The hon. Gentleman illustrated that point extremely well.

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28. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    The hon. Gentleman is absolutely right from the financial perspective. As he mentioned, there is, of course, the human perspective and the impact on someone’s recovery and their health, as well as their psychological health, if they are in hospital when they simply want to get home, because they have no medical need to be in hospital. My worry about clause 21 is that it essentially seeks to undermine the whole concept that ICBs rest upon. ICBs were conceived to bring together all the NHS services in a particular area, but also, as my hon. Friend the Member for Farnham and Bordon highlighted, to make sure that the NHS footprint mapped on to the geographical footprint of the upper-tier local authority delivering social care, so that the ICB is looking at the same geographical area for the two key parts of the system and they neatly map on to one another. With changes, mergers and acquisitions—as well as a whole range of other changes—that link is already breaking and weakening, as ICBs start covering larger areas and look in different directions. As my hon. Friend the Member for Farnham and Bordon set out, and as I think the hon. Member for Winchester highlighted in an earlier sitting, because we do not know what local government reorganisation will look like in the years to come, we increasingly run the risk of creating something that again will not map on to a geographical footprint and may have to change. In a number of areas—take my area, Leicestershire—we do not have a mayoral authority. At present, there is no plan or proposal before us for one. Yet the ICB is merged with Northamptonshire, which does not have one either. We will see a real gap in representation. We are moving away from what we sought to do with ICBs. During the passage of the 2022 legislation, I always used the phrase—the Minister probably heard it until she wished to hear it no more—that we were seeking to be permissive, not prescriptive, where we could be. However, this was one area where it was not just us in the then Government who were trying to put a bit of a guardrail around the membership of ICBs. We were pushed by the now Government, then Opposition MPs, to go further in what we prescribed for the membership of an ICB.

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29. 25 Jun 2026·Parliament·Edward Argar

    Health Bill (Seventh sitting)

    I take the hon. Gentleman’s point to a degree, but I would refute a chunk of it. We need within the organisation people who have those technical skills and know how to commission, draw up a specification, put it out to tender, or work out what is needed and ensure that what is delivered reflects what was commissioned and that the performance is what is sought to meet the needs of the local area. At board level, we need representation from local authorities and others, because it sets the strategic direction. The board members are not the people who are going to sit there and write the commissioning document. They will probably approve it, but they are not the experts who will be drafting it. We are talking about two different functions, and I argue that when a board-level decision is being made, we want those voices in the room to ensure that those different perspectives are reflected and there is that critical challenge to what is proposed by the executive directors. We essentially have non-executive directors who are there to challenge, to question—perhaps to agree, but perhaps to push back on things. That is how many boards operate. In what is proposed, we lose some powerful voices from round the table. They may not carry the day, but those voices should be heard. Having sat where the Minister is sitting now, I appreciate that she may not be willing or in a position to accept the amendments, but I hope that she will take away and reflect further on the challenges of representation.

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30. 25 Jun 2026·Parliament·Dr Neil Shastri-Hurst

    National Resilience Planning

    9. What steps his Department is taking to improve cross-Government co-ordination on national resilience planning.

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31. 25 Jun 2026·Parliament·Dr Neil Shastri-Hurst

    National Resilience Planning

    Space has a crucial role to play in our national resilience. Responsibility for it cuts across Government Departments. With that in mind, and given the Cabinet Office’s role in cross-Government co-ordination, can the Minister confirm when the National Space Council will next convene?

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32. 25 Jun 2026·Parliament·Dr Neil Shastri-Hurst

    Topical Questions

    T2. Indeed—I am back by popular demand.Will the Minister set out what steps the Cabinet Office is taking to ensure that public appointments are made on merit alone and not based on political patronage or ideological principles?

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33. 25 Jun 2026·Parliament·Dr Neil Shastri-Hurst

    Sudan

    This brutal conflict has resulted in more than 14 million people being displaced. Around 5 million of those have been displaced over the border, but 9 million are displaced in Sudan itself. Will the Minister set out what practical steps the Government are taking to support those who are displaced internally?

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34. 25 Jun 2026·Parliament·Dr Neil Shastri-Hurst

    Neuropsychiatric Conditions: PANS and PANDAS

    It is a privilege to respond to the debate on behalf of His Majesty’s loyal Opposition. I pay tribute to the hon. Member for North East Fife (Wendy Chamberlain) for securing the debate and for setting out the landscape facing those with PANS/PANDAS in the UK, as well as recognising the lack of knowledge about the conditions and the challenge that presents. I thank her for her sustained work through the APPG on the issue. Many right hon. and hon. Members have contributed to the debate. The hon. Member for Carlisle (Ms Minns) spoke movingly about Joanne and Jake, who have been living with PANS/PANDAS for the past six years, and the challenges of not getting the treatment or the funding that they need. The hon. Member for Henley and Thame (Freddie van Mierlo) made a good point about how those affected do not want sympathy but action. He talked about the excellent campaigning by Albie, who is in the Gallery today, following his brother’s diagnosis—I suspect Albie’s handwriting is somewhat better than my doctor’s scrawl and I commend him on his campaigning. The hon. Member for Harlow (Chris Vince), who is always keen to speak up and champion issues on behalf of his constituents, spoke about the importance of guidance. My right hon. Friend the Member for New Forest East (Sir Julian Lewis) talked about the importance of the early use of antibiotics. Above all, I want to speak directly to the families and children who are following the debate and who live with PANS/PANDAS every day, some of whom are with us in the Gallery today. For them, this is not an abstract discussion about guidance, systems or clinical pathways; it is about the child they love, the moment something changed and the exhaustion of trying to explain that change to people who may never have heard of the condition before. It is about parents who overnight become advocates, researchers, case managers and campaigners, while simultaneously trying to hold their families together, and about the children and young people whose lives can be altered suddenly and terrifyingly. As we have heard, PANS/PANDAS sit at the intersection of neurology, psychiatry, immunology and infectious diseases. That matters because they do not fit neatly into one service, specialty, clinic or budget line. For the children affected, symptoms can be sudden and severe. They include obsessive-compulsive behaviours, restricted eating, tics, anxiety, behavioural change, sleep disturbance, regression, movement difficulties, school refusal and distress that can overwhelm the entire family. For some families, the story is stark. A child who was settled and sociable becomes frightened, withdrawn and unable to eat. A child who was thriving at school begins to struggle. Families find themselves moving from GPs to child and adolescent mental health services, from paediatrics to emergency departments, and from school meetings to safeguarding conversations, often without a clear pathway or a clinician who is able to say, “Do you know what? I recognise this, and this is what we need to do next.” The first task before us is to diagnose the problem honestly. The problem is not that every scientific question has been answered, because clearly it has not. There is uncertainty and professional disagreement, and there is a need for stronger evidence, better data and more research into diagnosis, treatment and long-term outcomes. However, uncertainty has too often translated into inconsistency. It has meant too many families left without a clear answer, too many clinicians left without guidance, too many schools unsure of how to respond and too many children caught between services. Each see part of the picture, but they do not see the child as a whole. At present, there is no official NHS clinical guidance for the diagnosis and treatment of PANS/PANDAS. NICE has previously concluded that the evidence was insufficient to provide useful guidance. The Government have said that data on the number of children affected is not currently collected, because internationally the criteria cannot be agreed. Local integrated care systems are expected to plan services, but they are asked to do so without consistent national direction, which risks variation. As we have heard, in reality variation leads to a postcode lottery. It means that one family may find an informed GP, paediatrician or neurologist, while another family is left scrambling for help. It means that one school may understand the sudden onset and fluctuating need, while another school sees only challenging behaviour. It means that one parent may feel believed, while another parent feels blamed. That is the difficulty at the heart of this debate. PANS/PANDAS cut across the way our systems are organised. The NHS is still too often structured around separate silos, whether it is mental health, neurology, infectious disease, immunology or paediatrics, but children living with these conditions do not arrive in neat administrative categories; their needs are complex, sudden and overlapping. That makes it hard for families to know where to turn, as well as for clinicians who want to help but may not have had the training to do so, and for schools that see a child’s behaviour change dramatically without understanding what is driving it. We must also be candid about the emotional difficulty. Parents can feel dismissed. They can feel treated as difficult or seen as overanxious when they are simply trying to explain what has happened to their child. No child should be left waiting for help because the system is unsure about where they fit. The previous Government did not solve this issue, but foundations were laid through the UK rare diseases framework, annual action plans and engagement with research, including with the APPG and the working group. The current Government have welcomed clinical guidance being developed by PANS PANDAS UK and have said that NICE will consider national guidance as evidence improves. They have also pointed to NIHR research and extended the rare diseases framework into 2027. Where the Government do the right thing, we should welcome it, but the question is whether those actions are sufficient. Do they need to go faster? Are they reaching the families on the ground? Families do not experience this as a framework, action plan or written answer; they experience it as the moment when a child refuses food, compulsions appear, school attendance collapses or a parent is told that a professional has never heard of the condition. If the problem is complexity, inconsistency and a lack of recognition, the solution must be equal in its seriousness. The foundations have been set, and now we must all go further. We need action on guidance. The clinical guidance being developed by PANS PANDAS UK and the PANS guideline development group brings together expertise from general practice, paediatrics, neurology, immunology, infectious diseases, psychiatry, psychology and nursing. I would be grateful if the Minister could set out how the Government will engage with that guidance once it is published. Will she commit to a clear process for assessing emerging evidence? We also need to take action on professional awareness. I recall reading about these conditions in Kumar & Clark when I was a medical student, but I do not recall receiving any formal training on them. It is not enough to ask our clinicians to be responsible for keeping their knowledge up to date; atypical, complex and contested conditions require practical support. As such, I ask the Minister to consider an awareness package for frontline professionals, developed in conjunction with clinicians, families and experts. We also need action on data and research—we need better data, diagnostic clarity, and research into treatment and long-term outcomes. With that in mind, I would appreciate the Minister setting out how the Government intend to support that work and encourage greater patient involvement. There is also a need for greater consistency across local systems. If support is left entirely to local discretion, care will depend on where a family lives or how hard they are able to fight for it. Clearer information on how suspected cases can be supported across specialties should be available to ICBs, and schools also have to be part of the answer. For many families, school is where the change is first noticed; better awareness of sudden onset and fluctuating symptoms could help ensure sensible attendance policies and flexible, rapid and responsive classroom adjustments. This debate should not be one that divides the House, but one that unites it. There will be different views on the evidence, on treatment and on guidance, but there should be no difference between us on the need for children to be seen, for families to be heard, for clinicians to be supported, and for care to be based on evidence, rather than the accident of geography. For families living with PANS/PANDAS, progress will be measured by whether the next family gets an earlier answer, whether the next child is believed sooner, whether the next GP has somewhere to turn, and whether the next school understands. That is a fair and compassionate standard, and it is the one that the Government should now meet.

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35. 25 Jun 2026·Parliament·Dr Luke Evans

    National Lung Cancer Screening Programme

    It is a pleasure to be here in an air-conditioned room while we continue this debate. It is poignant that it is so hot today, because we know how that can impact people with respiratory illnesses; we are probably talking about this issue at a very useful time. I too thank the hon. Member for Wokingham (Clive Jones) for securing this important debate. As has been said, lung cancer remains a leading cause of cancer death in the UK, but it is also one of the cancers where early detection can make the biggest difference. I know that at first hand from my first year as a junior doctor working on a respiratory ward. It was eye-opening and harrowing, but also sometimes successful. I urge anyone who has the chance to visit a respiratory ward to see how important it is—and I believe that would make a difference to smoking rates. It is great that the hon. Member for Wokingham secured the debate, and great to see the hon. Member for Strangford (Jim Shannon) secured the debate, because it is a good debate—it is a good day. This is really a success story. The Liberal Democrat spokesperson, the hon. Member for Didcot and Wantage (Olly Glover), rightly told us John’s story; because of the screening that has been put in place, there will be plenty more Johns in the future, which is exactly what we want to hear. Often we talk about the problems, but this is a really good example of something positive that has come forward, and it all started under the previous Conservative Government. The roll-out of community diagnostic centres has fundamentally changed how we diagnose disease. There are now more than 170 centres across England, expanding capacity and bringing scans closer to where people live. Nationally, they have delivered millions upon millions of additional tests and have helped to ease pressure on acute services, with the clear aim of diagnosing conditions such as cancer faster and improving patient outcomes. Only this month I went to the first year anniversary of the opening of the CDC in Hinckley, a £24 million investment that has seen 59,000 patients through its door and is expanding. That means patients do not have to travel as far into Leicester or Nuneaton, and that they get their diagnoses more quickly and in a modern tech building. That is absolutely fantastic for my community, but I know that is replicated 170 times across the country. That matters because, when it comes to diseases like lung cancer, early diagnosis is everything. The sooner we can identify a problem, the sooner we can act, and crucially, the better the chances of survival. There is a real success story to talk about. The NHS lung cancer screening programme has its roots in work started by the Conservative Government, building on more than a decade of UK research and pilot studies. Following successful trials and local pilots, NHS England launched the targeted lung health check programme in 2019, focusing on high-risk groups in areas with the worst outcomes. That approach, using mobile scanners and proactive interventions, proved effective in detecting cancer earlier and reaching underserved communities. On the back of that success, and with a formal recommendation from the UK National Screening Committee in 2022, the Government announced a national roll-out in June 2023, committing to expand the screening across England and ultimately to reach full coverage by 2030. Since then, the programme has transitioned from pilots to a full national screening service and now forms a central part of efforts to improve cancer survival. I am pleased to see that the Government are continuing on that trajectory. Why does this matter? The NHS lung cancer screening programme is now delivering at scale and showing clear results. About 2.8 million people have been invited, with 1.5 million checks completed and close to 1 million scans carried out. Some 6,000 to 7,000 cancers have been detected, roughly three quarters of which have been identified at stage 1 or 2, the earlier stages, in comparison with fewer than 30% before the programme started. About 1.4% of the scans lead to a diagnosis, demonstrating a targeted and efficient approach, and uptake stands at about 60%. In short, the programme is not only reaching those most at risk, but consistently shifting diagnosis to an earlier, more treatable stage and saving lives at a national level. As I say, we welcome the proposed expansion of the lung cancer screening programme, but it is vital that steps be taken to improve the uptake of screening and lung health checks. The fact that uptake stands at 60% means that 40% of those invited are not coming forward, and they are often the ones at highest risk. The question is why. Can the Minister set out what specific interventions the Government will introduce to increase uptake, particularly among the most deprived and hard-to-reach groups? To that end, can he confirm how the Government plan to deliver targets set in the national cancer plan, including the allocation of resources and funding for the lung cancer screening programme, over the next few years? As my new Scottish Conservative colleague, my hon. Friend the Member for Aberdeen South (Douglas Lumsden), may rightly point out, progress on lung cancer screening is uneven. England is now rolling out a full national programme; Wales has committed to an implementation, with the first invitations expected from 2027; Scotland remains at a pilot stage, with a national roll-out likely to be years away; and Northern Ireland is still in the early planning phases, without a programme in place. Given that variation, will the Minister set out what discussions are taking place across all four nations? Most importantly, what lessons are been learned from the English experience that can be actively shared to support a faster and more consistent delivery and roll-out across the UK? More broadly, this issue speaks to the need for a coherent approach to respiratory disease. Under the last Conservative Government, there was a clear attempt to take a more joined-up approach to the country’s biggest killers through a major condition strategy, which was announced in 2023. It explicitly placed chronic respiratory diseases, alongside cancer and cardiovascular disease, as one of six national priorities, recognising both its scale—it affects millions—and its contribution to avoidable ill health. A detailed framework, setting out a shift towards prevention, early diagnosis and management of those conditions, was published later that year. However, although the direction of travel was established and widely consulted on, the strategy never reached full publication or implementation, because there was a general election. This Government have taken a different route, with modern service frameworks. They have committed to developing modern service frameworks for frailty, dementia, mental health and cardiovascular disease—just a few areas—so I ask the Minister directly: will the Government develop a modern service framework for respiratory disease? If not, how do they intend to drive the same level of improvement for a condition that affects millions and underpins outcomes in lung cancer? We are all serious about improving cancer survival. Across this House, we all have that ambition, but we must match our ambition with delivery. Just like the 10-year plan, the delivery chapter is missing. I worry that the same could be argued for respiratory conditions. I just hope that I am proved wrong.

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36. 25 Jun 2026·Parliament·Dr Luke Evans

    National Lung Cancer Screening Programme

    I appreciate that this is not part of the Minister’s brief. The speed of the programme’s roll-out is fantastic, but there remains a concern that if 60% of people have taken it up, 40% have not done so, despite having had an offer that could have been given to someone else who wanted to go. Can the Department take that point away and work out what is being done to close that gap of more than a third? There is clearly a greater opportunity to get more people in and get them detected sooner.

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37. 25 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Sixth sitting)

    I beg to move amendment 57, in clause 12, page 10, line 10, at end insert— “(4A) Before making regulations under subsection (1)(b) that would alter the range of services or facilities which the Secretary of State is required to commission nationally, the Secretary of State must— (a) prepare and publish a commissioning transition plan in accordance with subsection (4B), (b) consult in accordance with subsection (4C), and (c) lay the commissioning transition plan before Parliament. (4B) The commissioning transition plan must set out— (a) a description of each service or facility that the Secretary of State proposes to add to, or remove from, national commissioning responsibility under section 3B(1)(b), and the reasons for each proposed change; (b) a description of the body or bodies to which commissioning responsibility for each such service or facility would transfer and the basis on which that body is considered capable of commissioning that service or facility effectively; (c) an assessment of the impact of each proposed change on patients who rely on the affected services or facilities, including— (i) patients with rare diseases or conditions, (ii) patients whose needs cannot be met by a single integrated care board area, and (iii) patients who may face differential impacts on account of a protected characteristic within the meaning of the Equality Act 2010; (d) the transitional arrangements to be put in place to ensure continuity of service for patients during any transfer of commissioning responsibility; (e) the workforce and capacity implications for the bodies to which commissioning responsibility would transfer; (f) the financial arrangements for the transfer of commissioning responsibility, including the funding to be allocated to receiving bodies; and (g) the proposed timetable for implementation of each change. (4C) Consultation under this subsection must include— (a) integrated care boards that would assume commissioning responsibility under the proposed changes; (b) NHS trusts and NHS foundation trusts providing the services or facilities affected by the proposed changes; (c) patient groups and representative organisations for patients likely to be affected by the proposed changes; (d) clinicians with expertise in the services or facilities affected; and (e) such other persons as the Secretary of State considers appropriate. (4D) Consultation under subsection (4C) must— (a) run for a period of not less than twelve weeks, and (b) begin no earlier than the date on which the specialised commissioning transition plan is published under subsection (4A)(a). (4E) Following the consultation period, the Secretary of State must publish a response to the consultation that— (a) summarises the representations received, (b) sets out the Secretary of State's response to the key issues raised, and (c) describes any amendments made to the specialised commissioning transition plan in light of consultation responses. (4F) No regulations under section 3B(1)(b) that alter the range of nationally commissioned services or facilities may be made until at least 60 days have elapsed after the consultation response required by subsection (4E) has been published.” This amendment requires the Secretary of State to publish and consult on a commissioning transition plan before making any regulations under the new section 3B of the National Health Service Act 2006 (inserted by Clause 12) that would alter which services are commissioned nationally.

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38. 25 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Sixth sitting)

    In essence, the clause confers the commissioning duties of NHS England on to the Secretary of State, because NHS England is being abolished. In that respect, it is quite straightforward. In the existing National Health Service Act 2006, which is to be amended, section 3 sets out the duties of integrated care boards as to commissioning health services, and section 3A similarly. Section 4 is about NHS England’s responsibility for the provision of high-security psychiatric services. In essence, clause 12 replaces the references to “NHS England” in sections 3 and 3A with “the Secretary of State”. The ICBs now must act consistently with the discharge by the Secretary of State of the section 1 duty to promote a comprehensive health service. That is consistent with the aims of the Bill. I have concerns, which I have expressed previously, about how the Government ensure that the Secretary of State can make those decisions fairly, on the basis of clinical need, rather than because of pressure from a lobby group, a celebrity campaign or such like, but again, that seems consistent. The clause also replaces entirely section 3B of the 2006 Act. Under the previous section 3B, the Secretary of State could direct NHS England to commission the service nationally; the proposed new section 3B confers a regulation-making power to require the Secretary of State to arrange nationally services for members of the armed forces and their families specifically, as well as such services or facilities as may be prescribed. Perhaps the Minister will comment on what sort of services or facilities might be prescribed under that proposed new section. In doing that, the Secretary of State must have regard to the number of people needing the service, the cost and the number of possible providers. That reflects a balance. Some services, such as hip replacements, are very common. They occur in all areas of the country, perhaps at different rates, but they are broadly a common service. Accident and emergency is another common service. Some people, however, have the misfortune to have a condition that is rare and requires specialist care, in small numbers. That needs to be commissioned on a more national basis, because of the need for specific expertise among commissioners and health professionals. In subsection (4), proposed new section 3B(5) modifies section 4 of the 2006 Act so that the duty to arrange high-security psychiatric services transfers from NHS England to the Secretary of State, and the Secretary of State gains a new power to direct the providers of those bodies—but only non-public bodies—if he is satisfied that the provider is already licensed under the Health and Social Care Act 2012 and would be required by its licence to obey the direction. In one respect, as I said, it is necessary to transfer powers to Secretary of State, now that NHS England is to be abolished, but I have a couple of questions. NHS England published a direct commissioning update on 2 March, which describes a new commissioning structure. At the moment, NHS England commissions regional NHS England bodies and the ICBs at a more local level. The update suggests that we will have the ICBs commissioning services, and the Secretary of State instead of NHS England, but that each of the seven regions will have an office for pan-ICB commissioning, known as an OPIC, to support ICB commissioning services—both standard commissioning and at-scale commissioning in some instances. How is that more efficient than the old structure? Are we just going to see the people working in the regions of NHS England get made redundant, at a huge cost to the state, only to be re-employed by the OPIC? What is the estimated cost of that? Is that the intention? We are going to either lose the expertise of the regional advisers in NHS England or end up re-employing them having paid them redundancy. Can the Minister explain which she thinks it is? There is a hugely long list of specialist nationally commissioned services. Can the Minister guarantee that those services will not be moved locally? The ICBs only have so much capacity. It will be a challenge for an ICB to deal with conditions that may affect only one or two people in its area in a given year, particularly given the 50% budget cut; obviously, it will prioritise things that affect more of its population. People who have the rare conditions that are currently commissioned nationally may be worried that they will not get the same level of service that they are getting at the moment. The direct commissioning update talks about prisoners and the justice system. At the moment, NHS England works directly with the Ministry of Justice to commission healthcare for those in the justice system. That includes adults in the custodial system, children in secure children’s homes, non-custodial care, sexual assault and abuse centres, and abuse referral centres. There are eight high-security category A prisons in England. Instead of being specially commissioned as one batch, they are going to be commissioned specially by their local ICBs. Where are the ICBs going to get the advice and expertise to do that? Dealing with category A prisoners is about not only managing the prisoner and providing them with healthcare, but keeping the people providing that healthcare safe while they are working. This is a specialist area. I am interested to understand why the Minister thinks it will be managed best locally. If, under her new system, it is to be managed locally and the prisoner’s home address ICB is different from the prison address ICB, where will the funding move from and to? Will the prison’s ICB be reimbursed by the prisoner’s home ICB or will it bear the brunt locally? What will happen to the sexual abuse referral centres? It is perfectly possible, particularly in some areas of the country, that an individual is sexually assaulted in one ICB area, lives in another and reports a crime in a third. Will local commissioning have an impact on where the individual needs to go for their pretty intimate examination and assessment? Has the Minister considered that? What is her view? What happens to healthcare for migrants? That is another area that is dealt with partly by the justice system at the moment. Can the Minister update us on that? There are over 100,000 people in asylum accommodation, including 30,000 in hotels, and many members of her party are keen to welcome even more. Who will be responsible for commissioning their care? The Government are also delegating the child health information services, which are the record of whether children have been vaccinated and such like. Given that they are planning to have a single patient record and the electronic red book, why do they want the services to be commissioned locally rather than nationally? Do they expect commissioning for a uniform service, such as a screening service, to lead to differential outcomes—and if it does not, what is the rationale for it? A particular example is blood spot screening. The Minister will be aware that there was a Westminster Hall debate earlier in the week on spinal muscular atrophy, in which blood spot screening was mentioned. Metachromatic leukodystrophy is another condition for which people want blood spot screening. If blood spot screening is to be commissioned on a local ICB level, will ICBs be required to do it in line with Government guidelines, or will they be able to vary the service they provide to those patients? By delegating more to ICBs, Ministers are creating variation. On one hand, they want local differentiation and variation; on the other hand, they have put in a clause that requires the Secretary of State to limit local variation. Again, there is a tension there. Will the Minister talk about that? Moving to some technical points, I noticed that “hospital premises” is defined in section 4 of the 2006 Act, but I cannot find it defined in the Bill. Under the original section 3B of that Act, the Secretary of State had to obtain appropriate advice before making regulations about commissioning services; when services were commissioned locally or nationally, the Secretary of State had to take expert advice. That seems like a sensible thing that we want the Secretary of State to do. One would hope that if the Secretary of State were doing his job properly, he would do that, but it seems a little odd that that requirement has been taken out, as though there is an intention for the Secretary of State not to do that. I would appreciate the Minister’s comments on that. Proposed new section 3B provides that a direction can be given to a person other than a public authority regarding high-security psychiatric services. The Minister knows that high-security psychiatric services are currently provided at Broadmoor, Ashworth and Rampton, which are still stand-alone units run by NHS providers. Does she plan to ask a private provider—someone other than a public authority—to run those facilities? If not, what is the purpose of the clause? There is a secure children’s unit in Sleaford in my constituency. What will happen to those children if it is commissioned locally, and where will the money flow from? We asked in a previous sitting whether the Minister thought that the new Prime Minister will want to continue with this Bill. When it comes to the OPICs, in essence the Government will be firing staff from one job, paying them redundancy, and rehiring them, potentially on different terms and conditions, to do a similar job in the OPICs. Is the Minister aware that the right hon. Member for Makerfield (Andy Burnham) used to speak out against firing and rehiring staff, and abolishing and recreating organisations? That is essentially what is happening, so will she have to abandon these changes?

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39. 25 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Sixth sitting)

    I am afraid I do not know the answer to that question. The key point is that it is not logical to abolish a three-tier structure and recreate it with taxpayers’ money to do exactly the same thing. If NHS England is replaced by the Secretary of State, the regional NHS England is replaced by the OPICs and the ICBs are at the bottom—the more local tier—what has changed? The middle tier will be doing the same thing.

    Hansard source
40. 25 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Sixth sitting)

    But we were not planning to abolish NHS England, so we had no reason to worry about redundancy. We were not planning a large-scale abolition—the largest that has ever happened in this country. Amendment 57 would require the Secretary of State to publish and consult on commissioning transition plans before making regulations under proposed new section 3B that alter which services are commissioned nationally. It is a very reasonable amendment that would just mean that people get answers. It would mean that vulnerable people with unusually rare or highly complex conditions requiring regional or even national treatment could understand any changes the Government planned to make. We know that some services are delivered in only three or four centres in the UK. If a patient lives far from a centre, and suddenly that centre is closed, that can have huge travel and service implications, which can create huge distress and worry and make care worse.

    Hansard source