Defence Spending and Readiness
Will the Minister give way?
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Defence Spending and Readiness
Will the Minister give way?
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Defence Spending and Readiness
Will the Minister give way?
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Topical Questions
In my constituency, we have lost the Scotbeef abattoir and the famous Donald Russell butchers in recent months, both of which were crucial to the agricultural supply chain. Both blamed high energy costs and the increased costs of doing business, such as the huge rises in national insurance under this Government and big business rate rises under the SNP. What steps is the Treasury taking to support, not suffocate, the agricultural supply chain and other crucial elements of the farming sector?
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Defence Spending and Readiness
Will the Minister give way?
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Puberty Blockers
For clarity, are Scottish children going to be included in the trial, either by being able to travel south of the border or via NHS Scotland directly?
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Health Bill (Fourth sitting)
I rise to support my hon. Friend the Member for Sleaford and North Hykeham on amendment 59. The amendment fosters competition. That is not ideological; the Government themselves have accepted, in clause 5, that competition and choice are important. As my hon. Friend said, this is about ensuring that patients have real choice, and not just something that the Secretary of State has thought about. If one provider has a waiting list of 30 weeks, for example, while another can see patients in just four weeks, patients should clearly be given the opportunity to choose the faster option. By expanding patient choice and making better use of the available capacity, my hon. Friend’s amendment has the potential to reduce bottlenecks without necessarily increasing overall NHS spending—that is a good thing. Importantly, the amendment allows patients to choose between all approved providers, including NHS bodies and independent sector providers. It prevents integrated care boards from excluding suitable providers simply because of their organisational type. I think all Committee members believe in provision that is free at the point of use, but that can come from a number of different providers, including the independent sector.
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Health Bill (Fourth sitting)
I do not recognise the characterisation that the hon. Gentleman puts forward. He is essentially saying that, by allowing the private sector to carry out operations and procedures, we are somehow making the NHS unsustainable. The follow-on from that logic is that we remove all private sector providers and practice so that every single doctor, nurse and therapist is working in the NHS. I do not think that he is arguing for that situation, but it is the logical progression of his argument.
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Health Bill (Fourth sitting)
My hon. Friend is absolutely correct. I do not want to go down the cataracts route, but she and the hon. Member for Bury St Edmunds and Stowmarket have both mentioned them. Clearly, cataracts are a relatively low-complexity, high-volume type of operation. My hon. Friend is absolutely right to say that some providers can do five or six operations per list, while other places are doing two or three. That is often about the private sector being able to move more quickly, which is obviously better for patients, as well as for clinicians, who want to do the surgery that they have trained for. Unlike the hon. Member for Bury St Edmunds and Stowmarket, I think that competition can play an important role in driving improvement. When providers must attract and retain patients, they have a stronger incentive to deliver timely, high-quality services, and to innovate in how they provide care. In that sense, competition is not an end in itself but a means of improving outcomes and responsiveness for patients. If both sides of the Committee support clause 5, because we are interested in choice and competition, amendment 59 is the logical extension of that. The amendment is also clear about where the new obligation choices would apply. It covers a range of out-of-hospital services, including diagnostics, audiology, hearing-aid care, dietetics, physiotherapy, ambulatory cardiac monitoring and so on. By clearly defining the services in scope, it provides a realistic and workable road map for implementation. As I said, the amendment is not about ideology—I think we all agree about choice and competition—but about ensuring that patients receive timely care and have a meaningful choice about where that care is delivered. By fostering healthy competition, making full use of the capacity in the system and putting patients at the centre of the decision-making process, it offers a practical route to improving access and raising standards of care. For those reasons, I support it and commend it to the Committee.
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Health Bill (Fourth sitting)
What my hon. Friend describes is the real nub of the Bill. If we are to abolish NHS England and move most of its functions to the ICB level or to the Department of Health under a Secretary of State, it would be utter madness for us to, at best, move one set of bureaucrats from NHS England to the Department of Health and therefore gain no extra efficiency, or at worst, as seems to be the case in this clause, not only transfer the NHS England bureaucrats, but create a whole new set of bureaucrats and committees to continue the functions already performed under NHS England. We need to understand whether the Bill is really about making our NHS more efficient by removing levels of bureaucracy, as was the stated intent of the Minister and the previous Secretary of State, or whether it is simply a political power grab where we keep all the bureaucrats and the inefficiency of the current system.
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Health Bill (Fourth sitting)
I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham. We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector—I know that Labour Members have antibodies against the private sector—or to university research functions? It is very unclear who the prizes will go to. Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to “work done at any time (including work before the commencement of this section).” So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to. Then the clause says that the Secretary of State may set up a committee. I have been in enough Bill Committees to know that civil servants do not write something into Bills unless they have an idea of what they want to do with it. I would be very interested to hear from the Minister what sort of committee it will be, how many people will be on it, how much remuneration they will receive and how they will establish themselves and fulfil the function that the Secretary of State gives them. If we do not know that, the proposal is so open-ended that I would have real concerns about letting it go forward in the manner in which it is currently written. My hon. Friend the Member for Isle of Wight East suggested—I do not think he was joking—that the word “prize” made this sound like a game show. That is part of what we need to understand. Will the Secretary of State set up a competition in various areas of healthcare, technology, disease or treatment? Will they say, for example, “We want to find the best technology for dealing with cataracts”? Will a call go out for people to submit bids and say, “We have produced this amazing new laser treatment,” in order to win the prize? Or will it be entirely open-ended? Will people come into the Department of Health and Social Care to this new committee and say, “We have created this amazing piece of innovation—give us some money for having done so”? It is so unclear in the Bill. As I say, I am absolutely certain that the Minister knows the answer to those questions because this clause and subsection would not be in the Bill if she had no idea what she was hoping to achieve by them.
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Health Bill (Fourth sitting)
My hon. Friend’s point is correct. There is so little detail in the clause about how these prizes will be awarded and how the committee that will award them will be set up that we have no idea how conflicts of interest will be dealt with. That is another reason that the Minister needs to explain to the Committee how this is going to work. My hon. Friend mentions “Dragons’ Den”. I see her as the Deborah Meaden of our Committee, so I look forward to seeing that play out—I will not say what that makes me. What I see from amendment 58, tabled by my hon. Friend the Member for Sleaford and North Hykeham— I hope I am not misrepresenting her—is once again an attempt to codify, clarify and strengthen what is fairly woolly wording within the Bill. In particular, her amendment rightly emphasises the importance of “timely adoption and spread of clinically effective innovations”. Timeliness is so important to patients. We need innovation quickly. Again, it worries me that the prizes could be given for innovations that could have happened weeks, months, years or decades ago, according to the wording. We also need to ensure that innovation is not in isolated pockets, either in terms of geography or type of service. We need something that is consistently delivered across the healthcare system. By highlighting the need to address things such as procurement, the regulatory sector and cultural barriers, my hon. Friend’s amendment would support a more proactive and enabling environment for innovation to flourish, not one that shuts it down, as some Labour Members have suggested. Crucially, paragraph (d) of the amendment represents a significant and commendable commitment to fairness and inclusion by prioritising equal access to new technologies, medicines and models of care regardless of geography or socioeconomic background. It would help to tackle long-standing inequalities and move decisively towards ending the postcode lottery that we often see in care quality. The focus of the amendment would ensure that innovation benefits all patients, not just those in the most advantaged areas. It would ensure that rural and coastal communities are aligned with the urban. As someone who represents a semi-rural seat, I see those inequalities in service delivery, quality of care and innovation. The large towns in my constituency receive far more money and get far better services than the surrounding villages. I have many concerns about the clause as it currently stands, and I hope that the Minister will be able to clarify some of the Opposition’s questions. I entirely endorse amendment 58.
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Health Bill (Fourth sitting)
I shall speak briefly to the amendment that was just moved by the hon. Member for Bury St Edmunds and Stowmarket. I do not mean this rudely, but it is a relatively motherhood-and-apple-pie amendment. The onus would be on the Secretary of State to recognise that smoking, exposure to air pollution, occupational risk and harmful substances are bad, but I think we all agree on that. If the Secretary of State, or any future Secretary of State, does not already recognise that, I would be pretty surprised. I have a number of issues with the amendment, the first of which is that it expands some central duties without clear limits. Potentially, it could be a gateway to what I would describe as interventionism. Perhaps, too, it lacks some of the prioritisation or proportionality that I would like to see in the Bill—as I have said, however, I think that otherwise the training element is pretty good. Moving to amendment 50, in the name of my hon. Friend the Member for Sleaford and North Hykeham, I entirely support it. This amendment would be extraordinarily useful, because the NHS publishes independently audited forecasts of the workforce every five years, but the amendment would lead to better long-term planning. Regular, independently audited forecasts would help the NHS to anticipate staffing needs, plan training and recruitment, and use resources more effectively and with more efficiency. Amendment 50 would also increase transparency and trust. One of the key things that we will need to do as a Parliament when the Bill becomes an Act is to convince the public that, when this new world of how the NHS is going to be managed and operated comes in, they can have confidence that the treatment they get is the best that it can be and that those who are being trained and working in the NHS get the training that they require and are being established as some of the best in the world. Independent audits would make such forecasting more credible and give reassurance to the public and the stakeholders that the workforce planning is evidence-based and not potentially politically influenced, which is one of the big problems about having the Secretary of State in charge of everything throughout the Bill. The key thing must be improved patient care. Accurate workforce predictions will ensure that we have the right number of healthcare professionals available. We will see a reduction in shortages and more consistent, high-quality care. I support amendment 54, in the name of my hon. Friend the Member for Sleaford and North Hykeham, because it ensures that clinically trained managers maintain patient-facing roles, making better use of scarce clinical expertise and improving workforce efficiency. It strengthens accountability, like amendment 50, by tracking and increasing the proportion of care delivered by qualified professionals, helping to optimise staff deployment and reduce pressure on frontline services. I have some concerns about amendment 33, but amendments 50 and 54 have my support, and clause 7, hopefully amended, will also have my support.
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Health Bill (Fifth sitting)
It is a pleasure to serve under your chairmanship, Sir Roger. I agree heartily with the shadow Minister, and a couple of other things concern me about clause 8. On the one hand, the clause appears to bring more centralisation, but on the other hand it pushes things down to an ICB level at the same time. I am worried that if we have individualisation of ICBs, we will only exacerbate the disparity of services across regions. I would be interested to understand from the Minister how the Secretary of State’s functions will allow the independence of ICBs and, where an ICB understands its local population well, ensure that patients do not end up in a postcode lottery based on which ICB area they happen to live in. The danger here is that if the Bill does not deal with those problems and close regional gaps, it is not immediately clear from the clause how the Secretary of State could intervene to ensure that ICBs have the autonomy to make decisions based on their local populations and ensure at the same time that patients do not receive a worse service just because they happen to live in one ICB area rather than another.
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Health Bill (Fifth sitting)
I endorse the comments made by my hon. Friend the Member for Sleaford and North Hykeham. I am particularly concerned about subsection (2)(a) of proposed new section 12DA. On examination, this provision raises significant concerns about the control of public expenditure and the efficient use of resources within the health service, and I find it rather vague. There is no definition of the terms used, no indication of scope and no express limitation on how the power is to be exercised. When read together with subsection (1) of proposed new section 12DA, the effect, as I read it, is to allow the Secretary of State to provide funding to an extremely wide category of recipients. That includes not only public bodies and established NHS providers but, as my hon. Friend the Member for Sleaford and North Hykeham has said, private entities, charities, individuals and any person engaged in activities that the Secretary of State considers to be beneficial to the health service. That breadth is not accompanied by a corresponding statutory safeguard. The clause does not set out criteria for eligibility, priorities for funding or principles to guide decision making. It does not impose limits on the sums that may be disbursed, nor does it require any structured process for allocating funds. There is no express provision for transparency, such as publication of decisions or reporting obligations to another body such as Parliament. That absence is significant. Control over public expenditure ultimately lies with Parliament, yet the clause delegates a wide and flexible spending power to the Executive with little direction as to how that power is to be exercised. While it may be said that Treasury rules, audit requirements and general public law principles continue to apply, those are external controls and they do not substitute for clear statutory discipline within the provision itself. The practical consequences of such a broad power need to be considered. The NHS is already under considerable financial strain; as we all know, demand is rising and resources are constrained, and there is a continuing need to ensure that funding is allocated in a way that delivers measurable improvements in outcomes. In that context, certainty, prioritisation and efficiency are essential. By framing this power in such open terms, the clause risks undermining those objectives. It will create the possibility of fragmented funding decisions, with resources distributed across a wide range of initiatives without clear and consistent frameworks, and it may lead to duplication of effort or to supporting projects with benefits that are uncertain or difficult to evaluate. Without clear criteria or structured oversight, it will become more difficult to ensure that funding is directed to the areas of greatest need.
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Health Bill (Fifth sitting)
The shadow Minister has outlined a couple of hypotheticals for the future, when we have a different Prime Minister and a different Secretary of State. One might go down a route of more privatisation, another down a route of removing the private sector from health service provision. My concern is more practical and for the here and now: if the clause stands part of the Bill, it must be because the Government have some desire to do one of those two things now. Would it not be a good idea to hear from the Minister which of those two options it is?
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Health Bill (Fifth sitting)
I want to take the Minister back to her rejection of the amendment of my hon. Friend the Member for Sleaford and North Hykeham on the basis that—I paraphrase—she felt the definition of “patients” was too limiting because it would not count people who had not entered the health system at that point. The clause itself, however, refers to the benefit for the health service. Is the Minister suggesting that the health service, as defined in the Bill, includes what happens before people enter what I would describe as the health service? Is it something before that point? She seems to be saying that our definition is too narrow, but her definition in the Bill must apply to those who have entered some kind of formal setting. Or is the health service wider than that?
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Health Bill (Fifth sitting)
I rise to support amendment 47, tabled by my hon. Friend the Member for Sleaford and North Hykeham, and to ask a few questions about clause 11. I completely understand the thinking behind the clause. The Secretary of State for Health and Social Care is probably the most politically impotent of all Secretaries of State: as my hon. Friend said, they pull levers and not much seems to happen, because they do not have the control over the health service that the public think they do—or indeed, that Members of Parliament think they do, judging by the number of us who stand up and demand that the Secretary of State do things in our local areas. I understand the Government and the Secretary of State’s desire to change some of that, but there is concern about the potential politicisation of NHS leadership. Integrated care boards were established in various forms under the Health and Social Care Act 2012 precisely to remove politicisation to ensure that decisions in our healthcare service were made for the benefit of patients on the basis of clinical evidence and the needs of the local population, not on the whim of any Secretary of State or Minister. More importantly, ICBs were brought in to make sure that local health systems, local authorities, clinicians and communities made decisions based on local need. Those politically independent ICB chief executives were expected to exercise professional judgment, make difficult decisions about priorities and resources and sometimes deliver messages that Ministers, and indeed local Members of Parliament, found uncomfortable. If those leaders know that their continued employment ultimately depends on the confidence of the Secretary of State, there is a real risk that the independence of their judgment will be weakened and that patient safety will diminish. The amendment tabled by my hon. Friend the Member for Sleaford and North Hykeham tackles a core question: should an ICB chief executive focus solely on what is best for patients and the local health economy, or should they have to consider whether their decisions may attract ministerial displeasure? Even if the power is rarely used, and even if, as my hon. Friend said, there are currently some guardrails in the clause, its existence will change behaviour—it must do. Leaders will become more cautious, perhaps more risk-averse and potentially less willing to challenge national policy when local evidence points in a different direction. ICBs have benefited from the ability to speak truth to power. A system in which senior NHS leaders fear dismissal by Ministers risks discouraging precisely that kind of honesty. Do not get me wrong: there are good ICB chief executives and bad ICB chief executives, ones who understand their role well and ones who feel that they do not need to engage at all with their local communities. I have a very good ICB in what is currently Surrey Heartlands, soon to be a larger organisation, and an ICB that does not do the job as well—I will not name it, but any student of geography will be able to work out which one it is. Secondly, excessive ministerial power blurs the lines of accountability. The Minister, in her defence, has argued that Ministers need powers because Ministers are accountable. I get that argument, but one of the most important principles of effective public administration is clarity of responsibility. If the Secretary of State gains extensive powers to appoint and dismiss local NHS leaders, it will become increasingly difficult to know who is actually responsible for outcomes. When performance improves, Ministers will claim credit; when performance deteriorates, local leaders may be blamed. If Ministers possess the power to select and remove those leaders, they will inevitably become more directly responsible for those management decisions, so far from increasing accountability, this might dilute it by creating uncertainty about where true authority lies. Thirdly, there is a constitutional concern. Whether one likes it or not, the previous Act created a balance between democratic accountability and operational independence. Parliament rightly determines the funding, priorities and legislative frameworks, and Ministers rightly set national policy, but operational decisions have been made by healthcare professionals and the statutory bodies established for that purpose. That distinction exists for a good reason. No Secretary of State, regardless of ability or commitment, or indeed their own background in the health service, can personally manage every NHS organisation in England, and I do not think they should. The more powers we concentrate at the centre, the greater the temptation for Ministers to become involved in operational matters that are better addressed through professional expertise and local knowledge. My hon. Friend’s amendment seeks to preserve that distinction in a singular and precise way. It recognises that Ministers should govern the NHS and be held accountable at the top by us as Members of Parliament and our constituents, but should not seek to manage every aspect of it. Fourthly, there is a practical problem. Supporters of ministerial intervention often point to examples of failure and ask what should happen when an ICB is underperforming. That is a fair question, but the answer is not that the Secretary of State must personally possess dismissal powers. A range of mechanisms already exist: ICB boards have governance responsibilities; NHS England has oversight powers; professional regulators oversee the conduct of clinicians; there are provisions in employment law for procedures when it comes to misconduct and capability issues; and auditors and inspectors can identify failings. It would be far better if the Bill strengthened those provisions to ensure that accountability was brought forward, rather than giving the Secretary of State the ability to fire and hire as he or she sees fit. Of course, none of those mechanisms of accountability will disappear if amendment 47 is adopted. The amendment would not create any kind of immunity from accountability; it would simply ensure that accountability is exercised through the established governance structures, rather than through direct ministerial intervention on a chief executive. Indeed, one might ask whether a Secretary of State is really the best person to assess the performance of an individual ICB chief executive. Such judgments often require detailed understanding of local service pressures, workforce challenges, demographic factors, financial constraints and so on. Those are matters better evaluated by individual organisations with operational expertise than by politicians operating at national level. Fifthly, I think the clause as drafted would present a risk to recruitment and retention. The NHS already faces significant leadership challenges. Senior leaders are expected to manage enormous budgets, oversee complex organisations and make difficult decisions under intense public scrutiny. If we create a system in which their tenure can ultimately depend upon ministerial whim, we may deter talented individuals from seeking those positions. As my hon. Friend said, the NHS needs leaders who are willing to innovate, take calculated risks and make difficult long-term decisions. It does not need a culture in which leaders are constantly looking over their shoulder, wondering whether a politically controversial but clinically necessary decision could threaten their position. Strong organisations attract strong leaders when governance arrangements are stable, predictable and professionally driven. They do not attract them through uncertainty and political intervention. Sixthly, we need to consider the precedent being established. Powers granted to one Secretary of State are inherited by the next, as the hon. Member for North Shropshire said. Members may trust the intentions of the current Minister—I certainly do. They may also believe that these powers would be exercised responsibly—and at the moment I think they would be. However, legislation must be judged not on how it is going to be used by one individual, but on how it could be used by any future holder of the office. Therefore, the question is not whether the current Secretary of State or Minister would misuse the power, but whether Parliament wishes to establish a framework in which future Secretaries of State possess the ability to remove local NHS leaders whose decisions, views or priorities may conflict with their political objectives. That is a much more serious question. Finally, we must remember what ICBs were trying to achieve, even if we do not think that they have achieved it or performed in the way that we wanted them to. If we go back to the principle of why they were set up, they were designed to encourage collaboration rather than some sort of command-and-control structure. They were intended to bring decision making closer to patients and communities. They were established to support long-term planning across local health systems. Those objectives, I am afraid, are very difficult to reconcile with a model in which local leaders remain subject to direct ministerial dismissal. Partnership working flourishes when organisations have confidence in their independence and responsibilities. It is weakened when authority is increasingly concentrated at the centre. For all those reasons, I believe that amendment 47 in the name my hon. Friend the Member for Sleaford and North Hykeham raises an important principle. It is not about protecting poor performance or shielding individuals from accountability; it is about ensuring that accountability is exercised through proper governance structures rather than political control. Expanding ministerial powers to hire and fire local NHS leaders risks undermining all of those principles.
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Puberty Blockers
My hon. Friend says that we do not know the effects, but a number of children have been put through this process via the now discredited Tavistock process. Why does she think that the NHS will not refer to the data linkage study and use the data that would have been gained from the children who were put through that process, in order to find out what the effects are before deciding to put a whole new cohort of children through what is clearly a damaging procedure?
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Puberty Blockers
There is a third option, which is to get NHS England to motor ahead with the data-linkage study, so that we can use the data that has already been collected to find out the answers to the questions that the Secretary of State is posing. Only then, if the information is not there, should the trial go ahead. Why is he not pushing that third way?
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Support for Industry
Mid Buckinghamshire is home to a number of businesses that are part of the supply chain for the aerospace and defence industries. Those businesses rely on steel that is categorically not made here in the United Kingdom. If the Department for Business and Trade fails to rectify the cliff edge that is coming on steel tariffs, what will the Treasury do to backfill that and ensure that many businesses, such as those in my constituency, do not become completely unviable?
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Defence Spending and Readiness
Will my hon. Friend give way?
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Defence Spending and Readiness
Can my right hon. Friend clarify the financial offer that the Prime Minister made for the defence investment plan? Can he confirm that it was only 0.08% of GDP, which was £10 billion in real cash terms, not the £13 billion on offer? That was what prompted the Defence Secretary to resign, because it was not enough to keep our nation safe.
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Puberty Blockers
I thank the hon. Lady for giving way; I am listening to her very intently. Does she know what a measure of success would be in this puberty blocker trial? If 80% of the children on it were happy with the outcome, would that be a success? What are the ultimate measurements of success?
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Puberty Blockers
I have been listening to the debate and have not yet heard what the Government will deem to be a measure of success of this puberty blocker trial before it goes ahead. What are the criteria, the measurements, the percentages and the numbers, and what are the timelines over which they will be measured? Can the Minister explain what those are? If someone is unhappy, can they sue the Government?
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Health Bill (Fourth sitting)
This brings back memories of being in probably this same Committee Room a few years ago. I made this point during the previous sitting, but is the Minister able to commit that before the Bill leaves the Commons, a full and detailed statistical breakdown of the costs and benefits will be published, given their absence from the impact assessment?
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Fly-tipping: Residential Areas
It is a great pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) for bringing us this important debate. We have heard many contributions about the impact on local pride, sense of belonging and importantly mental health, but it was uplifting that pretty much all Members spoke about the great work that volunteers do to tackle litter and fly-tipping in their area. It seems that everyone has some Wombles in their area—I am not 100% sure of the collective noun for Wombles, but I think it might follow the wombat and be a wisdom of Wombles. I am very pleased to say that in Epping Forest we have the Loughton town council Wombles.
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Fly-tipping: Residential Areas
I thank the hon. Member for that intervention. We have heard great contributions from across the House today. Let me turn to some of the figures, which speak for themselves. Councils in England dealt with 1.26 million incidents of fly-tipping in 2024-25. That was a 9% increase on the previous year, and both the fifth successive annual increase and among the highest figure on record. The majority of those incidents, 62%, involved household waste. The most common sources were not lorry loads from organised criminals, although that is an issue I will come to, but car boots and small vans—everyday domestic dumps. Across the country, our constituents have sadly become all too familiar with the sight of dumped bin bags, mattresses and white goods including fridges, freezers, washing machines and dishwashers. The effects are serious. As well as the obvious awful environmental consequences and the effects on nature and wildlife, fly-tipping is a public health problem, as dumped waste attracts vermin, creates fire risk and can contaminate soil and local watercourses. The harm is not only physical. Antisocial behaviour such as fly-tipping causes real anxiety and distress to residents who live with it. Sadly, my constituents in Epping Forest are not immune to the blight of fly-tipping and its harmful impacts, with many serious cases across our area caused by shameless criminals who should face the full extent of the law. Fly-tipping threatens the precious wildlife and biodiversity that our forest of Epping Forest is so privileged to enjoy. As a positive counter to that situation, I have been privileged to meet unsung heroes, litter-picking groups right across Epping Forest, including Waltham Abbey community group and Theydon Bois parish council, who selflessly give up their time to clean up our communities, as I have seen at first hand on joining their litter picks. However, the sight of copious numbers of discarded large nitrous oxide canisters, used illegally for drug misuse and then chucked on the side of roads for those who do the right thing to clear up, is incredibly concerning. As I have raised in the House many times—I raised it with the Minister just last week—any activity to clear up waste needs to address that issue as a priority for urban, rural and semi-rural communities alike. Will the Minister outline the steps that the Government are taking to tackle the illegal use of nitrous oxide and the subsequent discarding of dangerous canisters, damaging our environment? The previous Conservative Government understood the fly-tipping problem and the need for further action. We increased the upper limit for fixed penalty notices for fly-tipping from £400 to £1,000 and established the Joint Unit for Waste Crime, a multi-agency taskforce bringing together key stakeholders, including the Environment Agency, the police, the National Crime Agency, the British Transport Police, His Majesty’s Revenue and Customs, the National Fire Chiefs Council and the Chartered Institution of Wastes Management. Through intelligence sharing and resource prioritisation, it has supported hundreds of operations contributing to arrests. I am pleased that the current Government are continuing with that measure. We Conservatives also introduced several projects across England that sought to crack down on fly-tipping in residential areas, including portable CCTV cameras to patrol and capture footage across Northumberland, anti-climb fencing to protect neighbourhood areas in Hyndburn and larger recycling bins in better locations in Mansfield to ensure that the public have access to the correct disposal facilities. Those projects had demonstrable positive effects. In Durham, which received funding from the last Government, the county council introduced educational bin stickers and permanent signage and installed CCTV on existing lighting columns. As a result, fly-tipping was cut by more than 60%. In Hyndburn, installing fencing and gates to prevent access to fly-tipping hotspots saw fly-tipping decrease by 100% in those areas in the following three months. The council saved approximately £4,000 in waste removal and clean-up costs over that period. In addition, the Conservative Government passed the landmark Environment Act 2021, which laid the foundation for electronic waste tracking, a measure the current Government are now implementing. I had the opportunity to discuss that with the Minister just last week as we passed a necessary piece of secondary legislation on that subject. The Minister will be aware that His Majesty’s official Opposition tabled amendments during the passage of the Crime and Policing Act 2026 that would have added points to driving licences for fly-tipping. That was a Conservative manifesto commitment and it is most welcome that the Government have finally adopted that policy. On the subject of manifestos, the Labour manifesto included this commitment: “Fly-tippers and vandals will…be forced to clean up the mess they have created.” I am sure that the Minister will have had the same conversations as I have had with farmers and landowners about the issue of fly-tipping on private property: that is not the responsibility of the local authority, whereas on public land it tends to be. We have heard about that from across the House today. When the fly-tipping is on private property, the landowner in many cases is left to pay sometimes thousands of pounds to clean up someone else’s mess. To make the situation worse, the landowner may sometimes face landfill tax liabilities despite being the victim, not the perpetrator. Meanwhile, offenders frequently face little or no meaningful action. Once again, the figures speak for themselves: nine in 10 members of the Country Land and Business Association report being targeted within the past year, with over three quarters suffering a significant financial impact. Although stronger enforcement and prevention measures will help to reduce incidents happening, can the Minister outline what support is available to landowners and farmers who are being particularly targeted? I would like to touch on the fact that although fly-tipping happens all over the country, some areas suffer more than others. The last Government provided targeted investment to the areas most affected by fly-tipping. Furthermore, just as the very act of fly-tipping varies geographically, so too does the rate of enforcement action. Only 31% of fly-tipping incidents are investigated, and over half the investigations result in no further action. Across England in 2024-25, there were just 13 custodial sentences for fly-tipping offences. The Government have issued guidance to local councils, but guidance is one thing and action another. The Minister may be aware that the Countryside Alliance has called on the Government to incentivise local authorities to use the enforcement powers available to them. I would be interested to hear the Minister’s thoughts on that suggestion. We are united across the House in our shared desire to end fly-tipping and to ensure that those who commit this crime are punished appropriately. To do that, local authorities need the right resources and tools, but more importantly they need to use them. We can do more to tackle fly-tipping, and I hope that the Government come forward with ambitious proposals. It has been great today to see so many people from across the House talking not only about this issue, but very much about what it means to their local community. A sense of optimism comes from highlighting the great work that local volunteers do. To conclude, I thank for their great contributions and interventions my hon. Friends the Members for Bromley and Biggin Hill (Peter Fortune) and for Brigg and Immingham (Martin Vickers) and the hon. Members for Gorton and Denton (Hannah Spencer), for Morecambe and Lunesdale (Lizzi Collinge), for Birmingham Perry Barr (Ayoub Khan), for Hexham (Joe Morris), for Strangford (Jim Shannon), for Portsmouth North (Amanda Martin), for Broxtowe (Juliet Campbell), for North West Leicestershire (Amanda Hack), for Kilmarnock and Loudoun (Lillian Jones), for Stevenage (Kevin Bonavia) and for Ilford South (Jas Athwal).
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Topical Questions
T3. Will the Chancellor explain why she is now clawing back VAT on the compassionate medicines scheme, which means that this Labour Government are taxing free cancer drugs given to children? Will she reverse that decision? Patients are starting to miss out on the treatments they really need.
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Defence Spending and Readiness
Shameful!
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Defence Spending and Readiness
The challenge we have at the minute is that not only do we have a shadow Opposition, but we have a shadow Government—a whole set of Ministers who will soon be in place. We have someone who is potentially about to become Prime Minister, but we know almost absolutely nothing about his priorities on defence, on the strategic challenges or on welfare. Does it concern my hon. Friend that we are going to get somebody new, when we know very little about his position on these incredibly important issues?
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Health Bill (Fourth sitting)
It is a pleasure to speak to clause 4 and this group of amendments. Health inequalities are commonly defined as the systemic differences in health status and distribution of health resources between different population groups. There are limits to how far the state can equalise health in a free society, but I am sure all Members would agree that the service should not preside over differences in access to health resources. Unequal access runs contrary to the vision of the NHS as a comprehensive service, available to all and based on clinical need, not ability to pay. Those principles are violated when people without fixed addresses struggle to access general practice, or patients in rural areas, such as my constituency, miss out on treatments—for example, specialist cancer treatments—that are available in more urban areas. The Health and Social Care Act 2012 inserted section 1C in the National Health Service Act 2006, placing a duty on the Secretary of State to consider the need to reduce inequalities in the benefits that people obtain from the health service. As the explanatory notes to the 2012 Act made clear, the intention of that was to “include consideration of the need to reduce inequalities in access...and the outcomes”. Clause 4 of this Bill takes that which was understood and makes it more explicit. The Minister will be pleased to hear that I support updating that duty—she is smiling. The word “benefits” in the original section is a nebulous and subjective term. The wording introduced by the clause is less imprecise and requires the Secretary of State to consider the whole health pipeline. None the less, I have some questions about the lens that clause 4 and its predecessor, section 1C of the 2006 Act, invite the Secretary of State to look through, particularly in relation to other statements made by the Government. In the Government’s policy paper “ICBs as strategic commissioners”, they say that increasing the commissioning responsibilities of integrated care boards will result in them being “better placed to support innovation” and “design new models of care”. Innovation can produce disparities; that is true in healthcare as well. If one ICB decides to innovate and produces a better service, that area will have a better service than another, and the Secretary of State will have the job of undoing that. That could be done by spreading the innovation across the whole of the country, but if the innovation is expensive or difficult to roll out, it could in effect be quashed. Does the Minister recognise that empowering health leaders to innovate and do things differently could widen inequalities, at least in the short term? Is she willing to accept that? A problem with using inequalities as a stand-alone metric is that it does not really tell you whether things are getting better or worse; it must be taken into consideration alongside a wide range of other metrics. An often forgotten fact is that disparities can be reduced by levelling down as well as by levelling up. Fixating on determining the size and cause of disparities can, in some cases, come at the expense of eliminating them. I recently tabled a written question to ask the Government if and when they plan to “set an explicit target to close the Black and Asian maternal mortality gap.” I note that the Minister stood on a manifesto pledge to close that gap. The Government response to my question indicated that they are waiting for Baroness Amos to finish looking at the drivers of inequalities before they do anything. It is possible to produce tomes on the nature of disparities; I suggest that energy would be better spent on addressing them. Amendment 13 would require the Secretary of State to consider health inequalities arising from differences in general health determinants. I understand the sentiment behind the amendment, as statistically, those with lower earning capacity, limited access to green space or unhealthy lifestyles have comparatively worse health outcomes, but would placing a duty to take stock of that on the Secretary of State make the health service any better for such groups, or for the population as a whole? What would be the practical purpose of the amendment? As somebody said to me yesterday evening, do we have a section in education legislation stating that the Education Secretary has to consider that their job is to ensure that people are educated? Do we have clauses in defence Bills saying that the Defence Secretary must consider the defence of the realm? I cannot be sure, but the amendment seems to be a statement of the blindingly obvious, so what effect would it have? Does the Member who tabled the amendment think that the Secretary of State will not consider those factors—essentially, that he will not do his job properly? Do they not have confidence in him or in future Secretaries of State? Under the amendment, the Secretary of State would need to consider inequalities arising from people’s employment, environmental conditions and lifestyle choices, which his Department has little to no control over. If poverty is the problem, the solution is employment and welfare policy, which is not in his gift. If poor environment is the problem, the solution is environmental policy. If a well-informed adult chooses, despite knowing the detriment it may cause them, to consume unhealthy food or an excessive volume of alcohol, or not to exercise, what can and should the Minister do about it in a free society? Amendment 13 would risk distracting from the focus of clause 4, which is, as I see it, to ensure equal access to health resources regardless of a person’s standing in society. What is the practical effect of making it a duty on the Minister to do these things? Will it cause a whole load of bureaucracy? Will the Minister have to produce impact statements for every new hospital? If, for example, one opened on the Isle of Wight—my hon. Friend the Member for Isle of Wight East was talking about that—would we need to consider what effect it would have on smokers, people who do not exercise or people who have a lower earning capacity, and produce an endless list of assessments? It would take a lot of money and effort and not really add anything. The amendment would also risk the Government getting bogged down in litigation, as people who disagreed with the Government’s or the ICB’s decision would spend their time litigating the question whether something that may or may not even be relevant was considered properly. Members will not be surprised to hear that my thoughts on amendment 29 are similar to those on amendment 13. I do not doubt for a minute that its supporters have the best intentions, but this type of public sector equality duty language does not do anything to improve public services. Too many arms of the state have been so concerned with disparities that they have become incompetent at getting on with the job that they are actually meant to be doing; they are distracted by trying to measure all these different equalities. Amendment 30 would require the Secretary of State to involve all Departments in reducing health inequalities and take all reasonable steps to ensure that all other Departments “consider the impact of their policy proposals on health inequalities.” Is this spreading the bureaucracy and the impact assessments more widely? If the Government decide to buy a new submarine, do they have to consider what effect it would have on people who smoke on the Isle of Wight? It does not make sense to me. It is a statement of the obvious that members of the Cabinet and Government have to work together to deliver better health for the country. Of course that is true, but what would be the practical effect? The Minister may be able to tell us. New clause 19 would require the Secretary of State to publish a health improvement and health inequalities strategy within six months, and an annual report thereafter. Again, that would invite more glossy brochures from the Government, using the precious time of civil servants. The new clause seeks a cross-Government approach by mandating that all Ministers of the Crown must have regard to the strategy when carrying out their functions. Again, it is basically stating what their job is.
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Health Bill (Fourth sitting)
I agree. The amendments include, in many cases, a statement of what someone’s job is. Does the Member who tabled them think that the Secretary of State is not doing his job and therefore needs to be told what his job is? That could create a whole load of bureaucracy detracting from the actual job in hand. Amendment 34 concerns transport access. I understand that that is a problem for many people in rural areas, such as my constituency. They often have a harder time, as the distance they need to travel is longer and public transport services are infrequent. Healthwatch, which will be cancelled by this Bill if the Government get their way, has heard from patients who struggle to book transport online, and whose transport turned up several hours early or was cancelled with little or notice at all. Those problems are well documented. I visited Lincoln county hospital, which has a unit for renal dialysis, where I heard that although transport is provided for individuals having dialysis, which is good, it often does not turn up when it should or does not pick people up at the time that it is supposed to. More concerning is the fact that if they need a transplant and transplant assessments, most have to go to Leicester to have that done, which is several hours’ drive from some parts of Lincolnshire. Most disturbingly, I heard concerns that some people would choose not to go through the transplant programme, and a factor in that decision would be the ability to get to the transplant centre to have the significant amount of testing and follow-up that needs to be done. Clearly, that is not equal access, so I urge the Minister to look at that. Imposing a duty on the Secretary of State to consider reducing inequalities is a good thing, but it does not magic up the resources necessary to fix them. In exercising his functions, it is a problem the Secretary of State is already capable of addressing. I am sure the Secretary of State, like the Minister, is a good person and wants people to be able to access the services. If Members believe the Government are failing in that regard, I would advise that adding another legislative duty is not likely to bring about the change desired. If we are being honest with the public, we must challenge the premise that every disparity is evidence of a policy failure. The duty placed on the Secretary of State should be to ensure that care is of an equally high standard across the board.
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Health Bill (Fourth sitting)
I beg to move amendment 59, in clause 5, page 4, leave out lines 2 to 4 and insert— “(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services. (2) For the purposes of subsection (1), the Secretary of State must ensure that patients who are referred for a service to be provided outside a hospital setting (‘out-of-hospital services’) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B. (3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must— (a) offer the patient a meaningful choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board; (b) provide the patient with information to support an informed choice, including for each available provider— (i) indicative waiting times; (ii) the location at which the service would be provided; (iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available; and (iv) whether any costs would be incurred by the patient in travelling to or receiving the service at that provider; (c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and (d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe. (4) For the purposes of this section, ‘out-of-hospital services’ means services— (a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department; and (b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2), and may include diagnostic services, audiology and hearing aid care, podiatry, dietetics and nutrition, physiotherapy, ambulatory cardiac monitoring and such other services as the Secretary of State may specify. (5) In specifying services under subsection (4)(b), the Secretary of State must have regard to— (a) the potential for the expansion of choice to reduce waiting times for the relevant service; (b) the availability of sufficient independent and NHS providers to make genuine choice meaningful; and (c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas. (6) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out— (a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply; (b) the timetable for extending the choice obligation to further services; and (c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section. (7) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.” This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.
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Health Bill (Fourth sitting)
This group is about how patients can exercise choice. When the national health service was founded in 1948, patients could select their own GP, but it was difficult to change things and exercise choice elsewhere in the system. The health service has come a long way since then. Successive Governments believed that they could make state institutions more responsive by treating the public, to some extent, like customers. Today, patients can choose their GP, hospital, consultant and different types of end-of-life care and mental health service, but choice is about more than just selecting among providers.
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Health Bill (Fourth sitting)
When I met surgeons, they said that one reason they like working in elective independent sector hospitals is that they can do more operations on a given day. The shadow Secretary of State visited a provider of cataract treatment yesterday. It is able to perform more treatments on a given day, partly for organisational reasons. The NHS, which is quite frustrating for surgeons, could learn from that. Does my hon. Friend agree?
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Health Bill (Fourth sitting)
I beg to move amendment 58, clause 6, page 4, line 10, leave out from “promote” to end of line 11 and insert— “(a) innovation in the provision of health services and in the arrangements made for their provision; (b) take steps to ensure the timely adoption and spread of clinically effective innovations across the health service in England; (c) identify and seek to remove barriers to the uptake of innovation by NHS bodies, including procurement barriers, regulatory barriers and cultural barriers to change; (d) promote access to innovation so that patients in all parts of England, and patients from all socioeconomic backgrounds, have equivalent access to effective new technologies, medicines and care models; and (e) have regard to the economic and industrial benefits to the United Kingdom of developing and deploying healthcare innovation in the NHS.” This amendment would further define the meaning of promoting innovation in health services in England.
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Health Bill (Fourth sitting)
In healthcare, as in many parts of life, innovation is the way in which new ideas, products and services are developed to solve problems and improve patient outcomes. Here, the entire country has a record to be proud of that goes back a long time. Dr John Preece, a GP and research fellow at the University of Exeter, was the first general practitioner to use a computer in a patient consultation. He co-designed a model with IBM in 1969, and his work led to the creation of the electronic patient record, the forerunner of the electronic patient record that we will discuss later. Innovators working with NHS England have also been seeking to reduce single-use plastic in gastrointestinal procedures, improving outcomes for haemodialysis patients, as well as improving the environment.
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Health Bill (Fourth sitting)
The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those. We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.
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Health Bill (Fourth sitting)
The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress—in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation. I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that—not because they are not taking higher rates of tax, but because they are squeezing the economy. There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is also a risk that prizes will be awarded on the basis of who shouts loudest. Certain charities will want the Government to focus on awarding innovations in cancer care, for example; some unions will want the Government to focus on awarding innovators who achieve greater equity in service delivery. There is little doubt that Ministers will have a tough time batting away lobbyists calling for more funding to incentivise this or that type of innovation. Clause 6 also gives the Secretary of State the power to set up a committee to provide advice on awarding prizes. It is right that the Health Secretary should solicit expert advice when determining which trusts, teams or individuals deserve incentive payments, but does that require the power to set up what is effectively a whole new quango? The Government created more than 25 arm’s length bodies and advisory councils in their first six months. Does the Secretary of State require the power to pay members of the advisory committee when there are many experts in their field who can give their time charitably? I notice there is no requirement for any prize committee to include the chief scientific officer or representatives from ICBs. It is ultimately an unchecked spending power.